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Polymeri E, Kjölhede H, Enqvist O, Ulén J, Poulsen MH, Simonsen JA, Borrelli P, Trägårdh E, Johnsson ÅA, Høilund-Carlsen PF, Edenbrandt L. Artificial intelligence-based measurements of PET/CT imaging biomarkers are associated with disease-specific survival of high-risk prostate cancer patients. Scand J Urol 2021; 55:427-433. [PMID: 34565290 DOI: 10.1080/21681805.2021.1977845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Artificial intelligence (AI) offers new opportunities for objective quantitative measurements of imaging biomarkers from positron-emission tomography/computed tomography (PET/CT). Clinical image reporting relies predominantly on observer-dependent visual assessment and easily accessible measures like SUVmax, representing lesion uptake in a relatively small amount of tissue. Our hypothesis is that measurements of total volume and lesion uptake of the entire tumour would better reflect the disease`s activity with prognostic significance, compared with conventional measurements. METHODS An AI-based algorithm was trained to automatically measure the prostate and its tumour content in PET/CT of 145 patients. The algorithm was then tested retrospectively on 285 high-risk patients, who were examined using 18F-choline PET/CT for primary staging between April 2008 and July 2015. Prostate tumour volume, tumour fraction of the prostate gland, lesion uptake of the entire tumour, and SUVmax were obtained automatically. Associations between these measurements, age, PSA, Gleason score and prostate cancer-specific survival were studied, using a Cox proportional-hazards regression model. RESULTS Twenty-three patients died of prostate cancer during follow-up (median survival 3.8 years). Total tumour volume of the prostate (p = 0.008), tumour fraction of the gland (p = 0.005), total lesion uptake of the prostate (p = 0.02), and age (p = 0.01) were significantly associated with disease-specific survival, whereas SUVmax (p = 0.2), PSA (p = 0.2), and Gleason score (p = 0.8) were not. CONCLUSION AI-based assessments of total tumour volume and lesion uptake were significantly associated with disease-specific survival in this patient cohort, whereas SUVmax and Gleason scores were not. The AI-based approach appears well-suited for clinically relevant patient stratification and monitoring of individual therapy.
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Affiliation(s)
- Eirini Polymeri
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Kjölhede
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olof Enqvist
- Department of Electrical Engineering, Region Västra Götaland, Chalmers University of Technology, Gothenburg, Sweden
| | | | - Mads H Poulsen
- Department of Urology, Odense University Hospital, Odense, Denmark
| | - Jane A Simonsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Pablo Borrelli
- Department of Clinical Physiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elin Trägårdh
- Clinical Physiology and Nuclear Medicine, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Åse A Johnsson
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Lars Edenbrandt
- Department of Clinical Physiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Latge A, Heimburger C, Severac F, Meyer N, Somme F, Imperiale A. Impact of pelvic dynamic acquisition on final reading of 18 F-Fluorocholine positron emission tomography in patients with prostate adenocarcinoma: True need or unnecessary burden? J Med Imaging Radiat Oncol 2021; 66:324-331. [PMID: 34323005 DOI: 10.1111/1754-9485.13296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/11/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Despite the increasing use of 18 F-fluorocholine (18 F-FCH) positron emission tomography (PET) in patients with prostate cancer, the acquisition protocol remains debated. We have evaluated the influence of the pelvic dynamic phase on the final reading of whole-body 18 F-FCH PET, to assess the need for a two-stage protocol. Reading the physician's experience and patient's previous treatment profile was also considered as potential influencing factors on final PET interpretation. METHODS All 18 F-FCH PET/CT performed from January 2018 to September 2019 in patients with prostate cancer and including a pelvic dynamic phase followed by a delayed whole-body acquisition were retrospectively retrieved. PET/CT were analysed by one expert nuclear medicine physician and one resident. The whole-body scan was analysed blinded (first reading) and nonblinded from the results of the dynamic phase. RESULTS 221 consecutive PET/CT were selected from 201 patients previously treated by radical prostatectomy (n = 31), pelvic radiation therapy (n = 60), or both (n = 94). 24 patients had no previous treatments, and 12 benefited from other focal treatments. In the whole population, dynamic acquisition modified final interpretation of 32/221 scans (14.5%) for residents, 26 (11.8%) for experts and 19 (8.6%) for consensual reading. No influence of previous treatments was found. The availability of a dynamic phase would have been responsible for treatment modification in 5/221 scans (2.3%). Considering only the prostate bed, dynamic acquisition modified the final interpretation in 7/125 (5.6%) studies (consensual reading) from patients with previous prostatic surgery and 4/84 (4.8%) scans from patients without a history of prostatic surgical intervention. No significant influence of dynamic acquisition was found on the final PET interpretation on prostate lodge accordingly to previous prostatic surgery. CONCLUSION The dynamic phase changes the interpretation of 18 F-FCH PET in about 9% of cases and the therapeutic strategy in <3% of patients. The influence of the early phase reduces with physician experience. Patient's treatment profile does not appear to have a significant influence on the variability of interpretation, also including the prostate bed.
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Affiliation(s)
- Adrien Latge
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg, France
| | - Céline Heimburger
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg, France
| | - Francois Severac
- Public Health, Strasbourg University Hospitals, Strasbourg, France
| | - Nicolas Meyer
- Public Health, Strasbourg University Hospitals, Strasbourg, France.,ICube, UMR7357, University of Strasbourg, Strasbourg, France
| | - François Somme
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg, France
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg, France.,Molecular Imaging - DRHIM, IPHC, UMR 7178, CNRS/University of Strasbourg, Strasbourg, France
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Meijer D, van Leeuwen PJ, Donswijk ML, Boellaard TN, Schoots IG, van der Poel HG, Hendrikse HN, Oprea-Lager DE, Vis AN. Predicting early outcomes in patients with intermediate- and high-risk prostate cancer using prostate-specific membrane antigen positron emission tomography and magnetic resonance imaging. BJU Int 2021; 129:54-62. [PMID: 34028165 PMCID: PMC9290881 DOI: 10.1111/bju.15492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/20/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
Objectives To identify predictors of early oncological outcomes in patients who opt for robot‐assisted laparoscopic radical prostatectomy (RARP) for localized prostate cancer (PCa), including conventional prognostic variables as well as multiparametric magnetic resonance imaging (mpMRI) and prostate‐specific membrane antigen (PSMA) positron emission tomography (PET). Patients and Methods This observational study included 493 patients who underwent RARP and extended pelvic lymph node dissection (ePLND) for unfavourable intermediate‐ or high‐risk PCa. Outcome measurement was biochemical progression of disease, defined as any postoperative prostate‐specific antigen (PSA) value ≥0.2 ng/mL, or the start of additional treatment. Cox regression analysis was performed to assess predictors for biochemical progression, including initial PSA value, biopsy Grade Group (GG), T‐stage on mpMRI, and lymph node status on PSMA PET imaging (miN0 vs miN1). Results The median (interquartile range) total follow‐up of all included patients without biochemical progression was 12.6 (7.5–22.7) months. When assessing biochemical progression after surgery, initial PSA value (per doubling; odds ratio [OR] 1.22, 95% confidence interval [CI] 1.07–1.40; P = 0.004), biopsy GG ≥4 vs GG 1–2 (OR 1.83, 95% CI 1.18–2.85; P = 0.007), T‐stage on mpMRI (rT3a vs rT2: OR 2.13, 95% CI 1.39–3.27; P = 0.001; ≥rT3b vs rT2: OR 4.78, 95% CI 3.20–7.16; P < 0.001) and miN1 on PSMA PET imaging (OR 2.94, 95% CI 2.02–4.27; P < 0.001) were independent predictors of early biochemical progression of disease. Conclusion Initial PSA value, biopsy GG ≥4, ≥rT3 disease on mpMRI and miN1 disease on PSMA PET were predictors of early biochemical progression after RARP. Identifying these patients with an increased risk of early biochemical progression after surgery may have major implications for patient counselling in radical treatment decisions and on patient selection for modern (neo‐)adjuvant and systematic treatments.
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Affiliation(s)
- Dennie Meijer
- Department of Urology, Prostate Cancer Network Amsterdam, Amsterdam University Medical Centre, VU University, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centre, VU University, Amsterdam, The Netherlands
| | - Pim J van Leeuwen
- Department of Urology, Prostate Cancer Network Amsterdam, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thierry N Boellaard
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ivo G Schoots
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, Prostate Cancer Network Amsterdam, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Harry N Hendrikse
- Department of Radiology and Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centre, VU University, Amsterdam, The Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centre, VU University, Amsterdam, The Netherlands
| | - André N Vis
- Department of Urology, Prostate Cancer Network Amsterdam, Amsterdam University Medical Centre, VU University, Amsterdam, The Netherlands.,Department of Urology, Prostate Cancer Network Amsterdam, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Borrelli P, Larsson M, Ulén J, Enqvist O, Trägårdh E, Poulsen MH, Mortensen MA, Kjölhede H, Høilund-Carlsen PF, Edenbrandt L. Artificial intelligence-based detection of lymph node metastases by PET/CT predicts prostate cancer-specific survival. Clin Physiol Funct Imaging 2020; 41:62-67. [PMID: 32976691 DOI: 10.1111/cpf.12666] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/03/2020] [Accepted: 09/17/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Lymph node metastases are a key prognostic factor in prostate cancer (PCa), but detecting lymph node lesions from PET/CT images is a subjective process resulting in inter-reader variability. Artificial intelligence (AI)-based methods can provide an objective image analysis. We aimed at developing and validating an AI-based tool for detection of lymph node lesions. METHODS A group of 399 patients with biopsy-proven PCa who had undergone 18 F-choline PET/CT for staging prior to treatment were used to train (n = 319) and test (n = 80) the AI-based tool. The tool consisted of convolutional neural networks using complete PET/CT scans as inputs. In the test set, the AI-based lymph node detections were compared to those of two independent readers. The association with PCa-specific survival was investigated. RESULTS The AI-based tool detected more lymph node lesions than Reader B (98 vs. 87/117; p = .045) using Reader A as reference. AI-based tool and Reader A showed similar performance (90 vs. 87/111; p = .63) using Reader B as reference. The number of lymph node lesions detected by the AI-based tool, PSA, and curative treatment was significantly associated with PCa-specific survival. CONCLUSION This study shows the feasibility of using an AI-based tool for automated and objective interpretation of PET/CT images that can provide assessments of lymph node lesions comparable with that of experienced readers and prognostic information in PCa patients.
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Affiliation(s)
- Pablo Borrelli
- Department of Clinical Physiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Måns Larsson
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.,Eigenvision AB, Malmö, Sweden
| | | | - Olof Enqvist
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.,Eigenvision AB, Malmö, Sweden
| | - Elin Trägårdh
- Department of Clinical Physiology and Nuclear Medicine, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Mads Hvid Poulsen
- Department of Urology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Henrik Kjölhede
- Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Poul Flemming Høilund-Carlsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Lars Edenbrandt
- Department of Clinical Physiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Tumor infiltrating M2 macrophages could predict biochemical recurrence of localized prostate cancer after radical prostatectomy. Exp Cell Res 2019; 384:111588. [DOI: 10.1016/j.yexcr.2019.111588] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/24/2019] [Accepted: 08/28/2019] [Indexed: 11/19/2022]
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