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Yoo JW, Lee KS. Usefulness of grayscale values measuring hypoechoic lesions for predicting prostate cancer: An experimental pilot study. Prostate Int 2021; 10:28-33. [PMID: 35510098 PMCID: PMC9042764 DOI: 10.1016/j.prnil.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/12/2021] [Accepted: 11/29/2021] [Indexed: 11/01/2022] Open
Abstract
Background Methods Results Conclusions
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Lampotang S, Stringer T, Lizdas D. Visualized Prostate Biopsy: An Intuitive Three-Dimensional User Interface for Systematic and Targeted Biopsy. J Endourol 2021; 35:1198-1203. [PMID: 33403896 DOI: 10.1089/end.2020.1013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Prostate biopsy false negative percentages are 21% to 47% and 16% to 30% for systematic and fused biopsy, respectively. An intuitive three-dimensional (3D) observed user interface may help reduce these percentages by providing real-time guidance and feedback during transrectal or transperineal biopsy. Materials and Methods: We track the moving prostate (including template locations and regions of interest), the transrectal ultrasound (TRUS) probe, and the biopsy device to construct a 3D environment. Users observe, aim, sample, and receive feedback in real time. Using a simulator with simulated TRUS, 48 participants performed freehand systematic prostate biopsy with traditional TRUS guidance and afterward with visualized prostate biopsy (vPBx). Results: During simulated biopsy, vPBx reduced the false negative percentage for a 0.5-mL spherical apical lesion from 52% to 2% (p < 0.001). Conclusions: Preliminary results during simulated systematic biopsy warrant retrofitting the vPBx to actual TRUS equipment as a step toward clinical trials with patients.
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Affiliation(s)
- Samsun Lampotang
- Center for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, Florida, USA.,Office of Educational Affairs/Office of Medical Education, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.,Clinical and Translational Science Institute, University of Florida, Gainesville, Florida, USA
| | - Thomas Stringer
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - David Lizdas
- Center for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
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Park MY, Park KJ, Lim B, Kim MH, Jeong IG, Kim JK. Comparison of biopsy strategies for prostate biopsy according to lesion size and PSA density in MRI-directed biopsy pathway. Abdom Radiol (NY) 2020; 45:4166-4177. [PMID: 32737545 DOI: 10.1007/s00261-020-02667-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/09/2020] [Accepted: 07/16/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE To investigate whether the detection of clinically significant prostate cancer (csPCa) and the added value of focal saturation biopsy and systematic biopsy (SBx) differ according to index lesion size, and to compare the current guidelines for csPCa detection. METHODS This retrospective study included consecutive men who underwent MRI and subsequent SBx and MRI-targeted biopsy (TBx) for a suspicious lesion between April 2019 and February 2020. Lesion visibility on transrectal ultrasound (US) and added value of focal saturation biopsy and SBx were compared according to index lesion size using chi-square and McNemar tests. csPCa detection rates and the proportion of biopsy-indicated men were compared among four biopsy strategies based on current guidelines. RESULTS Of 313 men evaluated (median age, 65; interquartile range 60‒71), csPCa was detected in 110 (35%). In lesions < 10 mm, greater US invisibility (42.7% of lesions < 10 mm versus 20.0% of lesions ≥ 10 mm; p < 0.001) and higher added value of focal saturation biopsy and SBx (11.1% and 17.1% in lesions < 10 mm versus 4.2% and 6.3% in lesions ≥ 10 mm) were observed, compared with lesions ≥ 10 mm. Consideration of prostate-specific antigen (PSA) density > 0.15 ng/mL/mL as a cutoff in unsuspicious MRI led to a 14% reduction (44/313) in men who needed biopsy. CONCLUSION Determination of the biopsy strategy in terms of the need for focal saturation biopsy or SBx should be made considering lesion size. The use of PSA density in non-suspicious MRI can lead to a reduction in biopsy-indicated men.
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Press B, Rosenkrantz AB, Huang R, Taneja SS. The ultrasound characteristics of regions identified as suspicious by magnetic resonance imaging (MRI) predict the likelihood of clinically significant cancer on MRI-ultrasound fusion-targeted biopsy. BJU Int 2018; 123:439-446. [PMID: 30415476 DOI: 10.1111/bju.14615] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether the presence of an ultrasound hypoechoic region at the site of a region of interest (ROI) on magnetic resonance imaging (MRI) results in improved prostate cancer (PCa) detection and predicts clinically significant PCa on MRI-ultrasonography fusion-targeted prostate biopsy (MRF-TB). MATERIALS AND METHODS Between July 2011 and June 2017, 1058 men who underwent MRF-TB, with or without systematic biopsy, by a single surgeon were prospectively entered into an institutional review board-approved database. Each MRI ROI was identified and scored for suspicion by a single radiologist, and was prospectively evaluated for presence of a hypoechoic region at the site by the surgeon and graded as 0, 1 or 2, representing none, a poorly demarcated ROI-HyR, or a well demarcated ROI-HyR, respectively. The interaction of MRI suspicion score (mSS) and ultrasonography grade (USG), and the prediction of cancer detection rate by USG, were evaluated through univariate and multivariate analysis. RESULTS For 672 men, the overall and Gleason score (GS) ≥7 cancer detection rates were 61.2% and 39.6%, respectively. The cancer detection rates for USGs 0, 1 and 2 were 46.2%, 58.6% and 76.0% (P < 0.001) for any cancer, and 18.7%, 35.2% and 61.1% (P < 0.001) for GS ≥7 cancer, respectively. For MRF-TB only, the GS ≥7 cancer detection rates for USG 0, 1 and 2 were 12.8%, 25.7% and 52.0%, respectively (P < 0.001). On univariate analysis, in men with mSS 2-4, USG was predictive of GS ≥7 cancer detection rate. Multivariable regression analysis showed that USG, prostate-specific antigen density and mSS were predictive of GS ≥7 PCa on MRF-TB. CONCLUSIONS Ultrasonography findings at the site of an MRI ROI independently predict the likelihood of GS ≥7 PCa, as men with a well-demarcated ROI-HyR at the time of MRF-TB have a higher risk than men without.
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Affiliation(s)
| | | | - Richard Huang
- Department of Urology, NYU Langone Health, New York, NY, USA
| | - Samir S Taneja
- Department of Urology and Radiology, NYU Langone Health, New York, NY, USA
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Impact of Lesion Visibility on Transrectal Ultrasound on the Prediction of Clinically Significant Prostate Cancer (Gleason Score 3 + 4 or Greater) with Transrectal Ultrasound-Magnetic Resonance Imaging Fusion Biopsy. J Urol 2018; 199:699-705. [DOI: 10.1016/j.juro.2017.09.075] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2017] [Indexed: 11/19/2022]
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6
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Rendon RA, Mason RJ, Marzouk K, Finelli A, Saad F, So A, Violette P, Breau RH. Recommandations de l'Association des urologues du Canada sur le dépistage et le diagnostic précoce du cancer de la prostate. Can Urol Assoc J 2017; 11:298-309. [PMID: 29381452 DOI: 10.5489/cuaj.4888] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ricardo A Rendon
- Département d'urologie, Université Dalhousie, Halifax, N.-É., Canada
| | - Ross J Mason
- Département d'urologie, Clinique Mayo, Rochester, Minn., États-Unis
| | - Karim Marzouk
- Division d'urologie, Centre de cancérologie Memorial Sloan Kettering, New York, NY, États-Unis
| | - Antonio Finelli
- Division d'urologie, Université de Toronto, Toronto, Ont., Canada
| | - Fred Saad
- Département de chirurgie (urologie), Université de Montréal, Montréal, Qc, Canada
| | - Alan So
- Département des sciences urologiques, Université de la Colombie-Britannique, Vancouver, C.-B., Canada
| | - Phillipe Violette
- Département de chirurgie, Université Western, London, Ont., Canada.,Départements de chirurgie et de méthodologie de recherche en santé, Données et répercussions, Université McMaster, Hamilton, Ont., Canada
| | - Rodney H Breau
- Division d'urologie, Université d'Ottawa, Ottawa, Ont., Canada
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[TNM-Classification of localized prostate cancer : The clinical T-category does not correspond to the required demands]. Urologe A 2016; 55:1564-1572. [PMID: 27830286 DOI: 10.1007/s00120-016-0264-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The TNM staging system for localized prostate cancer (PCa) divides tumors based on clinical parameters into a clinical (c)T category and, after radical prostatectomy (RP), a pathological (p)T category. OBJECTIVES This study examines the extent to which the cT and the pT category correspond to each other and whether the two categories differ in their prediction for organ-confined disease. PATIENTS AND METHODS Data of 687 RP patients were collected in a prospective, noninterventional, multicenter health service research study for the treatment of localized PCa (HAROW). Group comparisons were performed by analysis of variance and student t‑test as well as the chi-squared test or the Fisher exact test. RESULTS Clinical cT1 category (62.9%) and pathological pT2c category (56.6%) were diagnosed most frequently. The correspondence of cT and pT category was 15% for cT2a , 10.5% for cT2b, and 55% for cT2c. An extraprostatic extension (≥pT3) was observed for the categories cT1 and cT2 in 23.5% and 36.4% (p < 0.001), differences in the subcategories cT2a-c were not significant: cT2a = 28.8%, cT2b = 42.1%, and cT2c = 38.8% (p = 0.194). Tumors with a pathologically extraprostatic extension were not recognized clinically in >50%. CONCLUSIONS For localized PCa there is low agreement between clinical and pathologic T category, thus, often leading to understaging. An adaptation of the T classification of the TNM system with division into "not palpable" and "palpable" appears sufficient for a prognostic prediction.
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Nakano Junqueira VC, Zogbi O, Cologna A, Dos Reis RB, Tucci S, Reis LO, Westphalen AC, Muglia VF. Is a visible (hypoechoic) lesion at biopsy an independent predictor of prostate cancer outcome? ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1689-1694. [PMID: 22920545 DOI: 10.1016/j.ultrasmedbio.2012.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 05/16/2012] [Accepted: 06/11/2012] [Indexed: 06/01/2023]
Abstract
The aim of this study was to evaluate the prognostic implications of the sonographic appearance of prostate cancers. All patients with biopsy-proven prostate cancer between January 2003 and July 2004 (and at least 5 years of follow-up) were selected retrospectively. After exclusions, 101 patients constituted our study population and were divided into isoechoic (or nonvisible) and hypoechoic (or visible) lesion. The clinical outcomes of these two groups were compared. The outcomes for the two groups were significantly different (p < 0.01). For nonvisible lesions, 37 of the 41 patients (90.2%) had no disease relapse and 2 (4.9%) had biochemical failure. For the visible lesions, 37 of the 60 (61.6%) patients were free of recurrence, 7 (11.7%) had systemic metastases and 10 (16.7%) died of complications related to prostate cancer. Our data show that patients with nonvisible prostate cancer had significantly better outcomes than patients with visible lesions during a five-year period of evaluation.
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Izawa JI, Klotz L, Siemens DR, Kassouf W, So A, Jordan J, Chetner M, Iansavichene AE. Prostate cancer screening: Canadian guidelines 2011. Can Urol Assoc J 2011; 5:235-40. [PMID: 21801679 DOI: 10.5489/cuaj.11134] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jonathan I Izawa
- Departments of Surgery & Oncology, Divisions of Urology & Surgical Oncology, The Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON
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Eisenberg ML, Cowan JE, Davies BJ, Carroll PR, Shinohara K. The importance of tumor palpability and transrectal ultrasonographic appearance in the contemporary clinical staging of prostate cancer. Urol Oncol 2011; 29:171-6. [PMID: 19362864 DOI: 10.1016/j.urolonc.2009.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 01/09/2009] [Accepted: 01/12/2009] [Indexed: 10/20/2022]
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Modalities for imaging of prostate cancer. Adv Urol 2010:818065. [PMID: 20339583 PMCID: PMC2841248 DOI: 10.1155/2009/818065] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 09/08/2009] [Accepted: 12/31/2009] [Indexed: 12/29/2022] Open
Abstract
Prostate cancer is the second most common cause of cancer deaths among males in the United States. Prostate screening by digital rectal examination and prostate-specific
antigen has shifted the diagnosis of prostate cancer to lower grade, organ confined
disease, adding to overdetection and overtreatment of prostate cancer. The new challenge
is in differentiating clinically relevant tumors from ones that may otherwise never have
become evident if not for screening. The rapid evolution of imaging modalities and the
synthesis of anatomic, functional, and molecular data allow for improved detection and
characterization of prostate cancer. However, the appropriate use of imaging is difficult
to define, as many controversial studies regarding each of the modalities and their utilities
can be found in the literature. Clinical practice patterns have been slow to adopt many of
these advances as a result. This review discusses the more established imaging
techniques, including Ultrasonography, Magnetic Resonance Imaging, MR Spectroscopy,
Computed Tomography, and Positron Emission Tomography. We also review several
promising techniques on the horizon, including Dynamic Contrast-Enhanced MRI,
Diffuse-Weighted Imaging, Superparamagnetic Nanoparticles, and Radionuclide
Scintigraphy.
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Abstract
OBJECTIVE To determine if the adjunctive use of power Doppler imaging (PDI) could provide prognostic utility in the treatment of prostate cancer, as an accurate prediction of the clinical behaviour of prostate cancer is important to determine appropriate treatment. PATIENTS AND METHODS Most centres rely on a digital rectal examination or transrectal ultrasonography (TRUS) to assess the clinical stage of patients. In 2002, we began using a standardized form to evaluate TRUS findings and PDI findings. We compared preoperative clinical findings with those from pathological analysis of 620 radical prostatectomy specimens from 2002 to 2007. RESULTS The mean (sd) patient age was 58 (6.6) years with a mean prostate-specific antigen (PSA) level of 7.0 (4.5) ng/mL. Of the 620 specimens 157 (25.3%) had evidence of extracapsular extension on pathological evaluation; 443 (71.5%) men had a hypervascular lesion seen on TRUS, while 177 (28.5%) patients had none. There was no difference in preoperative PSA level, grade or stage of tumour. Furthermore, rates of biochemical recurrence or secondary treatment did not differ based on PDI findings. As a tool to help locate prostate tumours, PDI improved the specificity of TRUS but did not improve the overall accuracy or sensitivity. CONCLUSION PDI provides little prognostic utility to assess risk in prostate cancer. However, PDI might improve the specificity of TRUS in identifying prostate tumours and could have a role in image guidance for focal therapy of prostate cancer.
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Lee SW, Lee TY, Yeh HZ, Chang CS, Wang RC. An unusual case of metastatic small intestinal tumor due to prostate cancer. J Chin Med Assoc 2009; 72:271-4. [PMID: 19467952 DOI: 10.1016/s1726-4901(09)70069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Prostate cancer is a common cancer in men, and its clinical behavior ranges from microscopic tumors to aggressive cancer with metastatic potential. We report the case of an 81-year-old man with primary prostate cancer, AJCC stage T2 and Gleason's score 10, which was diagnosed in March 2007. The patient received upper endoscopy due to symptoms of abdominal fullness and body weight loss, and a soft tumor in the secondary portion of the duodenum was found. Biopsy demonstrated a poorly differentiated carcinoma with positive prostate specific antigen cytoplasmic stain. The pathologic appearance was consistent with prostate cancer metastatic to the small bowel. Abdominal computed tomography also showed multiple liver tumors with enlarged retroperitoneal lymph nodes. This case should help raise clinical awareness of the possibility of unusual metastatic sites in patients with primary prostate cancer.
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Affiliation(s)
- Shou-Wu Lee
- Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C.
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Dotan ZA, Ramon J. Staging of prostate cancer. RECENT RESULTS IN CANCER RESEARCH. FORTSCHRITTE DER KREBSFORSCHUNG. PROGRES DANS LES RECHERCHES SUR LE CANCER 2007; 175:109-30. [PMID: 17432557 DOI: 10.1007/978-3-540-40901-4_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Zohar A Dotan
- The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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Hsu CY, Joniau S, Oyen R, Roskams T, Van Poppel H. Detection of clinical unilateral T3a prostate cancer ? by digital rectal examination or transrectal ultrasonography? BJU Int 2006; 98:982-5. [PMID: 16945120 DOI: 10.1111/j.1464-410x.2006.06452.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess, in a retrospective study, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of digital rectal examination (DRE), transrectal ultrasonography (TRUS) and the combination of both in unilateral clinical T3a (cT3a) prostate cancer. PATIENTS AND METHODS The long-term outcome of surgical treatment for locally advanced prostate cancer is very good and surpasses that for radiotherapy outcomes, so it is anticipated that surgical management for cT3a disease will become more important, but staging methods for cT3a disease are not well studied. Between 1990 and 2004, 2240 patients had a radical prostatectomy at our institution; 267 were diagnosed as having clinical cT3a prostate cancer either by DRE or TRUS. The final histopathology was compared with the findings of DRE and TRUS. The sensitivity, specificity, PPV and NPV for DRE, TRUS and the combination of both were calculated. RESULTS The sensitivity, specificity, PPV and NPV by DRE only was 90.9%, 15.8%, 47.2% and 67.7%, by TRUS only was 80.2%, 25.3%, 47.1% and 60.7%, and by both DRE and TRUS was 71.1%, 41.1%, 50.0% and 63.2%. Although the sensitivity was lower in the combined group, it had the highest specificity (41.1%) and PPV (50.0%). The combination of DRE and TRUS can detect T3a prostate cancer more accurately than either method alone. CONCLUSION Until data on staging methods like magnetic resonance imaging become available, the combination of DRE and TRUS is advisable in selecting cT3a patients for primary radical prostatectomy.
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Affiliation(s)
- Chao-Yu Hsu
- Department of Urology, University Hospitals, KU Leuven, Belgium
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Meraney AM, Haese A, Palisaar J, Graefen M, Steuber T, Huland H, Klein EA. Surgical management of prostate cancer: Advances based on a rational approach to the data. Eur J Cancer 2005; 41:888-907. [PMID: 15808956 DOI: 10.1016/j.ejca.2005.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2005] [Revised: 02/08/2005] [Accepted: 02/08/2005] [Indexed: 11/18/2022]
Abstract
The management of localised prostate cancer has undergone important changes in the past two decades, with major improvements in surgical technique, a greater emphasis on structured assessment of quality of life, and a greater attempt to tailor treatment to biological risk. Disease diagnosis is predicated on identification of demographic risk factors, serum levels of prostate-specific antigen and its derivatives, and extended biopsy techniques. Surgical removal of the prostate may be accomplished by open or minimally invasive techniques and in experienced hands results in good functional outcomes a high rate of cure for those with organ confined disease. Radical prostatectomy is also appropriate in selected patients with locally advanced disease and after failed radiation therapy.
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Affiliation(s)
- Anoop M Meraney
- Glickman Urological Institute A-100, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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