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Choi YH, Lee CU, Song W, Chang Jeong B, Seo SI, Jeon SS, Lee HM, Jeon HG, Lee SJ. Combination of multiparametric magnetic resonance imaging and transperineal template-guided mapping prostate biopsy to determine potential candidates for focal therapy. Prostate Int 2022. [DOI: 10.1016/j.prnil.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Zhou SR, Priester AM, Jayadevan R, Johnson DC, Yang JJ, Ballon J, Natarajan S, Marks LS. Using spatial tracking with magnetic resonance imaging/ultrasound-guided biopsy to identify unilateral prostate cancer. BJU Int 2019; 125:399-406. [PMID: 31680423 DOI: 10.1111/bju.14943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To create reliable predictive metrics of unilateral disease using spatial tracking from a fusion device, thereby improving patient selection for hemi-gland ablation of prostate cancer. PATIENTS AND METHODS We identified patients who received magnetic resonance imaging (MRI)/ultrasound-guided biopsy and radical prostatectomy at a single institution between 2011 and 2018. In addition to standard clinical features, we extracted quantitative features related to biopsy core and MRI target locations predictive of tumour unilaterality. Classification and Regression Tree (CART) analysis was used to create a decision tree (DT) for identifying cancer laterality. We evaluated concordance of model-determined laterality with final surgical pathology. RESULTS A total of 173 patients were identified with biopsy coordinates and surgical pathology available. Based on CART analysis, in addition to biopsy- and MRI-confirmed disease unilaterality, patients should be further screened for cancer detected within 7 mm of midline in a 40 mL prostate, which equates to the central third of any-sized prostate by radius. The area under the curve for this DT was 0.82. Standard diagnostics and the DT correctly identified disease laterality in 73% and 80% of patients, respectively (P = 0.13). Of the patients identified as unilateral by standard diagnostics, 47% had undetected contralateral disease or were otherwise incorrectly identified. This error rate was reduced to 17% (P = 0.01) with the DT. CONCLUSION Using spatial tracking from fusion devices, a DT was more reliable for identifying laterality of prostate cancer compared to standard diagnostics. Patients with cancer detected within the central third of the prostate by radius are poor hemi-gland ablation candidates due to the risk of midline extension of tumour.
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Affiliation(s)
- Steve R Zhou
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Alan M Priester
- Department of Urology, University of California, Los Angeles, CA, USA.,Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Rajiv Jayadevan
- Department of Urology, University of California, Los Angeles, CA, USA
| | - David C Johnson
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Jason J Yang
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jorge Ballon
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Shyam Natarajan
- Department of Urology, University of California, Los Angeles, CA, USA.,Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Leonard S Marks
- Department of Urology, University of California, Los Angeles, CA, USA
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Johnson DC, Yang JJ, Kwan L, Barsa DE, Mirak SA, Pooli A, Sadun T, Jayadevan R, Zhou S, Priester AM, Natarajan S, Bajgiran AM, Shakeri S, Sisk A, Felker ER, Raman SS, Marks LS, Reiter RE. Do contemporary imaging and biopsy techniques reliably identify unilateral prostate cancer? Implications for hemiablation patient selection. Cancer 2019; 125:2955-2964. [PMID: 31042322 DOI: 10.1002/cncr.32170] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/24/2019] [Accepted: 03/14/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hemiablation is a less morbid treatment alternative for appropriately selected patients with unilateral prostate cancer (PCa). However, to the authors' knowledge, traditional diagnostic techniques inadequately identify appropriate candidates. In the current study, the authors quantified the accuracy for identifying hemiablation candidates using contemporary diagnostic techniques, including multiparametric magnetic resonance imaging (mpMRI) and MRI-fusion with complete systematic template biopsy. METHODS A retrospective analysis of patients undergoing MRI and MRI-fusion prostate biopsy, including full systematic template biopsy, prior to radical prostatectomy in a single tertiary academic institution between June 2010 and February 2018 was performed. Hemiablation candidates had unilateral intermediate-risk PCa (Gleason score [GS] of 3+4 or 4+3, clinical T classification ≤T2, and prostate-specific antigen level <20 ng/dL) on MRI-fusion biopsy and 2) no contralateral highly or very highly suspicious Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) MRI lesions. Hemiablation candidates were inappropriately selected if pathologists identified contralateral GS ≥3+4 or high-risk ipsilateral PCa on prostatectomy. The authors tested a range of hemiablation inclusion criteria and performed multivariable analysis of preoperative predictors of undetected contralateral disease. RESULTS Of 665 patients, 92 met primary hemiablation criteria. Of these 92 patients, 44 (48%) were incorrectly identified due to ipsilateral GS ≥3+4 tumors crossing the midline (21 patients), undetected distinct contralateral GS ≥3+4 tumors (20 patients), and/or ipsilateral high-risk PCa (3 patients) on prostatectomy. The rate of undetected contralateral disease ranged from 41% to 48% depending on inclusion criteria. On multivariable analysis, men with anterior index tumors were found to be 2.4 times more likely to harbor undetected contralateral GS ≥3+4 PCa compared with men with posterior lesions (P < .05). CONCLUSIONS Clinicians and patients must weigh the risk of inadequate oncologic treatment against the functional benefits of hemiablation. Further investigation into methods for improving patient selection for hemiablation is necessary.
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Affiliation(s)
- David C Johnson
- National Clinician Scholars Program, Department of Veterans Affairs, Los Angeles, California.,Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Jason J Yang
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Danielle E Barsa
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Sohrab A Mirak
- Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Aydin Pooli
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Taylor Sadun
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Rajiv Jayadevan
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Steve Zhou
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Alan M Priester
- Department of Bioengineering, University of California at Los Angeles, Los Angeles, California
| | - Shyam Natarajan
- Department of Bioengineering, University of California at Los Angeles, Los Angeles, California
| | - Amirhossein M Bajgiran
- Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Sepideh Shakeri
- Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Anthony Sisk
- Department of Pathology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Ely R Felker
- Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Steven S Raman
- Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Robert E Reiter
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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Konyalioglu E, Tarhan H, Cakmak O, Pala EE, Zorlu F. Prostate cancer volume estimations based on transrectal ultrasonography-guided biopsy in order to predict clinically significant prostate cancer. Int Braz J Urol 2015. [PMID: 26200537 PMCID: PMC4752136 DOI: 10.1590/s1677-5538.ibju.2014.0251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Tumor diameter is a reliable parameter to estimate tumor volume in solid organ cancers; its use in prostate cancer is controversial since it exhibits a more irregular pattern of growth. This study aimed to examine the association between the tumor volume estimations based on transrectal ultrasound (TRUS) guided biopsy results and the tumor volume measured on the pathological specimen. MATERIALS AND METHODS A total of 237 patients who underwent radical retropubic prostatectomy (RRP) were included in this retrospective study. The differences and correlations between cancer volume estimations based on TRUS guided biopsy findings and cancer volume estimations based on post-prostatectomy pathology specimens were examined. In addition, diagnostic value of TRUS guided biopsy-based volume estimations in order to predict clinically significant cancer (>0.5 cc) were calculated. RESULTS The mean cancer volume estimated using TRUS biopsy results was lower (5.5±6.5 cc) than the mean cancer volume calculated using prostatectomy specimens (6.4±7.6 cc) (p<0.041).TRUS guided biopsy examination resulted in 5 false positive and 15 false negative cases. There was a significant but weak correlation between the two parameters (r=0.62, p<0.001). The sensitivity and specificity of TRUS guided biopsy in predicting the presence of clinically significant cancer was 93.4% (95% CI, 89.1-96.1) and 50.0% (95% CI, 20.1-79.9), respectively. CONCLUSIONS TRUS guided biopsy-derived estimations seem to have a limited value to predict pathologically established tumor volume. Further studies are warranted to identify additional methods that may more accurately predict actual pathological characteristics and prognosis of prostate cancer.
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Affiliation(s)
| | - Huseyin Tarhan
- Department of Urology, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Ozgur Cakmak
- Department of Urology, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Emel Ebru Pala
- Department of Pathology, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Ferruh Zorlu
- Department of Urology, Tepecik Research and Training Hospital, Izmir, Turkey
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Tran M, Thompson J, Böhm M, Pulbrook M, Moses D, Shnier R, Brenner P, Delprado W, Haynes AM, Savdie R, Stricker PD. Combination of multiparametric MRI and transperineal template-guided mapping biopsy of the prostate to identify candidates for hemi-ablative focal therapy. BJU Int 2015; 117:48-54. [PMID: 25682968 DOI: 10.1111/bju.13090] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Minh Tran
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre; Darlinghurst NSW Australia
- School of Medicine; University of Sydney; Sydney NSW Australia
| | - James Thompson
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre; Darlinghurst NSW Australia
- School of Medicine; University of New South Wales; Sydney NSW Australia
| | - Maret Böhm
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Marley Pulbrook
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Daniel Moses
- Spectrum Medical Imaging; Randwick NSW Australia
| | - Ron Shnier
- Southern Radiology; Randwick NSW Australia
| | - Phillip Brenner
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre; Darlinghurst NSW Australia
- School of Medicine; University of New South Wales; Sydney NSW Australia
| | | | - Anne-Maree Haynes
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Richard Savdie
- School of Medicine; University of New South Wales; Sydney NSW Australia
| | - Phillip D. Stricker
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre; Darlinghurst NSW Australia
- School of Medicine; University of New South Wales; Sydney NSW Australia
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