1
|
Tyloch DJ, Tyloch JF, Adamowicz J, Neska-Długosz I, Grzanka D, Van Breda S, Drewa T. Comparison of Strain and Shear Wave Elastography in Prostate Cancer Detection. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:889-900. [PMID: 36572589 DOI: 10.1016/j.ultrasmedbio.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 11/14/2022] [Accepted: 11/19/2022] [Indexed: 06/18/2023]
Abstract
The aim of the study was to compare strain elastography with shear wave elastography in prostate cancer detection by comparing data gained during elastography with histological analysis after prostatectomy. Thirty patients with prostate cancer qualified for radical prostatectomy were enrolled into the study. All patients underwent transrectal strain elastography and shear wave elastography during pre-surgical evaluation. In each prostate, 36 regions were evaluated separately whether there was a suspicious prostate cancer lesion or not. Subsequently, the same regions were analyzed during histological analysis of the resected gland. Strain elastography and shear wave elastography (overall stiffness cutoff value = 35 kPa) in our study were characterized by overall sensitivities of 58.9% and 65.3% and specificities of 71.8% and 70.2%, respectively. Cutoff values specific to the zones in the shear wave elastography examination (peripheral zone: 35 kPa, transitional zone: 45 kPa) were characterized by an overall prostate cancer detection sensitivity and specificity of 63.4% and 73% respectively. Shear wave elastography examination revealed a higher sensitivity versus strain elastography, 63.4% versus 58.9% (p = 0.038, p < 0.05), and comparable specificity, 73.0% versus 71.8% (p = 0.547, p > 0.05), respectively. Sensitivity in prostate cancer detection for both methods is higher for larger lesions (except Gleason score 5 massive lesions in strain elastography). Controversially we observed a decrease in sensitivity for strain elastography in the detection of lesions with a large diameter and a Gleason score of 5 near the prostate capsule. Overall sensitivity in the diagnosis of prostate cancer is more significant for shear wave elastography versus strain elastography.
Collapse
Affiliation(s)
- Dominik Janusz Tyloch
- Chair of Urology and Andrology, Department of General and Oncological Urology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
| | - Janusz Ferdynand Tyloch
- Chair of Urology and Andrology, Department of General and Oncological Urology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Jan Adamowicz
- Chair of Urology and Andrology, Department of General and Oncological Urology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Izabela Neska-Długosz
- Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland; Department of Pathological Anatomy, Multispecialist Hospital of Dr. Ludwik Błażek, Inowrocław, Poland
| | - Dariusz Grzanka
- Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Shane Van Breda
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Tomasz Drewa
- Chair of Urology and Andrology, Department of General and Oncological Urology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| |
Collapse
|
2
|
Structured approach to resolving discordance between PI-RADS v2.1 score and targeted prostate biopsy results: an opportunity for quality improvement. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2917-2927. [PMID: 35674785 DOI: 10.1007/s00261-022-03562-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Prostate multiparametric magnetic resonance imaging (mpMRI) can identify lesions within the prostate with characteristics identified in Prostate Imaging Reporting and Data System (PI-RADS) v2.1 associated with clinically significant prostate cancer (csPCa) or Gleason grade group (GGG) ≥ 2 at biopsy. OBJECTIVE To assess concordance (PI-RADS 5 lesions with csPCa) of PI-RADS v2/2.1 with targeted, fusion biopsy results and to examine causes of discordance (PI-RADS 5 lesions without csPCa) with aim to provide a structured approach to resolving discordances and develop quality improvement (QI) protocols. METHODS A retrospective study of 392 patients who underwent mpMRI at 3 Tesla followed by fusion biopsy. PI-RADS v2/2.1 scores were assigned to lesions identified on mpMRI and compared to biopsy results expressed as GGG. Positive predictive value (PPV) of PI-RADS v2/2.1 was calculated for all prostate cancer and csPCa. Discordant cases were re-reviewed by a radiologist with expertise in prostate mpMRI to determine reason for discordance. RESULTS A total of 521 lesions were identified on mpMRI. 121/521 (23.2%), 310/524 (59.5%), and 90/521 (17.3%) were PI-RADS 5, 4, and 3, respectively. PPV of PI-RADS 5, 4, and 3 for all PCa and csPCa was 0.80, 0.55, 0.24 and 0.63, 0.33, and 0.09, respectively. 45 cases of discordant biopsy results for PI-RADS 5 lesions were found with 27 deemed "true" discordances or "unresolved" discordances where imaging re-review confirmed PI-RADS appropriateness, while 18 were deemed "false" or resolved discordances due to downgrading of PI-RADS scores based on imaging re-review. Adjusting for resolved discordances on re-review, the PPV of PI-RADS 5 lesions for csPCa was deemed to be 0.74 and upon adjusting for presence of csPCa found in cases of unresolved discordance, PPV rose to 0.83 for PI-RADS 5 lesions. CONCLUSION Although PIRADS 5 lesions are considered high risk for csPCa, the PPV is not 100% and a diagnostic dilemma occurs when targeted biopsy returns discordant. While PI-RADS score is downgraded in some cases upon imaging re-review, a number of "false" or "unresolved" discordances were identified in which MRI re-review confirmed initial PI-RADS score and subsequent pathology confirmed presence of csPCa in these lesions. CLINICAL IMPACT We propose a structured approach to resolving discordant biopsy results using multi-disciplinary re-review of imaging and archived biopsy strikes as a quality improvement pathway. Further work is needed to determine the value of re-biopsy in cases of unresolved discordance and to develop robust QI systems for prostate MRI.
Collapse
|
3
|
Kotamarti S, Gupta RT, Wang B, Séguier D, Michael Z, Zhang D, Abern MR, Huang J, Polascik TJ. Reconciling Discordance Between Prostate Biopsy Histology and Magnetic Resonance Imaging Suspicion - Implementation of a Quality Improvement Protocol of Imaging Re-review and Reverse-fusion Target Analysis. Eur Urol Oncol 2022; 5:483-493. [PMID: 35879190 DOI: 10.1016/j.euo.2022.06.007] [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: 05/15/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/04/2022]
Abstract
There is uncertainty with how to proceed when targeted prostate biopsy of suspicious multiparametric magnetic resonance imaging (mpMRI) lesions return without clinically significant prostate cancer (csPCa). While possible, there are error sources that could contribute to such discordance including the mpMRI read, mpMRI-ultrasound fusion, biopsy technique, and histologic classification. Consequences are potentially significant; mistakenly missing csPCa can lead to delays in curative treatment. Conversely, in cases of incorrect mpMRI interpretation, the patient may be subjected to unnecessary workup/burden. At our institution, we implemented a quality improvement (QI) initiative triggered after a discordant case occurs. This multidisciplinary review process incorporates mpMRI re-review and assessment of accurate lesion-sampling, termed "reverse-fusion." Herein, we describe the protocol, present sample cases, and discuss clinical implications.
Collapse
Affiliation(s)
- Srinath Kotamarti
- Division of Urology, Duke University Medical Center, Durham, NC, United States.
| | - Rajan T Gupta
- Division of Urology, Duke University Medical Center, Durham, NC, United States; Department of Radiology, Duke University Medical Center, Durham, NC, United States; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, United States
| | - Bangchen Wang
- Department of Pathology, Duke University Medical Center, Durham, NC, United States
| | - Denis Séguier
- Division of Urology, Duke University Medical Center, Durham, NC, United States; Department of Urology, Lille University, Lille, France
| | - Zoe Michael
- Division of Urology, Duke University Medical Center, Durham, NC, United States
| | - Dylan Zhang
- Department of Radiology, Duke University Medical Center, Durham, NC, United States
| | - Michael R Abern
- Division of Urology, Duke University Medical Center, Durham, NC, United States; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, United States
| | - Jiaoti Huang
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, United States; Department of Pathology, Duke University Medical Center, Durham, NC, United States
| | - Thomas J Polascik
- Division of Urology, Duke University Medical Center, Durham, NC, United States; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, United States
| |
Collapse
|
4
|
Derigs F, Doryumu S, Tollens F, Nörenberg D, Neuberger M, von Hardenberg J, Michel MS, Ritter M, Westhoff N. A prospective study on inter-operator variability in semi-robotic software-based MRI/TRUS-fusion targeted prostate biopsies. World J Urol 2021; 40:427-433. [PMID: 34825944 PMCID: PMC8921147 DOI: 10.1007/s00345-021-03891-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/14/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose Magnetic resonance imaging (MRI)/ultrasound-fusion prostate biopsy (FB) comprises multiple steps each of which can cause alterations in targeted biopsy (TB) accuracy leading to false-negative results. The aim was to assess the inter-operator variability of software-based fusion TB by targeting the same MRI-lesions by different urologists. Methods In this prospective study, 142 patients eligible for analysis underwent software-based FB. TB of all lesions (n = 172) were carried out by two different urologists per patient (n = 31 urologists). We analyzed the number of mismatches [overall prostate cancer (PCa), clinically significant PCa (csPCa) and non-significant PCa (nsPCa)] between both performed TB per patient. In addition we evaluated factors contributing to inter-operator variability by uni- and multivariable analyses. Results In 11.6% of all MRI-lesions (10.6% of all patients) there was a mismatch between TB1 and TB2 in terms of overall prostate cancer (PCa detection. Regarding csPCa, patient-based mismatch occurred in 14.8% (n = 21). Overall PCa and csPCa detection rate of TB1 and TB2 did not differ significantly on a per-patient and per-lesion level. Analyses revealed a smaller lesion size as predictive for mismatches (OR 9.19, 95% CI 2.02–41.83, p < 0.001). Conclusion Reproducibility and precision of targeting particularly small lesions is still limited although using software-based FB. Further improvements in image-fusion, segmentation, needle-guidance, and automatization are necessary. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03891-3.
Collapse
Affiliation(s)
- Fabian Derigs
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Department of Urology and Urosurgery, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Samuel Doryumu
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Fabian Tollens
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dominik Nörenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Manuel Neuberger
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jost von Hardenberg
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Maurice Stephan Michel
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Manuel Ritter
- Department of Urology and Pediatric Urology, University Hospital of Bonn, Bonn, Germany
| | - Niklas Westhoff
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| |
Collapse
|
5
|
Bardis MD, Houshyar R, Chang PD, Ushinsky A, Glavis-Bloom J, Chahine C, Bui TL, Rupasinghe M, Filippi CG, Chow DS. Applications of Artificial Intelligence to Prostate Multiparametric MRI (mpMRI): Current and Emerging Trends. Cancers (Basel) 2020; 12:E1204. [PMID: 32403240 PMCID: PMC7281682 DOI: 10.3390/cancers12051204] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/02/2020] [Accepted: 05/08/2020] [Indexed: 01/13/2023] Open
Abstract
Prostate carcinoma is one of the most prevalent cancers worldwide. Multiparametric magnetic resonance imaging (mpMRI) is a non-invasive tool that can improve prostate lesion detection, classification, and volume quantification. Machine learning (ML), a branch of artificial intelligence, can rapidly and accurately analyze mpMRI images. ML could provide better standardization and consistency in identifying prostate lesions and enhance prostate carcinoma management. This review summarizes ML applications to prostate mpMRI and focuses on prostate organ segmentation, lesion detection and segmentation, and lesion characterization. A literature search was conducted to find studies that have applied ML methods to prostate mpMRI. To date, prostate organ segmentation and volume approximation have been well executed using various ML techniques. Prostate lesion detection and segmentation are much more challenging tasks for ML and were attempted in several studies. They largely remain unsolved problems due to data scarcity and the limitations of current ML algorithms. By contrast, prostate lesion characterization has been successfully completed in several studies because of better data availability. Overall, ML is well situated to become a tool that enhances radiologists' accuracy and speed.
Collapse
Affiliation(s)
- Michelle D. Bardis
- Department of Radiology, University of California, Irvine, Orange, CA 92868-3201, USA; (R.H.); (P.D.C.); (J.G.-B.); (C.C.); (T.-L.B.); (M.R.); (D.S.C.)
| | - Roozbeh Houshyar
- Department of Radiology, University of California, Irvine, Orange, CA 92868-3201, USA; (R.H.); (P.D.C.); (J.G.-B.); (C.C.); (T.-L.B.); (M.R.); (D.S.C.)
| | - Peter D. Chang
- Department of Radiology, University of California, Irvine, Orange, CA 92868-3201, USA; (R.H.); (P.D.C.); (J.G.-B.); (C.C.); (T.-L.B.); (M.R.); (D.S.C.)
| | - Alexander Ushinsky
- Mallinckrodt Institute of Radiology, Washington University Saint Louis, St. Louis, MO 63110, USA;
| | - Justin Glavis-Bloom
- Department of Radiology, University of California, Irvine, Orange, CA 92868-3201, USA; (R.H.); (P.D.C.); (J.G.-B.); (C.C.); (T.-L.B.); (M.R.); (D.S.C.)
| | - Chantal Chahine
- Department of Radiology, University of California, Irvine, Orange, CA 92868-3201, USA; (R.H.); (P.D.C.); (J.G.-B.); (C.C.); (T.-L.B.); (M.R.); (D.S.C.)
| | - Thanh-Lan Bui
- Department of Radiology, University of California, Irvine, Orange, CA 92868-3201, USA; (R.H.); (P.D.C.); (J.G.-B.); (C.C.); (T.-L.B.); (M.R.); (D.S.C.)
| | - Mark Rupasinghe
- Department of Radiology, University of California, Irvine, Orange, CA 92868-3201, USA; (R.H.); (P.D.C.); (J.G.-B.); (C.C.); (T.-L.B.); (M.R.); (D.S.C.)
| | | | - Daniel S. Chow
- Department of Radiology, University of California, Irvine, Orange, CA 92868-3201, USA; (R.H.); (P.D.C.); (J.G.-B.); (C.C.); (T.-L.B.); (M.R.); (D.S.C.)
| |
Collapse
|
6
|
Sterling J, Jang TL, Kim IY. EDITORIAL COMMENT. Urology 2020; 135:122. [PMID: 31895674 DOI: 10.1016/j.urology.2019.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/22/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Joshua Sterling
- Section of Urologic Oncology, Rutgers, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ
| | - Isaac Yi Kim
- Section of Urologic Oncology, Rutgers, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ
| |
Collapse
|
7
|
Three-dimensional localization and targeting of prostate cancer foci with imaging and histopathologic correlation. Curr Opin Urol 2018; 28:506-511. [DOI: 10.1097/mou.0000000000000554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
8
|
Targets missed: predictors of MRI-targeted biopsy failing to accurately localize prostate cancer found on systematic biopsy. Prostate Cancer Prostatic Dis 2018; 21:549-555. [PMID: 29988101 DOI: 10.1038/s41391-018-0062-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/15/2018] [Accepted: 04/21/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided biopsy has improved the ability to localize and detect prostate cancer (PCa) with efficiency surpassing systematic biopsy. Nevertheless, some patients have PCa missed using the MRI-targeted biopsy sampling alone. We aim to identify clinical and imaging parameters associated with cases where targeted biopsy did not detect PCa compared to systematic biopsy. METHODS We conducted a retrospective review of patients who underwent MRI/US fusion-guided biopsy in addition to concurrent systematic, extended-sextant biopsy between 2014 and 2017. For patients with PCa detected on systematic biopsy not properly localized by MRI/US fusion-guided biopsy, the sextant distance from MRI-targeted lesion to the cancer-positive sextant was calculated and parameters potentially predicting this targeting miss were evaluated. RESULTS In all, 35/127 (27.6%) patients with single-session MRI/US fusion-guided biopsy plus standard biopsy finding PCa had lesions incorrectly localized. Of these, 15/35 (42.9%) were identified as possible fusion-software misregistrations. The remainder, 12/35 (34.3%), represented targeted biopsies one sextant away from the cancer focus and 8/35 (22.9%) targeted biopsies two sextants away from the cancer focus. Only 7/35 (20.0%) patients were determined to have clinically significant PCa, which represents 7/127 (5.5%) of the overall population. Lower MRI lesion volumes (p = 0.022), lesion density (p < 0.001), and PI-RADS scores (p < 0.001) were significantly associated with targeted biopsy missing PCa detected on systematic biopsy. CONCLUSION Clinically significant PCa is rarely missed utilizing MRI/US fusion-guided biopsy. With the majority of missed tumors representing targeting misregistrations or cases of low-grade cancer in sextants immediately adjacent to MRI suspicious lesions. Lower MRI lesion volumes, lesion density, and PI-RADS are predictors of cases with targeted biopsies missing cancer, for which systematic sampling of the sextants containing MRI targets and adjacent sextants would most optimize PCa detection.
Collapse
|
9
|
|
10
|
Halstuch D, Baniel J, Lifshitz D, Sela S, Ber Y, Margel D. Assessment of Needle Tip Deflection During Transrectal Guided Prostate Biopsy: Implications for Targeted Biopsies. J Endourol 2018; 32:252-256. [PMID: 29284293 DOI: 10.1089/end.2017.0694] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To measure needle tip deflection during transrectal ultrasound (TRUS) prostate biopsy and evaluate predictors for needle tip deflection. MATERIALS AND METHODS Analysis of 568 prostate biopsies obtained from 51 consecutive patients who underwent a standard 12-core TRUS guided prostate biopsy. TRUS guided prostate biopsies were performed using BK flex500, with a side-fire biplane probe. Each biopsy core image was captured and clinical data were recorded prospectively. The angle between the expected trajectory of the needle and actual needle course was measured using the longitudinal view of the captured image. The distance between expected and actual needle tip was calculated. We measured median and interquartile needle tip deflection rate stratified by side and location (apex, midgland, base). Univariable and multivariable linear regressions analysis were performed. RESULTS The overall median needle tip deflection was 1.77 mm (IQR 1.35-2.47). Location did not significantly alter needle deflection measurements. On multivariable linear regression analysis, higher prostate volume (B = 0.007 95%, CI 0.004, 0.011; p < 0.001) and the right sided biopsy (B = 0.191 95%, CI 0.047, 0.336; p = 0.010) emerged as predictors of higher needle tip deflection. CONCLUSIONS To the best of our knowledge this is the first study to measure needle tip deflection during TRUS guided prostate biopsies. We demonstrated that larger prostate size and biopsy side may affect the accuracy of biopsies. These results may have clinical implication to those performing targeted biopsies.
Collapse
Affiliation(s)
- Daniel Halstuch
- 1 Division of Urology, Rabin Medical Center , Petah-Tikva, Israel .,2 Division of Surgery, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Jack Baniel
- 1 Division of Urology, Rabin Medical Center , Petah-Tikva, Israel .,2 Division of Surgery, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - David Lifshitz
- 1 Division of Urology, Rabin Medical Center , Petah-Tikva, Israel .,2 Division of Surgery, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Sivan Sela
- 1 Division of Urology, Rabin Medical Center , Petah-Tikva, Israel
| | - Yaara Ber
- 1 Division of Urology, Rabin Medical Center , Petah-Tikva, Israel
| | - David Margel
- 1 Division of Urology, Rabin Medical Center , Petah-Tikva, Israel .,2 Division of Surgery, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| |
Collapse
|
11
|
Tay KJ, Schulman AA, Sze C, Tsivian E, Polascik TJ. New advances in focal therapy for early stage prostate cancer. Expert Rev Anticancer Ther 2017. [PMID: 28635336 DOI: 10.1080/14737140.2017.1345630] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Prostate focal therapy offers men the opportunity to achieve oncological control while preserving sexual and urinary function. The prerequisites for successful focal therapy are to accurately identify, localize and completely ablate the clinically significant cancer(s) within the prostate. We aim to evaluate the evidence for current and upcoming technologies that could shape the future of prostate cancer focal therapy in the next five years. Areas covered: Current literature on advances in patient selection using imaging, biopsy and biomarkers, ablation techniques and adjuvant treatments for focal therapy are summarized. A literature search of major databases was performed using the search terms 'focal therapy', 'focal ablation', 'partial ablation', 'targeted ablation', 'image guided therapy' and 'prostate cancer'. Expert commentary: Advanced radiological tools such as multiparametric magnetic resonance imaging (mpMRI), multiparametric ultrasound (mpUS), prostate-specific-membrane-antigen positron emission tomography (PSMA-PET) represent a revolution in the ability to understand cancer function and biology. Advances in ablative technologies now provide a menu of modalities that can be rationalized based on lesion location, size and perhaps in the near future, pre-determined resistance to therapy. However, these need to be carefully studied to establish their safety and efficacy parameters. Adjuvant strategies to enhance focal ablation are under development.
Collapse
Affiliation(s)
- Kae Jack Tay
- a Department of Urology , Singapore General Hospital, SingHealth Duke-NUS Academic Medical Center , Singapore.,b Division of Urology, Department of Surgery , Duke University Medical Center , Durham , NC , USA.,c Duke Cancer Institute , Durham , NC , USA
| | - Ariel A Schulman
- b Division of Urology, Department of Surgery , Duke University Medical Center , Durham , NC , USA.,c Duke Cancer Institute , Durham , NC , USA
| | - Christina Sze
- b Division of Urology, Department of Surgery , Duke University Medical Center , Durham , NC , USA.,c Duke Cancer Institute , Durham , NC , USA
| | - Efrat Tsivian
- b Division of Urology, Department of Surgery , Duke University Medical Center , Durham , NC , USA.,c Duke Cancer Institute , Durham , NC , USA
| | - Thomas J Polascik
- b Division of Urology, Department of Surgery , Duke University Medical Center , Durham , NC , USA.,c Duke Cancer Institute , Durham , NC , USA
| |
Collapse
|
12
|
Schulman AA, Sze C, Tsivian E, Gupta RT, Moul JW, Polascik TJ. The Contemporary Role of Multiparametric Magnetic Resonance Imaging in Active Surveillance for Prostate Cancer. Curr Urol Rep 2017; 18:52. [DOI: 10.1007/s11934-017-0699-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
13
|
Holtz JN, Tay KJ, Polascik TJ, Gupta RT. Integration of multiparametric MRI into active surveillance of prostate cancer. Future Oncol 2016; 12:2513-2529. [DOI: 10.2217/fon-2016-0142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Prostate cancer is the most common noncutaneous cancer in men though many men will not die of this disease and may not require definitive treatment. Active surveillance (AS) is an increasingly utilized potential solution to the issue of overtreatment of prostate cancer. Traditionally, prostate cancer patients have been stratified into risk groups based on clinical stage on digital rectal examination, prostate-specific antigen and biopsy Gleason score, though each of these variables has significant limitations. This review will discuss the potential role for prostate multiparametric MRI and targeted biopsy techniques incorporating MRI in the selection of candidates for AS, monitoring patients on AS and as triggers for definitive treatment.
Collapse
Affiliation(s)
- Jamie N Holtz
- Duke University Medical Center, Department of Radiology, DUMC Box 3808, Durham, NC 27710, USA
| | - Kae Jack Tay
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery & Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA
| | - Thomas J Polascik
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery & Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA
- Duke Cancer Institute, DUMC Box 3494, 20 Duke Medicine Circle, Durham, NC 27710, USA
| | - Rajan T Gupta
- Duke University Medical Center, Department of Radiology, DUMC Box 3808, Durham, NC 27710, USA
- Duke Cancer Institute, DUMC Box 3494, 20 Duke Medicine Circle, Durham, NC 27710, USA
| |
Collapse
|
14
|
Muthigi A, Sidana A, George AK, Kongnyuy M, Maruf M, Valayil S, Wood BJ, Pinto PA. Current beliefs and practice patterns among urologists regarding prostate magnetic resonance imaging and magnetic resonance-targeted biopsy. Urol Oncol 2016; 35:32.e1-32.e7. [PMID: 27743850 DOI: 10.1016/j.urolonc.2016.08.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 08/04/2016] [Accepted: 08/19/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVE Multiparametric magnetic resonance imaging (MRI) and magnetic resonance (MR) -targeted biopsy have a growing role in the screening and evaluation of prostate cancer. We aim to evaluate the current knowledge, attitude, and practice patterns of urologists regarding this new technique. METHODS An anonymous online questionnaire was designed to collect information on urologists' beliefs and use of prostate multiparametric MRI and MR-targeted biopsy. The survey was sent to members of the Society of Urologic Oncology, the Endourological Society, and European Association of Urology. Multivariate logistic regression analysis was performed to determine predictors for use of prostate MRI and MR-targeted biopsy. RESULTS A total of 302 responses were received (Endourological Society: 175, European Association of Urology: 23, and Society of Urologic Oncology: 104). Most respondents (83.6%) believe MR-targeted biopsy to be moderately to extremely beneficial in the evaluation of prostate cancer. Overall, 85.7% of responders use prostate MRI in their practice, and 63.0% use MR-targeted biopsy. The 2 most common settings for use of MR-targeted biopsy include patients with history of prior negative biopsy result (96.3%) and monitoring patients on active surveillance (72.5%). In those who do not use MR-targeted biopsy, the principal reasons were lack of necessary infrastructure (64.1%) and prohibitive costs (48.1%). On multivariate logistic regression analysis, practice in an academic setting (1.86 [1.02-3.40], P = 0.043) and performing greater than 25 radical prostatectomies per year (2.32 [1.18-4.56], P = 0.015) remained independent predictors for using MR-targeted biopsy. CONCLUSIONS Most respondents of our survey look favorably on use of prostate MRI and MR-targeted biopsy in clinical practice. Over time, reduction in fixed costs and easier access to equipment may lead to further dissemination of this novel and potentially transformative technology.
Collapse
Affiliation(s)
- Akhil Muthigi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Abhinav Sidana
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Arvin K George
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Michael Kongnyuy
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mahir Maruf
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Subin Valayil
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, MD
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| |
Collapse
|
15
|
Muthigi A, George AK, Sidana A, Kongnyuy M, Simon R, Moreno V, Merino MJ, Choyke PL, Turkbey B, Wood BJ, Pinto PA. Missing the Mark: Prostate Cancer Upgrading by Systematic Biopsy over Magnetic Resonance Imaging/Transrectal Ultrasound Fusion Biopsy. J Urol 2016; 197:327-334. [PMID: 27582434 DOI: 10.1016/j.juro.2016.08.097] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE Multiparametric magnetic resonance imaging and fusion biopsy detect more high risk prostate cancer and less low risk prostate cancer than systematic biopsy. However, there remains a small subset of patients in whom systematic biopsy captures higher grade disease than fusion biopsy. We sought to identify potential mechanisms of the failure of fusion biopsy in the detection of clinically significant prostate cancer. MATERIALS AND METHODS We reviewed a prospectively maintained database of patients who underwent multiparametric magnetic resonance imaging followed by fusion biopsy and systematic biopsy from 2007 to 2014. In patients in whom disease was upgraded to clinically significant disease (Gleason 7 or greater) by systematic biopsy over fusion biopsy, independent re-review of magnetic resonance imaging, archived biopsy imaging and whole mount pathology as well as needle coordinate mapping were performed. Multivariate logistic regression analysis was done to determine predictors of upgrading by systematic biopsy. RESULTS Disease was upgraded based on systematic biopsy over fusion biopsy in 135 of 1,003 patients (13.5%), of whom only 62 (6.2%) were upgraded to intermediate (Gleason 7) and high risk (Gleason 8 or greater) prostate cancer (51 or 5.1% and 11 or 1.1%, respectively). On multivariate analysis lower prostate specific antigen (p <0.001), higher magnetic resonance imaging prostate volume (p <0.001) and a lower number of target cores (p = 0.001) were predictors of upgrading by systematic biopsy. Main mechanisms of under grading by fusion biopsy included multiparametric magnetic resonance imaging reader oversight, presence of magnetic resonance imaging invisible cancer, fusion biopsy technique error and intralesion Gleason heterogeneity. CONCLUSIONS Magnetic resonance imaging and fusion biopsy rarely missed clinically significant prostate cancer as only 62 of 1,003 cases (6.2%) were upgraded to clinically significant disease by systematic biopsy. Imaging and biopsy techniques are continually refined. Further studies will help clarify mechanisms of fusion biopsy failure and the patient populations that benefit from systematic biopsy in addition to fusion biopsy.
Collapse
Affiliation(s)
- Akhil Muthigi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Arvin K George
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Abhinav Sidana
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael Kongnyuy
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Richard Simon
- Biometric Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Vanessa Moreno
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
16
|
Targeted Anterior Gland Focal Therapy—a Novel Treatment Option for a Better Defined Disease. Curr Urol Rep 2016; 17:69. [DOI: 10.1007/s11934-016-0628-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
17
|
Moul JW. Editorial Comment. J Urol 2016; 196:732. [PMID: 27264352 DOI: 10.1016/j.juro.2016.03.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Judd W Moul
- Duke Cancer Institute, Durham, North Carolina; Division of Urology, Department of Surgery, Duke University, Durham, North Carolina
| |
Collapse
|