1
|
Awiwi MO, Gjoni M, Vikram R, Altinmakas E, Dogan H, Bathala TK, Naik S, Ravizzini G, Kandemirli SG, Elsayes KM, Salem UI. MRI and PSMA PET/CT of Biochemical Recurrence of Prostate Cancer. Radiographics 2023; 43:e230112. [PMID: 37999983 DOI: 10.1148/rg.230112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Prostate cancer may recur several years after definitive treatment, such as prostatectomy or radiation therapy. A rise in serum prostate-specific antigen (PSA) level is the first sign of disease recurrence, and this is termed biochemical recurrence. Patients with biochemical recurrence have worse survival outcomes. Radiologic localization of recurrent disease helps in directing patient management, which may vary from active surveillance to salvage radiation therapy, androgen-deprivation therapy, or other forms of systemic and local therapy. The likelihood of detecting the site of recurrence increases with higher serum PSA level. MRI provides optimal diagnostic performance for evaluation of the prostatectomy bed. Prostate-specific membrane antigen (PSMA) PET radiotracers currently approved by the U.S. Food and Drug Administration demonstrate physiologic urinary excretion, which can obscure recurrence at the vesicourethral junction. However, MRI and PSMA PET/CT have comparable diagnostic performance for evaluation of local recurrence after external-beam radiation therapy or brachytherapy. PSMA PET/CT outperforms MRI in identifying recurrence involving the lymph nodes and bones. Caveats for use of both PSMA PET/CT and MRI do exist and may cause false-positive or false-negative results. Hence, these techniques have complementary roles and should be interpreted in conjunction with each other, taking the patient history and results of any additional prior imaging studies into account. Novel PSMA agents at various stages of investigation are being developed, and preliminary data show promising results; these agents may revolutionize the landscape of prostate cancer recurrence imaging in the future. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center. See the invited commentary by Turkbey in this issue. The slide presentation from the RSNA Annual Meeting is available for this article.
Collapse
Affiliation(s)
- Muhammad O Awiwi
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Migena Gjoni
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Raghunandan Vikram
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Emre Altinmakas
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Hakan Dogan
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Tharakeswara K Bathala
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Sagar Naik
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Gregory Ravizzini
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Sedat Giray Kandemirli
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Khaled M Elsayes
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Usama I Salem
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| |
Collapse
|
2
|
Turkbey B, Oto A, Allen BC, Akin O, Alexander LF, Ari M, Froemming AT, Fulgham PF, Gettle LM, Maranchie JK, Rosenthal SA, Schieda N, Schuster DM, Venkatesan AM, Lockhart ME. ACR Appropriateness Criteria® Post-Treatment Follow-up of Prostate Cancer: 2022 Update. J Am Coll Radiol 2023; 20:S164-S186. [PMID: 37236741 DOI: 10.1016/j.jacr.2023.02.012] [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: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Prostate cancer has a wide spectrum ranging between low-grade localized disease and castrate-resistant metastatic disease. Although whole gland and systematic therapies result in cure in the majority of patients, recurrent and metastatic prostate cancer can still occur. Imaging approaches including anatomic, functional, and molecular modalities are continuously expanding. Currently, recurrent and metastatic prostate cancer is grouped in three major categories: 1) Clinical concern for residual or recurrent disease after radical prostatectomy, 2) Clinical concern for residual or recurrent disease after nonsurgical local and pelvic treatments, and 3) Metastatic prostate cancer treated by systemic therapy (androgen deprivation therapy, chemotherapy, immunotherapy). This document is a review of the current literature regarding imaging in these settings and the resulting recommendations for imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
- Baris Turkbey
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Aytekin Oto
- Panel Chair, University of Chicago, Chicago, Illinois
| | - Brian C Allen
- Panel Vice-Chair, Duke University Medical Center, Durham, North Carolina
| | - Oguz Akin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Mim Ari
- The University of Chicago, Chicago, Illinois, Primary care physician
| | | | - Pat F Fulgham
- Urology Clinics of North Texas, Dallas, Texas; American Urological Association
| | | | | | - Seth A Rosenthal
- Sutter Medical Group, Sacramento, California; Commission on Radiation Oncology
| | - Nicola Schieda
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada
| | - David M Schuster
- Emory University, Atlanta, Georgia; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
3
|
Zhang J, Xu L, Zhang G, Zhang X, Bai X, Sun H, Jin Z. Effects of dynamic contrast enhancement on transition zone prostate cancer in Prostate Imaging Reporting and Data System Version 2.1. Radiol Oncol 2023; 57:42-50. [PMID: 36655324 PMCID: PMC10039479 DOI: 10.2478/raon-2023-0007] [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: 10/09/2022] [Accepted: 11/18/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The aim of the study was to analyse the effects of dynamic contrast enhanced (DCE)-MRI on transitional-zone prostate cancer (tzPCa) and clinically significant transitional-zone prostate cancer (cs-tzPCa) in Prostate Imaging Reporting and Data System (PI-RADS) Version 2.1. PATIENTS AND METHODS The diagnostic efficiencies of T2-weighted imaging (T2WI) + diffusion-weighted imaging (DWI), T2WI + dynamic contrast-enhancement (DCE), and T2WI + DWI + DCE in tzPCa and cs-tzPCa were compared using the score of ≥ 4 as the positive threshold and prostate biopsy as the reference standard. RESULTS A total of 425 prostate cases were included in the study: 203 cases in the tzPCa group, and 146 in the cs-tzPCa group. The three sequence combinations had the similar areas under the curves in diagnosing tzPCa and cs-tzPCa (all P < 0.05). The sensitivity of T2WI + DCE and T2WI + DWI + DCE (84.7% and 85.7% for tzPCa; 88.4% and 89.7% for cs-tzPCa, respectively) in diagnosing tzPCa and cs-tzPCa was significantly greater than that of T2WI + DWI (79.3% for tzPCa; 82.9% for cs-tzPCa). The specificity of T2WI + DWI (86.5% for tzPCa; 74.9% for cs-tzPCa) were significantly greater than those of T2WI + DCE and T2WI + DWI + DCE (68.0% and 68.5% for tzPCa; 59.1% and 59.5% for cs-tzPCa, respectively) (all P > 0.05). The diagnostic efficacies of T2WI + DCE and T2WI + DWI + DCE had no significant differences (all P < 0.05). CONCLUSIONS DCE can improve the sensitivity of diagnosis for tzPCa and cs-tzPCa, and it is useful for small PCa lesion diagnosis.
Collapse
Affiliation(s)
- Jiahui Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Lili Xu
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Gumuyang Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxiao Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Bai
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hao Sun
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Quality Control of Radiology, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Quality Control of Radiology, Beijing, China
| |
Collapse
|
4
|
Comparison between MRI and choline-PET trans-perineal target biopsies and saturation biopsies for detection and topography of intra-prostatic recurrence after primary radiation therapy for prostate cancer. Prog Urol 2021; 31:683-691. [PMID: 34154955 DOI: 10.1016/j.purol.2021.04.008] [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: 07/20/2020] [Revised: 04/07/2021] [Accepted: 04/30/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Biochemical recurrence of prostate cancer after radiation therapy occurs in 5 to 50% of cases depending on the radiation technique used. The diagnosis of recurrence of prostate adenocarcinoma must be made accurately. The aim of this study was to compare transperineal saturation and target biopsies to index lesion (IL) as defined on MRI and 18FCholine PET-CT (PETc) for detection of intra-prostatic recurrence after primary radiation therapy for prostate cancer. MATERIALS AND METHODS Thirty-eight patients with an history of prostate radiation for prostate cancer and biochemical recurrence were retrospectively included between March 2013 and June 2017. All patients had PETc and multiparametric MRI (MRI) defining IL. All patients had transperineal saturation biopsies and target biopsies the IL. RESULTS Among 38 patients with biochemical recurrence, 33 (87%) had biopsy proven recurrence in the prostate. The sensitivity and specificity of MRI were 32% (SD:19%) and 91% respectively (SD:7%). The sensitivity and specificity of PETc were 33% (SD:22%) and 78% respectively (SD:12%). Saturation trans-perineal and target biopsies allowed detection of disease recurrence in 79% and 84% of patients, respectively. CONCLUSION In case of positive imaging, both trans-perineal prostate saturation and target biopsies offer good performance to confirm intraprostatic recurrence. However, MRI and PETc low sensitivity to detect all sites of local recurrence of prostate cancer after radiation still justify the completion of systematic saturation biopsies. LEVEL OF EVIDENCE 3.
Collapse
|
5
|
Wang YF, Tadimalla S, Hayden AJ, Holloway L, Haworth A. Artificial intelligence and imaging biomarkers for prostate radiation therapy during and after treatment. J Med Imaging Radiat Oncol 2021; 65:612-626. [PMID: 34060219 DOI: 10.1111/1754-9485.13242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/18/2021] [Accepted: 05/02/2021] [Indexed: 12/15/2022]
Abstract
Magnetic resonance imaging (MRI) is increasingly used in the management of prostate cancer (PCa). Quantitative MRI (qMRI) parameters, derived from multi-parametric MRI, provide indirect measures of tumour characteristics such as cellularity, angiogenesis and hypoxia. Using Artificial Intelligence (AI), relevant information and patterns can be efficiently identified in these complex data to develop quantitative imaging biomarkers (QIBs) of tumour function and biology. Such QIBs have already demonstrated potential in the diagnosis and staging of PCa. In this review, we explore the role of these QIBs in monitoring treatment response during and after PCa radiotherapy (RT). Recurrence of PCa after RT is not uncommon, and early detection prior to development of metastases provides an opportunity for salvage treatments with curative intent. However, the current method of monitoring treatment response using prostate-specific antigen levels lacks specificity. QIBs, derived from qMRI and developed using AI techniques, can be used to monitor biological changes post-RT providing the potential for accurate and early diagnosis of recurrent disease.
Collapse
Affiliation(s)
- Yu-Feng Wang
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Sirisha Tadimalla
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Amy J Hayden
- Sydney West Radiation Oncology, Westmead Hospital, Wentworthville, New South Wales, Australia
- Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Lois Holloway
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Annette Haworth
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
6
|
Kowa JY, Soneji N, Sohaib SA, Mayer E, Hazell S, Butterfield N, Shur J, Ap Dafydd D. Detection and staging of radio-recurrent prostate cancer using multiparametric MRI. Br J Radiol 2021; 94:20201423. [PMID: 33586998 DOI: 10.1259/bjr.20201423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE We determined the sensitivity and specificity of multiparametric magnetic resonance imaging (MP-MRI) in detection of locally recurrent prostate cancer and extra prostatic extension in the post-radical radiotherapy setting. Histopathological reference standard was whole-mount prostatectomy specimens. We also assessed for any added value of the dynamic contrast enhancement (DCE) sequence in detection and staging of local recurrence. METHODS This was a single centre retrospective study. Participants were selected from a database of males treated with salvage prostatectomy for locally recurrent prostate cancer following radiotherapy. All underwent pre-operative prostate-specific antigen assay, positron emission tomography CT, MP-MRI and transperineal template prostate mapping biopsy prior to salvage prostatectomy. MP-MRI performance was assessed using both Prostate Imaging-Reporting and Data System v. 2 and a modified scoring system for the post-treatment setting. RESULTS 24 patients were enrolled. Using Prostate Imaging-Reporting and Data System v. 2, sensitivity, specificity, positive predictive value and negative predictive value was 64%, 94%, 98% and 36%. MP-MRI under staged recurrent cancer in 63%. A modified scoring system in which DCE was used as a co-dominant sequence resulted in improved diagnostic sensitivity (61%-76%) following subgroup analysis. CONCLUSION Our results show MP-MRI has moderate sensitivity (64%) and high specificity (94%) in detecting radio-recurrent intraprostatic disease, though disease tends to be under quantified and under staged. Greater emphasis on dynamic contrast images in overall scoring can improve diagnostic sensitivity. ADVANCES IN KNOWLEDGE MP-MRI tends to under quantify and under stage radio-recurrent prostate cancer. DCE has a potentially augmented role in detecting recurrent tumour compared with the de novo setting. This has relevance in the event of any future modified MP-MRI scoring system for the irradiated gland.
Collapse
Affiliation(s)
- Jie-Ying Kowa
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - Neil Soneji
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - S Aslam Sohaib
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - Erik Mayer
- Department of Surgery, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK.,Department of Surgery & Cancer, St Mary's Hospital Campus, Imperial College London, Praed Street, London, UK
| | - Stephen Hazell
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - Nicholas Butterfield
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - Joshua Shur
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - Derfel Ap Dafydd
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| |
Collapse
|
7
|
Panebianco V, Villeirs G, Weinreb JC, Turkbey BI, Margolis DJ, Richenberg J, Schoots IG, Moore CM, Futterer J, Macura KJ, Oto A, Bittencourt LK, Haider MA, Salomon G, Tempany CM, Padhani AR, Barentsz JO. Prostate Magnetic Resonance Imaging for Local Recurrence Reporting (PI-RR): International Consensus -based Guidelines on Multiparametric Magnetic Resonance Imaging for Prostate Cancer Recurrence after Radiation Therapy and Radical Prostatectomy. Eur Urol Oncol 2021; 4:868-876. [PMID: 33582104 DOI: 10.1016/j.euo.2021.01.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/16/2021] [Accepted: 01/22/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Imaging techniques are used to identify local recurrence of prostate cancer (PCa) for salvage therapy and to exclude metastases that should be addressed with systemic therapy. For magnetic resonance imaging (MRI), a reduction in the variability of acquisition, interpretation, and reporting is required to detect local PCa recurrence in men with biochemical relapse after local treatment with curative intent. OBJECTIVE To propose a standardised method for image acquisition and assessment of PCa local recurrence using MRI after radiation therapy (RP) and radical prostatectomy (RT). EVIDENCE ACQUISITION Prostate Imaging for Recurrence Reporting (PI-RR) was formulated using the existing literature. An international panel of experts conducted a nonsystematic review of the literature. The PI-RR system was created via consensus through a combination of face-to-face and online discussions. EVIDENCE SYNTHESIS Similar to with PI-RADS, based on the best available evidence and expert opinion, the minimum acceptable MRI parameters for detection of recurrence after radiation therapy and radical prostatectomy are set. Also, a simplified and standardised terminology and content of the reports that use five assessment categories to summarise the suspicion of local recurrence (PI-RR) are designed. PI-RR scores of 1 and 2 are assigned to lesions with a very low and low likelihood of recurrence, respectively. PI-RR 3 is assigned if the presence of recurrence is uncertain. PI-RR 4 and 5 are assigned for a high and very high likelihood of recurrence, respectively. PI-RR is intended to be used in routine clinical practice and to facilitate data collection and outcome monitoring for research. CONCLUSIONS This paper provides a structured reporting system (PI-RR) for MRI evaluation of local recurrence of PCa after RT and RP. PATIENT SUMMARY A new method called PI-RR was developed to promote standardisation and reduce variations in the acquisition, interpretation, and reporting of magnetic resonance imaging for evaluating local recurrence of prostate cancer and guiding therapy.
Collapse
Affiliation(s)
- Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy.
| | - Geert Villeirs
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jeffrey C Weinreb
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Baris I Turkbey
- National Cancer Institute, Center for Cancer Research, Bethesda, MD, USA
| | | | - Jonathan Richenberg
- Department of Imaging, Brighton and Sussex University Hospitals NHS Trust and Brighton and Sussex Medical School, Brighton, UK
| | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Jurgen Futterer
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Katarzyna J Macura
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aytekin Oto
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | | | - Masoom A Haider
- Department of Medical Imaging, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Georg Salomon
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Clare M Tempany
- Department of Radiology, Brigham &Women's Hospital, Boston, MA, USA
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Jelle O Barentsz
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| |
Collapse
|
8
|
Tamada T, Kido A, Yamamoto A, Takeuchi M, Miyaji Y, Moriya T, Sone T. Comparison of Biparametric and Multiparametric MRI for Clinically Significant Prostate Cancer Detection With PI-RADS Version 2.1. J Magn Reson Imaging 2020; 53:283-291. [PMID: 32614123 DOI: 10.1002/jmri.27283] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Biparametric MRI (bpMRI) without dynamic contrast-enhanced MRI (DCE-MRI) results in an elimination of adverse events, shortened examination time, and reduced costs, compared to multiparametric MRI (mpMRI). The ability of bpMRI to detect clinically significant prostate cancer (csPC) with the Prostate Imaging and Reporting Data System version 2.1 (PI-RADS v2.1) compared to standard mpMRI has not been studied extensively. PURPOSE To compare the interobserver reliability and diagnostic performance for detecting csPC of bpMRI and mpMRI using PI-RADS v2.1. STUDY TYPE Retrospective. POPULATION In all, 103 patients with elevated prostate-specific antigen (PSA) levels who underwent mpMRI and subsequent MRI-ultrasonography fusion-guided prostate-targeted biopsy (MRGB) with or without prostatectomy. FIELD STRENGTH/SEQUENCES T2 -weighted imaging (T2 WI), diffusion-weighted imaging (DWI), and DCE-MRI at 3T. ASSESSMENT Three readers independently assessed each suspected PC lesion, assigning a score of 1-5 for T2 WI, a score of 1-5 for DWI, and positive and negative for DCE-MRI according to PI-RADS v2.1 and determined the overall PI-RADS assessment category of bpMRI (T2 WI and DWI) and mpMRI (T2 WI, DWI, and DCE-MRI). The reference standard was MRGB or prostatectomy-derived histopathology. STATISTICAL TESTING Statistical analysis was performed using the kappa statistic and McNemar and Delong tests. RESULTS Of the 165 suspected PC lesions in 103 patients, 81 were diagnosed with csPC and 84 with benign conditions. Interobserver variability of PI-RADS assessment category showed good agreement for bpMRI (kappa value = 0.642) and mpMRI (kappa value = 0.644). For three readers, the diagnostic sensitivity was significantly higher for mpMRI than for bpMRI (P < 0.001 to P = 0.016, respectively), whereas diagnostic specificity was significantly higher for bpMRI than for mpMRI (P < 0.001 each). For three readers, the area under the receiver operating characteristic curve (AUC) was higher for bpMRI than for mpMRI; however, the difference was significant only for Reader 1 and Reader 3 (Reader 1: 0.823 vs. 0.785, P = 0.035; Reader 2: 0.852 vs. 0.829, P = 0.099; and Reader 3: 0.828 vs. 0.773, P = 0.002). DATA CONCLUSION For detecting csPC using PI-RADS v2.1, the interobserver reliability and diagnostic performance of bpMRI was comparable with those of mpMRI. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY STAGE: 2.
Collapse
Affiliation(s)
- Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Ayumu Kido
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Akira Yamamoto
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | | | - Yoshiyuki Miyaji
- Department of Urology, Kawasaki Medical School, Kurashiki, Japan
| | - Takuya Moriya
- Department of pathology, Kawasaki Medical School, Kurashiki, Japan
| | - Teruki Sone
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| |
Collapse
|
9
|
Abstract
Prostate cancer is the fifth leading cause of death worldwide. A variety of treatment options is available for localized prostate cancer and may range from active surveillance to focal therapy or whole gland treatment, that is, surgery or radiotherapy. Serum prostate-specific antigen levels are an important tool to monitor treatment success after whole gland treatment, unfortunately prostate-specific antigen is unreliable after focal therapy. Multiparametric magnetic resonance imaging of the prostate is rapidly gaining field in the management of prostate cancer and may play a crucial role in the evaluation of recurrent prostate cancer. This article will focus on postprocedural magnetic resonance imaging after different forms of local therapy in patients with prostate cancer.
Collapse
|
10
|
Liao XL, Wei JB, Li YQ, Zhong JH, Liao CC, Wei CY. Functional Magnetic Resonance Imaging in the Diagnosis of Locally Recurrent Prostate Cancer: Are All Pulse Sequences Helpful? Korean J Radiol 2018; 19:1110-1118. [PMID: 30386142 PMCID: PMC6201967 DOI: 10.3348/kjr.2018.19.6.1110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 04/24/2018] [Indexed: 11/16/2022] Open
Abstract
Objective To perform a meta-analysis to quantitatively assess functional magnetic resonance imaging (MRI) in the diagnosis of locally recurrent prostate cancer. Materials and Methods A comprehensive search of the PubMed, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews was conducted from January 1, 1995 to December 31, 2016. Diagnostic accuracy was quantitatively pooled for all studies by using hierarchical logistic regression modeling, including bivariate modeling and hierarchical summary receiver operating characteristic (HSROC) curves (AUCs). The Z test was used to determine whether adding functional MRI to T2-weighted imaging (T2WI) results in significantly increased diagnostic sensitivity and specificity. Results Meta-analysis of 13 studies involving 826 patients who underwent radical prostatectomy showed a pooled sensitivity and specificity of 91%, and the AUC was 0.96. Meta-analysis of 7 studies involving 329 patients who underwent radiotherapy showed a pooled sensitivity of 80% and specificity of 81%, and the AUC was 0.88. Meta-analysis of 11 studies reporting 1669 sextant biopsies from patients who underwent radiotherapy showed a pooled sensitivity of 54% and specificity of 91%, and the AUC was 0.85. Sensitivity after radiotherapy was significantly higher when diffusion-weighted MRI data were combined with T2WI than when only T2WI results were used. This was true when meta-analysis was performed on a per-patient basis (p = 0.027) or per sextant biopsy (p = 0.046). A similar result was found when 1H-magnetic resonance spectroscopy (1H-MRS) data were combined with T2WI and sextant biopsy was the unit of analysis (p = 0.036). Conclusion Functional MRI data may not strengthen the ability of T2WI to detect locally recurrent prostate cancer in patients who have undergone radical prostatectomy. By contrast, diffusion-weight MRI and 1H-MRS data may improve the sensitivity of T2WI for patients who have undergone radiotherapy.
Collapse
Affiliation(s)
- Xiao-Li Liao
- Department of First Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
| | - Jun-Bao Wei
- Department of Therapeutic Radiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
| | - Yong-Qiang Li
- Department of First Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
| | - Jian-Hong Zhong
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
| | - Cheng-Cheng Liao
- Department of Third Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
| | - Chang-Yuan Wei
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
| |
Collapse
|
11
|
|
12
|
Update on the ICUD-SIU consultation on multi-parametric magnetic resonance imaging in localised prostate cancer. World J Urol 2018; 37:429-436. [DOI: 10.1007/s00345-018-2395-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 06/28/2018] [Indexed: 11/26/2022] Open
|
13
|
Kawanaka Y, Kitajima K, Yamamoto S, Nakanishi Y, Yamada Y, Hashimoto T, Suzuki T, Go S, Kanematsu A, Nojima M, Sofue K, Trsurusaki M, Tamaki Y, Yoshida R, Yamakado K. Comparison of 11C-choline Positron Emission Tomography/Computed Tomography (PET/CT) and Conventional Imaging for Detection of Recurrent Prostate Cancer. Cureus 2018; 10:e2966. [PMID: 30210954 PMCID: PMC6135306 DOI: 10.7759/cureus.2966] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We aimed to compare 11C-choline positron emission tomography/computed tomography (PET/CT) with conventional imaging, including pelvic magnetic resonance imaging (MRI), contrast-enhanced chest, abdomen, and pelvic computed tomography (CT), and bone scintigraphy, for prostate cancer restaging. Thirty patients (median prostate-specific antigen [PSA: 11.8 ng/mL]) with suspected recurrent prostate cancer following definitive treatment underwent 11C-choline PET/CT and conventional imaging, including pelvic MRI, contrast-enhanced chest, abdomen, and pelvic CT, and bone scintigraphy. The results were compared with regard to patient- and lesion-based diagnostic performance for local recurrence, and for lymph node and bony metastases using receiver operating characteristic (ROC) analysis and McNemar’s test. Documented local recurrence and node and bony metastases were present in 11 (36.7%), 10 (33.3%), and 17 (56.7%) cases, respectively, of the enrolled patients. Patient-based sensitivity / specificity / accuracy / area under the ROC curve for 11C-choline-PET/CT for diagnosing local recurrence were 90.9% / 94.7% / 93.3% / 0.975 and for conventional imaging were 90.9% / 100% / 96.7% / 1.0. Those who underwent 11C-choline-PET/CT for node metastasis were 90.0% / 95.0% / 93.3% / 0.925 and for conventional imaging were 70.0% / 95.0% / 86.7% / 0.905. Those who underwent 11C-choline-PET/CT for bone metastasis were 94.1% / 92.3% / 93.3% / 0.991 and who underwent conventional imaging were 94.1% / 84.6% / 90.0% / 0.982. No significant differences were observed among them. The lesion-based detection rate of 11C-choline PET/CT for local recurrences and node and bone metastases as compared to conventional imaging was 92.9% (13/14) vs. 92.9% (13/14); 87.1% (27/31) vs. 54.8% (17/31); and 96.9% (219/226) vs. 90.3% (204/226) respectively, with significant differences noted for detection of node and bone lesions (p=0.0044 and p=0.00030, respectively). 11C-choline-PET/CT is more accurate in the detection of recurrent prostate cancer nodes and bony metastatic lesions compared to conventional imaging and has the advantage of restaging the disease in a single step.
Collapse
Affiliation(s)
| | | | | | | | - Yusuke Yamada
- Urology, Hyogo College of Medicine, Nishinomiya, JPN
| | | | - Toru Suzuki
- Urology, Hyogo College of Medicine, Nishinomiya, JPN
| | - Shuken Go
- Urology, Hyogo College of Medicine, Nisnomiya, JPN
| | | | - Michio Nojima
- Urology, Hyogo College of Medicine, Nishinomiya, JPN
| | - Keitaro Sofue
- Radiology, Kobe University Graduate School of Medicine, Kobe, JPN
| | | | - Yukihisa Tamaki
- Radiation Oncology, Shimane University Faculty of Medicine, Izumo, JPN
| | - Rika Yoshida
- Radiology, Shimane University, Faculty of Medicine, Izumo, JPN
| | | |
Collapse
|
14
|
Li Q, Xiang F, Lin X, Grajo JR, Yang L, Xu Y, Duan Y, Vyas U, Harisinghani M, Mahmood U, Samir AE. The Role of Imaging in Prostate Cancer Care Pathway: Novel Approaches to Urologic Management Challenges Along 10 Imaging Touch Points. Urology 2018; 119:23-31. [PMID: 29730256 DOI: 10.1016/j.urology.2018.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/17/2018] [Accepted: 04/24/2018] [Indexed: 01/21/2023]
Abstract
We map out a typical prostate cancer care pathway through discussion of updates on modern imaging. Multiparametric magnetic resonance imaging is the most sensitive and specific imaging tool for diagnosis and local staging, but transrectal ultrasound remains the most widely used technique for prostate biopsy guidance. Computed tomography and bone scan are useful in initial staging and recurrence detection. Novel imaging techniques in ultrasound elastography and multiparametric magnetic resonance imaging allow for increased lesion detection sensitivity and have the potential to enhance biopsy, while the development of new positron emission tomography radiotracers has great promise for improved detection of local and metastatic disease in patients with biochemical recurrence.
Collapse
Affiliation(s)
- Qian Li
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Feixiang Xiang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xueying Lin
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - Joseph R Grajo
- Department of Radiology, Division of Abdominal Imaging, University of Florida College of Medicine, Gainesville, FL
| | - Long Yang
- Department of Ultrasound, Henan Province People's Hospital, Zhengzhou, China
| | - Yufeng Xu
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Yu Duan
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Urvi Vyas
- Product Management, BK Ultrasound, Peabody, MA
| | - Mukesh Harisinghani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Umar Mahmood
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Anthony E Samir
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| |
Collapse
|
15
|
ACR Appropriateness Criteria ® Post-treatment Follow-up Prostate Cancer. J Am Coll Radiol 2018; 15:S132-S149. [DOI: 10.1016/j.jacr.2018.03.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 11/23/2022]
|
16
|
Akin-Akintayo O, Tade F, Mittal P, Moreno C, Nieh PT, Rossi P, Patil D, Halkar R, Fei B, Master V, Jani AB, Kitajima H, Osunkoya AO, Ormenisan-Gherasim C, Goodman MM, Schuster DM. Prospective evaluation of fluciclovine ( 18F) PET-CT and MRI in detection of recurrent prostate cancer in non-prostatectomy patients. Eur J Radiol 2018; 102:1-8. [PMID: 29685521 DOI: 10.1016/j.ejrad.2018.02.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/16/2017] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the disease detection rate, diagnostic performance and interobserver agreement of fluciclovine (18F) PET-CT and multiparametric magnetic resonance imaging (mpMR) in recurrent prostate cancer. METHODS Twenty-four patients with biochemical failure after non-prostatectomy definitive therapy, 16/24 of whom had undergone brachytherapy, underwent fluciclovine PET-CT and mpMR with interpretation by expert readers blinded to patient history, PSA and other imaging results. Reference standard was established via a multidisciplinary truth panel utilizing histology and clinical follow-up (22.9 ± 10.5 months) and emphasizing biochemical control. The truth panel was blinded to investigative imaging results. Diagnostic performance and interobserver agreement (kappa) for the prostate and extraprostatic regions were calculated for each of 2 readers for PET-CT (P1 and P2) and 2 different readers for mpMR (M1 and M2). RESULTS On a whole body basis, the detection rate for fluciclovine PET-CT was 94.7% (both readers), while it ranged from 31.6-36.8% for mpMR. Kappa for fluciclovine PET-CT was 0.90 in the prostate and 1.0 in the extraprostatic regions. For mpMR, kappa was 0.25 and 0.74, respectively. In the prostate, 22/24 patients met the reference standard with 13 malignant and 9 benign results. Sensitivity, specificity and positive predictive value (PPV) were 100.0%, 11.1% and 61.9%, respectively for both PET readers. For mpMR readers, values ranged from 15.4-38.5% for sensitivity, 55.6-77.8% for specificity and 50.0-55.6% for PPV. For extraprostatic disease determination, 18/24 patients met the reference standard. Sensitivity, specificity and PPV were 87.5%, 90.0% and 87.5%, respectively, for fluciclovine PET-CT, while for mpMR, sensitivity ranged from 50 to 75%, specificity 70-80% and PPV 57-75%. CONCLUSION The disease detection rate for fluciclovine PET-CT in non-prostatectomy patients with biochemical failure was 94.7% versus 31.6-36.8% for mpMR. For extraprostatic disease detection, fluciclovine PET-CT had overall better diagnostic performance than mpMR. For the treated prostate, fluciclovine PET-CT had high sensitivity though low specificity for disease detection, while mpMR had higher specificity, though low sensitivity. Interobserver agreement was also higher with fluciclovine PET-CT compared with mpMR.
Collapse
Affiliation(s)
| | - Funmilayo Tade
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - Pardeep Mittal
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - Courtney Moreno
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - Peter T Nieh
- Urology, Emory University, Atlanta, GA, United States
| | - Peter Rossi
- Urology, Emory University, Atlanta, GA, United States
| | | | - Raghuveer Halkar
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - Baowei Fei
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - Viraj Master
- Urology, Emory University, Atlanta, GA, United States
| | - Ashesh B Jani
- Radiation Oncology, Emory University, Atlanta, GA, United States
| | - Hiroumi Kitajima
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - Adeboye O Osunkoya
- Urology, Emory University, Atlanta, GA, United States; Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
| | - Claudia Ormenisan-Gherasim
- Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States; Pathology, Brigham & Women's Hospital-Harvard Medical School, Boston, MA, United States
| | - Mark M Goodman
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - David M Schuster
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States.
| |
Collapse
|
17
|
Valle LF, Greer MD, Shih JH, Barrett T, Law YM, Rosenkrantz AB, Shebel H, Muthigi A, Su D, Merino MJ, Wood BJ, Pinto PA, Krauze AV, Kaushal A, Choyke PL, Türkbey B, Citrin DE. Multiparametric MRI for the detection of local recurrence of prostate cancer in the setting of biochemical recurrence after low dose rate brachytherapy. Diagn Interv Radiol 2018; 24:46-53. [PMID: 29317377 PMCID: PMC5765929 DOI: 10.5152/dir.2018.17285] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/20/2017] [Accepted: 11/13/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE Prostate multiparametric magnetic resonance imaging (mpMRI) has utility in detecting post-radiotherapy local recurrence. We conducted a multireader study to evaluate the diagnostic performance of mpMRI for local recurrence after low dose rate (LDR) brachytherapy. METHODS A total of 19 patients with biochemical recurrence after LDR brachytherapy underwent 3T endorectal coil mpMRI with T2-weighted imaging, dynamic contrast-enhanced imaging (DCE) and diffusion-weighted imaging (DWI) with pathologic confirmation. Prospective reads by an experienced prostate radiologist were compared with reads from 4 radiologists of varying experience. Readers identified suspicious lesions and rated each MRI detection parameter. MRI-detected lesions were considered true-positive with ipsilateral pathologic confirmation. Inferences for sensitivity, specificity, positive predictive value (PPV), kappa, and index of specific agreement were made with the use of bootstrap resampling. RESULTS Pathologically confirmed recurrence was found in 15 of 19 patients. True positive recurrences identified by mpMRI were frequently located in the transition zone (46.7%) and seminal vesicles (30%). On patient-based analysis, average sensitivity of mpMRI was 88% (standard error [SE], 3.5%). For highly suspicious lesions, specificity of mpMRI was 75% (SE, 16.5%). On lesion-based analysis, the average PPV was 62% (SE, 6.7%) for all lesions and 78.7% (SE, 10.3%) for highly suspicious lesions. The average PPV for lesions invading the seminal vesicles was 88.8% (n=13). The average PPV was 66.6% (SE, 5.8%) for lesions identified with T2-weighted imaging, 64.9% (SE, 7.3%) for DCE, and 70% (SE, 7.3%) for DWI. CONCLUSION This series provides evidence that mpMRI after LDR brachytherapy is feasible with a high patient-based cancer detection rate. Radiologists of varying experience demonstrated moderate agreement in detecting recurrence.
Collapse
Affiliation(s)
- Luca F. Valle
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Matthew D. Greer
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Joanna H. Shih
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Tristan Barrett
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Yan Mee Law
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Andrew B. Rosenkrantz
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Haytham Shebel
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Akhil Muthigi
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Daniel Su
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Maria J. Merino
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Bradford J. Wood
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Peter A. Pinto
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Andra V. Krauze
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Aradhana Kaushal
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Peter L. Choyke
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Barış Türkbey
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Deborah E. Citrin
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| |
Collapse
|
18
|
Abstract
Prostate multiparametric MR imaging (mpMRI) plays an important role in local evaluation after treatment of prostate cancer. After radical prostatectomy, radiation therapy, and focal therapy, mpMRI can be used to visualize normal post-treatment changes and to diagnose locally recurrent disease. An understanding of the various treatments and expected changes is essential for complete and accurate post-treatment mpMRI interpretation.
Collapse
|
19
|
Couñago F, Sancho G, Catalá V, Hernández D, Recio M, Montemuiño S, Hernández JA, Maldonado A, del Cerro E. Magnetic resonance imaging for prostate cancer before radical and salvage radiotherapy: What radiation oncologists need to know. World J Clin Oncol 2017; 8:305-319. [PMID: 28848697 PMCID: PMC5554874 DOI: 10.5306/wjco.v8.i4.305] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/30/2017] [Accepted: 06/12/2017] [Indexed: 02/06/2023] Open
Abstract
External beam radiotherapy (EBRT) is one of the principal curative treatments for patients with prostate cancer (PCa). Risk group classification is based on prostate-specific antigen (PSA) level, Gleason score, and T-stage. After risk group determination, the treatment volume and dose are defined and androgen deprivation therapy is prescribed, if appropriate. Traditionally, imaging has played only a minor role in T-staging due to the low diagnostic accuracy of conventional imaging strategies such as transrectal ultrasound, computed tomography, and morphologic magnetic resonance imaging (MRI). As a result, a notable percentage of tumours are understaged, leading to inappropriate and imprecise EBRT. The development of multiparametric MRI (mpMRI), an imaging technique that combines morphologic studies with functional diffusion-weighted sequences and dynamic contrast-enhanced imaging, has revolutionized the diagnosis and management of PCa. As a result, mpMRI is now used in staging PCa prior to EBRT, with possible implications for both risk group classification and treatment decision-making for EBRT. mpMRI is also being used in salvage radiotherapy (SRT), the treatment of choice for patients who develop biochemical recurrence after radical prostatectomy. In the clinical context of biochemical relapse, it is essential to accurately determine the site of recurrence - pelvic (local, nodal, or bone) or distant - in order to select the optimal therapeutic management approach. Studies have demonstrated the value of mpMRI in detecting local recurrences - even in patients with low PSA levels (0.3-0.5 ng/mL) - and in diagnosing bone and nodal metastasis. The main objective of this review is to update the role of mpMRI prior to radical EBRT or SRT. We also consider future directions for the use and development of MRI in the field of radiation oncology.
Collapse
|
20
|
Catalá V, Vilanova J, Gaya J, Algaba F, Martí T. Multiparametric magnetic resonance imaging and prostate cancer: What's new? RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2017.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
21
|
Resonancia magnética multiparamétrica y cáncer de próstata: ¿qué hay de nuevo? RADIOLOGIA 2017; 59:196-208. [DOI: 10.1016/j.rx.2016.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 11/20/2022]
|
22
|
Starobinets O, Kurhanewicz J, Noworolski SM. Improved multiparametric MRI discrimination between low-risk prostate cancer and benign tissues in a small cohort of 5α-reductase inhibitor treated individuals as compared with an untreated cohort. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3696. [PMID: 28164396 PMCID: PMC5522750 DOI: 10.1002/nbm.3696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 06/06/2023]
Abstract
The purpose of this study was to determine whether 5α-reductase inhibitors (5-ARIs) affect the discrimination between low-grade prostate cancer and benign tissues on multiparametric MRI (mpMRI). Twenty men with biopsy-proven Gleason 3 + 3 prostate cancer and 3 T mpMRI were studied. Ten patients (Tx) had been receiving 5-ARIs for at least a year at scan time. Ten untreated patients (Un) were matched to the treated cohort. For each subject two regions of interest representing cancerous and benign tissues were drawn within the peripheral zone of each prostate, MR measures evaluated, and cancer contrast versus benign (contrast = (MRTumor - MRHealthy )/MRHealthy ) calculated. Decreased cancer contrast was noted on T2 -weighted images: 0.4 (Un) versus 0.3 (Tx). However, for functional MR measures, a better separation of cancerous and benign tissues was observed in the treated group. Cancer contrast on high-b diffusion-weighted imaging (DWI) was 0.61 (Un) versus 0.99 (Tx). Logistic regression analysis yielded higher AUC (area under the curve) values for distinguishing cancerous from benign regions in treated subjects on high-b DWI (0.71 (Un), 0.94 (Tx)), maximal enhancement slope (0.95 (Un), 1 (Tx)), peak enhancement (0.84 (Un), 0.93 (Tx)), washout slope (0.78 (Un), 0.99 (Tx)), Ktrans (0.9 (Un), 1 (Tx)), and combined measures (0.86 (Un), 0.99 (Tx)). Coefficients of variation for MR measures were lower in benign and cancerous tissues in the treated group compared with the untreated group. This study's results suggest an increase in homogeneity of benign and malignant peripheral zone prostatic tissues with 5-ARI exposure, observed as reduced variability of MR measures after treatment. Cancer discrimination was lower with T2 -weighted imaging, but was higher with functional MR measures in a 5-ARI-treated cohort compared with controls.
Collapse
Affiliation(s)
- Olga Starobinets
- Graduate Group in Bioengineering, UCSF and UC Berkeley
- Department of Radiology and Biomedical Imaging, UCSF
| | - John Kurhanewicz
- Graduate Group in Bioengineering, UCSF and UC Berkeley
- Department of Radiology and Biomedical Imaging, UCSF
| | - Susan M Noworolski
- Graduate Group in Bioengineering, UCSF and UC Berkeley
- Department of Radiology and Biomedical Imaging, UCSF
| |
Collapse
|
23
|
Abstract
There is growing consensus that multiparametric magnetic resonance imaging (mpMRI) is an effective modality in the detection of locally recurrent prostate cancer after prostatectomy and radiation therapy. The emergence of magnetic resonance (MR)-guided focal therapies, such as cryoablation, high-intensity focused ultrasound, and laser ablation, have made the use of mpMRI even more important, as the normal anatomy is inevitably altered and the detection of recurrence is made more difficult. The aim of this article is to review the utility of mpMRI in detecting recurrent prostate cancer in patients following radical prostatectomy, radiation therapy, and focal therapy and to discuss expected post-treatment mpMRI findings, the varied appearance of recurrent tumors, and their mimics.
Collapse
|
24
|
Zattoni F, Kawashima A, Morlacco A, Davis BJ, Nehra AK, Mynderse LA, Froemming AT, Jeffrey Karnes R. Detection of recurrent prostate cancer after primary radiation therapy: An evaluation of the role of multiparametric 3T magnetic resonance imaging with endorectal coil. Pract Radiat Oncol 2017; 7:42-49. [DOI: 10.1016/j.prro.2016.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/27/2016] [Accepted: 06/07/2016] [Indexed: 02/02/2023]
|
25
|
Ueno Y, Tamada T, Bist V, Reinhold C, Miyake H, Tanaka U, Kitajima K, Sugimura K, Takahashi S. Multiparametric magnetic resonance imaging: Current role in prostate cancer management. Int J Urol 2016; 23:550-7. [PMID: 27184019 DOI: 10.1111/iju.13119] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 04/07/2016] [Indexed: 12/31/2022]
Abstract
Digital rectal examination, serum prostate-specific antigen screening and transrectal ultrasound-guided biopsy are conventionally used as screening, diagnostic and surveillance tools for prostate cancer. However, they have limited sensitivity and specificity. In recent years, the role of multiparametric magnetic resonance imaging has steadily grown, and is now part of the standard clinical management in many institutions. In multiparametric magnetic resonance imaging, the morphological assessment of T2-weighted imaging is correlated with diffusion-weighted imaging, dynamic contrast-enhanced imaging perfusion and/or magnetic resonance spectroscopic imaging. Multiparametric magnetic resonance imaging is currently regarded as the most sensitive and specific imaging technique for the evaluation of prostate cancer, including detection, staging, localization and aggressiveness evaluation. This article presents an overview of multiparametric magnetic resonance imaging, and discusses the current role of multiparametric magnetic resonance imaging in the different fields of prostate cancer management.
Collapse
Affiliation(s)
- Yoshiko Ueno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Vipul Bist
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Utaru Tanaka
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazuhiro Kitajima
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Department of Nuclear Medicine and PET Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuro Sugimura
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satoru Takahashi
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| |
Collapse
|
26
|
Oppenheimer DC, Weinberg EP, Hollenberg GM, Meyers SP. Multiparametric Magnetic Resonance Imaging of Recurrent Prostate Cancer. J Clin Imaging Sci 2016; 6:18. [PMID: 27195184 PMCID: PMC4863405 DOI: 10.4103/2156-7514.181494] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/14/2016] [Indexed: 11/30/2022] Open
Abstract
Multiparametric magnetic resonance (MR) imaging of the prostate combines both morphological and functional MR techniques by utilizing small field of view T1-weighted, T2-weighted, diffusion-weighted imaging, dynamic contrast-enhanced imaging, and MR spectroscopy to accurately detect, localize, and stage primary and recurrent prostate cancer. Localizing the site of recurrence in patients with rising prostate-specific antigen following treatment affects decision making regarding treatment and can be accomplished with multiparametric prostate MR. Several different treatment options are available for prostate cancer including radical prostatectomy, external beam radiation therapy, brachytherapy, androgen deprivation therapy, or a number of focal therapy techniques. The findings of recurrent prostate cancer can be different depending on the treatment the patient has received, and the radiologist must be able to recognize the variety of imaging findings seen with this common disease. This review article will detail the findings of recurrent prostate cancer on multiparametric MR and describe common posttreatment changes which may create challenges to accurate interpretation.
Collapse
Affiliation(s)
| | - Eric P Weinberg
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Gary M Hollenberg
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Steven P Meyers
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
27
|
Al-Shraideh Y, Sejpal SV, Meeks JJ. Radiation-Resistant Prostate Cancer and Salvage Prostatectomy. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00031-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
28
|
Abd-Alazeez M, Ramachandran N, Dikaios N, Ahmed HU, Emberton M, Kirkham A, Arya M, Taylor S, Halligan S, Punwani S. Multiparametric MRI for detection of radiorecurrent prostate cancer: added value of apparent diffusion coefficient maps and dynamic contrast-enhanced images. Prostate Cancer Prostatic Dis 2015; 18:128-36. [PMID: 25644248 DOI: 10.1038/pcan.2014.55] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 11/16/2014] [Accepted: 12/10/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mp-MRI) is increasingly advocated for prostate cancer detection. There are limited reports of its use in the setting of radiorecurrent disease. Our aim was to assess mp-MRI for detection of radiorecurrent prostate cancer and examine the added value of its functional sequences. METHODS Thirty-seven men with mean age of 69.7 (interquartile range, 66-74) with biochemical failure after external beam radiotherapy underwent mp-MRI (T2-weighted, high b-value, multi-b-value apparent diffusion coefficient (ADC) and dynamic contrast-enhanced (DCE) imaging); then transperineal systematic template prostate mapping (TPM) biopsy. Using a locked sequential read paradigm (with the sequence order above), two experienced radiologists independently reported mp-MRI studies using score 1-5. Radiologist scores were matched with TPM histopathology at the hemigland level (n=74). Accuracy statistics were derived for each reader. Interobserver agreement was evaluated using kappa statistics. RESULTS Receiver-operator characteristic area under curve (AUC) for readers 1 and 2 increased from 0.67 (95% confidence interval (CI), 0.55-0.80) to 0.80 (95% CI, 0.69-0.91) and from 0.67 (95% CI, 0.55-0.80) to 0.84 (95% CI, 0.76-0.93), respectively, between T2-weighted imaging alone and full mp-MRI reads. Addition of ADC maps and DCE imaging to the examination did not significantly improve AUC for either reader (P=0.08 and 0.47 after adding ADC, P=0.90 and 0.27 after adding DCE imaging) compared with T2+high b-value review. Inter-reader agreement increased from k=0.39 to k=0.65 between T2 and full mp-MRI review. CONCLUSIONS mp-MRI can detect radiorecurrent prostate cancer. The optimal examination included T2-weighted imaging and high b-value DWI; adding ADC maps and DCE imaging did not significantly improve the diagnostic accuracy.
Collapse
Affiliation(s)
- M Abd-Alazeez
- 1] Department of Urology, University College Hospital NHS Foundation Trust, London, UK [2] Department of Urology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - N Ramachandran
- Department of Radiology, University College London Hospital, London, UK
| | - N Dikaios
- 1] Department of Radiology, University College London Hospital, London, UK [2] Centre for Medical Imaging, University College London, London, UK
| | - H U Ahmed
- 1] Department of Urology, University College Hospital NHS Foundation Trust, London, UK [2] Division of Surgery and Interventional Science, University College London, London, UK
| | - M Emberton
- 1] Department of Urology, University College Hospital NHS Foundation Trust, London, UK [2] Division of Surgery and Interventional Science, University College London, London, UK
| | - A Kirkham
- Department of Radiology, University College London Hospital, London, UK
| | - M Arya
- 1] Department of Urology, University College Hospital NHS Foundation Trust, London, UK [2] Barts Cancer Institute, Queen Mary University of London, London, UK
| | - S Taylor
- 1] Department of Radiology, University College London Hospital, London, UK [2] Centre for Medical Imaging, University College London, London, UK
| | - S Halligan
- 1] Department of Radiology, University College London Hospital, London, UK [2] Centre for Medical Imaging, University College London, London, UK
| | - S Punwani
- 1] Department of Radiology, University College London Hospital, London, UK [2] Centre for Medical Imaging, University College London, London, UK
| |
Collapse
|
29
|
|
30
|
Multiparametric MRI for recurrent prostate cancer post radical prostatectomy and postradiation therapy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:316272. [PMID: 24967355 PMCID: PMC4055489 DOI: 10.1155/2014/316272] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 04/25/2014] [Indexed: 12/30/2022]
Abstract
The clinical suspicion of local recurrence of prostate cancer (PCa) after radical prostatectomy (RP) and after radiation therapy (RT) is based on the onset of biochemical failure. The aim of this paper was to review the current role of multiparametric-MRI (mp-MRI) in the detection of locoregional recurrence. A systematic literature search using the Medline and Cochrane Library databases was performed from January 1995 up to November 2013. Bibliographies of retrieved and review articles were also examined. Only those articles reporting complete data with clinical relevance for the present review were selected. This review article is divided into two major parts: the first one considers the role of mp-MRI in the detection of PCa local recurrence after RP; the second part provides an insight about the impact of mp-MRI in the depiction of locoregional recurrence after RT (interstitial or external beam). Published data indicate an emerging role for mp-MRI in the detection and localization of locally recurrent PCa both after RP and RT which represents an information of paramount importance to perform focal salvage treatments.
Collapse
|
31
|
Baco E, Gelet A, Crouzet S, Rud E, Rouvière O, Tonoli-Catez H, Berge V, Chapelon JY, Eggesbø HB. Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: a prospective two-centre study. BJU Int 2014; 114:532-40. [DOI: 10.1111/bju.12545] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Eduard Baco
- Division of Surgery and Cancer Medicine; Department of Urology Oslo University Hospital; Aker Norway
| | - Albert Gelet
- Hospices Civils de Lyon; Department of Urology and Transplantation Surgery; Edouard Herriot Hospital; Lyon France
- Inserm; U1032; LabTau
| | - Sébastien Crouzet
- Hospices Civils de Lyon; Department of Urology and Transplantation Surgery; Edouard Herriot Hospital; Lyon France
- Inserm; U1032; LabTau
| | - Erik Rud
- Division of Diagnostic and Intervention; Department of Radiology and Nuclear Medicine; Oslo University Hospital; Aker Norway
| | - Olivier Rouvière
- Inserm; U1032; LabTau
- Department of Urinary and Vascular Imaging; Hospices Civils de Lyon; Edouard Herriot Hospital; Lyon France
- Faculté de Médecine; Hospices Civils de Lyon; Edouard Herriot Hospital; Lyon France
| | - Hélène Tonoli-Catez
- Hospices Civils de Lyon; Department of Urology and Transplantation Surgery; Edouard Herriot Hospital; Lyon France
| | - Viktor Berge
- Division of Surgery and Cancer Medicine; Department of Urology Oslo University Hospital; Aker Norway
| | | | - Heidi B. Eggesbø
- Division of Diagnostic and Intervention; Department of Radiology and Nuclear Medicine; Oslo University Hospital; Rikshospitalet Norway
| |
Collapse
|
32
|
Detection of Radiorecurrent Prostate Cancer Using Diffusion-Weighted Imaging and Targeted Biopsies. AJR Am J Roentgenol 2014; 202:W241-6. [DOI: 10.2214/ajr.12.10483] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
33
|
Abstract
OBJECTIVE The purpose of this article is to review the many evolving facets of MRI in the evaluation of prostate cancer. We will discuss the roles of multiparametric MRI, including diffusion-weighted MRI, dynamic contrast-enhanced MRI, and MR spectroscopy, as adjuncts to morphologic T2-weighted imaging in detection, staging, treatment planning, and surveillance of prostate cancer. CONCLUSION Radiologists need to understand the advantages, limitations, and potential pitfalls of the different sequences to provide optimal assessment of prostate cancer.
Collapse
|
34
|
Tamada T, Sone T, Jo Y, Yamamoto A, Ito K. Diffusion-weighted MRI and its role in prostate cancer. NMR IN BIOMEDICINE 2014; 27:25-38. [PMID: 23712781 DOI: 10.1002/nbm.2956] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 02/28/2013] [Accepted: 03/05/2013] [Indexed: 06/02/2023]
Abstract
In the last 5 years, the multiparametric approach has been investigated as the method for the MRI of prostate cancer. In multiparametric MRI of the prostate, at least two functional MRI techniques, such as diffusion-weighted MRI (DW-MRI) and dynamic contrast-enhanced MRI, are combined with conventional MRI, such as T2 -weighted imaging. DW-MRI has the ability to qualitatively and quantitatively represent the diffusion of water molecules by the apparent diffusion coefficient, which indirectly reflects tissue cellularity. DW-MRI is characterized by a short acquisition time without the administration of contrast medium. Thus, DW-MRI has the potential to become established as a noninvasive diagnostic method for tumor detection and localization, tumor aggressiveness, local staging and local recurrence after various therapies. Accordingly, radiologists should recognize the principles of DW-MRI, the methods of image acquisition and the pitfalls of image interpretation.
Collapse
Affiliation(s)
- Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama, Japan
| | | | | | | | | |
Collapse
|
35
|
Wallace T, Torre T, Grob M, Yu J, Avital I, Brücher BLDM, Stojadinovic A, Man Y. Current approaches, challenges and future directions for monitoring treatment response in prostate cancer. J Cancer 2014; 5:3-24. [PMID: 24396494 PMCID: PMC3881217 DOI: 10.7150/jca.7709] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 11/01/2013] [Indexed: 01/23/2023] Open
Abstract
Prostate cancer is the most commonly diagnosed non-cutaneous neoplasm in men in the United States and the second leading cause of cancer mortality. One in 7 men will be diagnosed with prostate cancer during their lifetime. As a result, monitoring treatment response is of vital importance. The cornerstone of current approaches in monitoring treatment response remains the prostate-specific antigen (PSA). However, with the limitations of PSA come challenges in our ability to monitor treatment success. Defining PSA response is different depending on the individual treatment rendered potentially making it difficult for those not trained in urologic oncology to understand. Furthermore, standard treatment response criteria do not apply to prostate cancer further complicating the issue of treatment response. Historically, prostate cancer has been difficult to image and no single modality has been consistently relied upon to measure treatment response. However, with newer imaging modalities and advances in our understanding and utilization of specific biomarkers, the future for monitoring treatment response in prostate cancer looks bright.
Collapse
Affiliation(s)
- T.J. Wallace
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 2. Division of Radiation Oncology, Bon Secours Health Care System, Richmond VA, USA
- 3. Virginia Urology, Richmond VA, USA
| | - T. Torre
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 2. Division of Radiation Oncology, Bon Secours Health Care System, Richmond VA, USA
- 3. Virginia Urology, Richmond VA, USA
| | - M. Grob
- 4. Department of Urology, Virginia Commonwealth University Health System, Richmond VA, USA
| | - J. Yu
- 5. Department of Radiology, Virginia Commonwealth University Health System, Richmond VA, USA
| | - I. Avital
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 6. Division of Surgical Oncology, Bon Secours Health Care System, Richmond VA, USA
| | - BLDM Brücher
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 6. Division of Surgical Oncology, Bon Secours Health Care System, Richmond VA, USA
- 7. INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Adademy
| | - A. Stojadinovic
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 6. Division of Surgical Oncology, Bon Secours Health Care System, Richmond VA, USA
- 7. INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Adademy
| | - Y.G. Man
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 6. Division of Surgical Oncology, Bon Secours Health Care System, Richmond VA, USA
- 8. South Hospital of Nanjing, Nanjing, China
| |
Collapse
|
36
|
Punnen S, Cooperberg MR, D'Amico AV, Karakiewicz PI, Moul JW, Scher HI, Schlomm T, Freedland SJ. Management of biochemical recurrence after primary treatment of prostate cancer: a systematic review of the literature. Eur Urol 2013; 64:905-15. [PMID: 23721958 DOI: 10.1016/j.eururo.2013.05.025] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/08/2013] [Indexed: 12/31/2022]
Abstract
CONTEXT Despite excellent cancer control with the treatment of localized prostate cancer (PCa), some men will experience a recurrence of disease. The optimal management of recurrent disease remains uncertain. OBJECTIVE To systematically review recent literature regarding management of biochemical recurrence after primary treatment for localized PCa. EVIDENCE ACQUISITION A comprehensive systematic review of the literature was performed from 2000 to 2012 to identify articles pertaining to management after recurrent PCa. Search terms included prostate cancer recurrence, salvage therapy, radiorecurrent prostate cancer, post HIFU, post cryoablation, postradiation, and postprostatectomy salvage. Studies were selected according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines and required to provide a comprehensive description of primary and secondary treatments along with outcomes. EVIDENCE SYNTHESIS The data from 32 original publications were reviewed. The most common option for local salvage therapy after radical prostatectomy (RP) was radiation. Options for local salvage therapy after primary radiation included RP, brachytherapy, and cryotherapy. Different definitions of recurrence and risk profiles among patients make comparative assessment among salvage treatment modalities difficult. Triggers for intervention and factors predicting response to salvage therapy vary. CONCLUSIONS Radiation therapy (RT) after RP can provide durable prostate-specific antigen (PSA) responses in a sizeable percentage of men, especially when given early (ie, PSA <1 ng/ml). Though a few studies suggest improvements in mortality, prospective randomized trials are needed and underway. The role of salvage treatment after RT is less clear.
Collapse
Affiliation(s)
- Sanoj Punnen
- Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Donati OF, Jung SI, Vargas HA, Gultekin DH, Zheng J, Moskowitz CS, Hricak H, Zelefsky MJ, Akin O. Multiparametric prostate MR imaging with T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences: are all pulse sequences necessary to detect locally recurrent prostate cancer after radiation therapy? Radiology 2013; 268:440-50. [PMID: 23481164 DOI: 10.1148/radiol.13122149] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare diagnostic accuracy of T2-weighted magnetic resonance (MR) imaging with that of multiparametric (MP) MR imaging combining T2-weighted imaging with diffusion-weighted (DW) MR imaging, dynamic contrast material-enhanced (DCE) MR imaging, or both in the detection of locally recurrent prostate cancer (PCa) after radiation therapy (RT). MATERIALS AND METHODS This retrospective HIPAA-compliant study was approved by the institutional review board; informed consent was waived. Fifty-three men (median age, 70 years) suspected of having post-RT recurrence of PCa underwent MP MR imaging, including DW and DCE sequences, within 6 months after biopsy. Two readers independently evaluated the likelihood of PCa with a five-point scale for T2-weighted imaging alone, T2-weighted imaging with DW imaging, T2-weighted imaging with DCE imaging, and T2-weighted imaging with DW and DCE imaging, with at least a 4-week interval between evaluations. Areas under the receiver operating characteristic curve (AUC) were calculated. Interreader agreement was assessed, and quantitative parameters (apparent diffusion coefficient [ADC], volume transfer constant [K(trans)], and rate constant [k(ep)]) were assessed at sextant- and patient-based levels with generalized estimating equations and the Wilcoxon rank sum test, respectively. RESULTS At biopsy, recurrence was present in 35 (66%) of 53 patients. In detection of recurrent PCa, T2-weighted imaging with DW imaging yielded higher AUCs (reader 1, 0.79-0.86; reader 2, 0.75-0.81) than T2-weighted imaging alone (reader 1, 0.63-0.67; reader 2, 0.46-0.49 [P ≤ .014 for all]). DCE sequences did not contribute significant incremental value to T2-weighted imaging with DW imaging (reader 1, P > .99; reader 2, P = .35). Interreader agreement was higher for combinations of MP MR imaging than for T2-weighted imaging alone (κ = 0.34-0.63 vs κ = 0.17-0.20). Medians of quantitative parameters differed significantly (P < .0001 to P = .0233) between benign tissue and PCa (ADC, 1.64 × 10(-3) mm(2)/sec vs 1.13 × 10(-3) mm(2)/sec; K(trans), 0.16 min(-1) vs 0.33 min(-1); k(ep), 0.36 min(-1) vs 0.62 min(-1)). CONCLUSION MP MR imaging has greater accuracy in the detection of recurrent PCa after RT than T2-weighted imaging alone, with no additional benefit if DCE is added to T2-weighted imaging and DW imaging.
Collapse
Affiliation(s)
- Olivio F Donati
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Wu LM, Xu JR, Gu HY, Hua J, Zhu J, Chen J, Zhang W, Hu J. Role of magnetic resonance imaging in the detection of local prostate cancer recurrence after external beam radiotherapy and radical prostatectomy. Clin Oncol (R Coll Radiol) 2013; 25:252-64. [PMID: 23313568 DOI: 10.1016/j.clon.2012.11.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 09/05/2012] [Accepted: 10/16/2012] [Indexed: 01/23/2023]
Abstract
AIMS To carry out a meta-analysis to assess the effectiveness of magnetic resonance imaging (MRI) during the follow-up of patients with prostate cancer after undergoing external beam radiotherapy (EBRT) or radical prostatectomy. MATERIALS AND METHODS MEDLINE, EMBASE and other databases were searched for relevant original articles published from January 1995 to October 2011. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Pooled estimation and subgroup analysis data were obtained by statistical analysis. RESULTS Fourteen of 768 initially identified studies were included in the meta-analysis. Seven studies examining patient after radical prostatectomy had a pooled sensitivity and specificity on the patient level of 82% (95% confidence interval 78-86%) and 87% (95% confidence interval 81-92%), respectively. In the subgroup analysis, compared with T2-weighted imaging (T2WI), dynamic contrast-enhanced (DCE) MRI showed higher pooled sensitivity (85%, 95% confidence interval 78-90%) and specificity (95%, 95% confidence interval 88-99%). DCE MRI combined with magnetic resonance spectroscopic imaging (1H-MRSI) had the highest pooled sensitivity (92%, 95% confidence interval 83-97%). Nine studies examining men after EBRT had a pooled sensitivity and specificity on the patient level of 82% (95% confidence interval 75-88%) and 74% (95% confidence interval 64-82%), respectively. Compared with T2WI, DCE MRI showed higher pooled sensitivity (90%, 95% confidence interval 77-97%) and specificity (81%, 95% confidence interval 64-93%). DCE combined with 1H-MRSI had the highest pooled specificity (90%, 95% confidence interval 56-100%). The pooled sensitivity and specificity on sextant analysis was 58% (95% confidence interval 53-64%) and 85% (95% confidence interval 82-88%), respectively. DCE MRI showed the highest pooled sensitivity: 71% (95% confidence interval 60-80%). CONCLUSION A limited number of small studies suggest that MRI can accurately detect local recurrences after EBRT and radical prostatectomy. DCE MRI is particularly accurate. The addition of MRSI to DCE MRI can significantly improve the diagnostic accuracy of local prostate cancer recurrence. The eventual role of 1H-MRSI alone remains controversial and needs to be defined further.
Collapse
Affiliation(s)
- L M Wu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Talab SS, Preston MA, Elmi A, Tabatabaei S. Prostate cancer imaging: what the urologist wants to know. Radiol Clin North Am 2013; 50:1015-41. [PMID: 23122036 DOI: 10.1016/j.rcl.2012.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
No consensus exists at present regarding the use of imaging for the evaluation of prostate cancer. Ultrasonography is mainly used for biopsy guidance and magnetic resonance imaging is the mainstay in evaluating the extent of local tumor. Computed tomography and radionuclide bone scanning are mainly reserved for assessment of advanced disease. Positron emission tomography is gaining acceptance in the evaluation of treatment response and recurrence. The combination of anatomic, functional, and metabolic imaging modalities has promise to improve treatment. This article reviews current imaging techniques and touches on the evolving technologies being used for detection and follow-up of prostate cancer.
Collapse
Affiliation(s)
- Saman Shafaat Talab
- Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | | | |
Collapse
|
40
|
Prostate cancer: multiparametric MRI for index lesion localization--a multiple-reader study. AJR Am J Roentgenol 2012; 199:830-7. [PMID: 22997375 DOI: 10.2214/ajr.11.8446] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the utility of multiparametric MRI in localization of the index lesion of prostate cancer. MATERIALS AND METHODS Fifty-one patients who underwent 3-T MRI of the prostate with a pelvic phased-array coil that included T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences before prostatectomy were included. Six radiologists assessed all images to identify the lesion most suspicious of being the index lesion, which was localized to one of 18 regions. A uropathologist using the same 18-region scheme reviewed the prostatectomy slides to localize the index lesion. MRI performance was assessed by requiring either an exact match or an approximate match (discrepancy of up to one region) between the MRI and pathologic findings in terms of assigned region. RESULTS The pathologist identified an index lesion in 49 of 51 patients. In exact-match analysis, the average sensitivity was 60.2% (range, 51.0-63.3%), and the average positive predictive value (PPV) was 65.3% (range, 61.2-69.4%). In approximate-match analysis, the average sensitivity was 75.9% (range, 65.3-69.6%), and the average PPV was 82.6% (range, 79.2-91.4%). The sensitivity was higher for index lesions with a Gleason score greater than 6 in exact-match (74.8% vs 15.3%, p<0.001) and approximate-match (88.7% vs 36.1%, p=<0.001) analyses and for index lesions measuring at least 1 cm in approximate-match analysis (80.3% vs 58.3%, p=0.016). In exact-match analysis, 30.0%, 44.9%, and 79.1% of abnormalities found with one, two, and three MRI parameters represented the index lesion (p<0.001). CONCLUSION The sensitivity and PPV of multiparametric MRI for index lesion localization were moderate, although they improved in the setting of more aggressive pathologic features and a greater number of abnormal MRI parameters, respectively.
Collapse
|
41
|
|
42
|
Impact of delay after biopsy and post-biopsy haemorrhage on prostate cancer tumour detection using multi-parametric MRI: a multi-reader study. Clin Radiol 2012; 67:e83-90. [PMID: 22981729 DOI: 10.1016/j.crad.2012.08.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 08/07/2012] [Accepted: 08/09/2012] [Indexed: 11/21/2022]
Abstract
AIM To assess impact of haemorrhage and delay after biopsy on prostate tumour detection using multi-parametric (MP) magnetic resonance imaging (MRI) assessment. MATERIALS AND METHODS Forty-four patients underwent prostate MRI at 1.5 T using a pelvic phased-array coil, including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) imaging, before prostatectomy. Three radiologists independently reviewed images during four sessions [T2WI, DWI, DCE, and all parameters combined (MP-MRI)] to assess for tumour in each sextant. In a separate session, readers reviewed T1WI to score the extent of haemorrhage per sextant. Accuracy was assessed using logistic regression for correlated data. RESULTS There was no significant difference in accuracy between readers for any session (p ≥ 0.166), and results were averaged across the three readers for remaining comparisons. Accuracy was significantly greater for MP-MRI than for any parameter alone (p ≤ 0.020). For T2WI alone, there was a trend toward decreased sensitivity in sextants with extensive haemorrhage (p = 0.072). However, accuracy, sensitivity, and specificity were otherwise similar for sextants with and without extensive haemorrhage for all sessions (p = 0.192-0.934). No session showed a significant improvement in accuracy, sensitivity, or specificity in cases with delay after biopsy of over 4 weeks compared with shorter delay. CONCLUSION Extensive haemorrhage and short delay after biopsy did not negatively impact accuracy for tumour detection using MP-MRI. Further studies using MP-MRI protocols and interpretation schemes from other institutions are required to confirm these observations.
Collapse
|
43
|
Nguyen PL, Chen MH, Zhang Y, Tempany CM, Cormack RA, Beard CJ, Hurwitz MD, Suh WW, D'Amico AV. Updated results of magnetic resonance imaging guided partial prostate brachytherapy for favorable risk prostate cancer: implications for focal therapy. J Urol 2012; 188:1151-6. [PMID: 22901567 DOI: 10.1016/j.juro.2012.06.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE We report updated results of magnetic resonance imaging guided partial prostate brachytherapy and propose a definition of biochemical failure following focal therapy. MATERIALS AND METHODS From 1997 to 2007, 318 men with cT1c, prostate specific antigen less than 15 ng/ml, Gleason 3 + 4 or less prostate cancer received magnetic resonance imaging guided brachytherapy in which only the peripheral zone was targeted. To exclude benign prostate specific antigen increases due to prostatic hyperplasia, we investigated the usefulness of defining prostate specific antigen failure as nadir +2 with prostate specific antigen velocity greater than 0.75 ng/ml per year. Cox regression was used to determine the factors associated with prostate specific antigen failure. RESULTS Median followup was 5.1 years (maximum 12.1). While 36 patients met the nadir +2 criteria, 16 of 17 biopsy proven local recurrences were among the 26 men who also had a prostate specific antigen velocity greater than 0.75 ng/ml per year (16 of 26 vs 1 of 10, p = 0.008). Using the nadir +2 definition, prostate specific antigen failure-free survival for low risk cases at 5 and 8 years was 95.1% (91.0-97.3) and 80.4% (70.7-87.1), respectively. This rate improved to 95.6% (91.6-97.7) and 90.0% (82.6-94.3) using nadir +2 with prostate specific antigen velocity greater than 0.75 ng/ml per year. For intermediate risk cases survival was 73.0% (55.0-84.8) at 5 years and 66.4% (44.8-81.1) at 8 years (the same values as using nadir +2 with prostate specific antigen velocity greater than 0.75 ng/ml per year). CONCLUSIONS Requiring a prostate specific antigen velocity greater than 0.75 ng/ml per year in addition to nadir +2 appears to better predict clinical failure after therapies that target less than the whole gland. Further followup will determine whether magnetic resonance imaging guided brachytherapy targeting the peripheral zone produces comparable cancer control to whole gland treatment in men with low risk disease. However, at this time it does not appear adequate for men with even favorable intermediate risk disease.
Collapse
Affiliation(s)
- Paul L Nguyen
- Department of Radiation Oncology, Dana Farber Cancer Institute, and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Weidner AM, Dinter DJ, Bohrer M, Sertdemir M, Hausmann D, Wenz F, Schoenberg SO. [Multiparametric prostate MRI for follow-up monitoring after radiation therapy]. Radiologe 2012; 52:235-42. [PMID: 22349898 DOI: 10.1007/s00117-011-2196-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
CLINICAL/METHODICAL ISSUE Radiation therapy is a therapeutic option with curative intent for patients with prostate cancer. Monitoring of prostate-specific antigen (PSA) values is the current standard of care in the follow-up. Imaging is recommended only for symptomatic patients and/or for further therapeutic options. STANDARD RADIOLOGICAL METHODS For detection of local recurrence magnetic resonance imaging (MRI) of the prostate is acknowledged as the method of choice. PERFORMANCE Good results for primary diagnosis were found especially in combination with functional techniques, whereas in recurrent prostate cancer only few studies with heterogeneous study design are available for prostate MRI. Furthermore, changes in different MRI modalities due to radiation therapy have been insufficiently investigated to date. PRACTICAL RECOMMENDATIONS As the initial results were promising prostate MRI and available therapeutic options for detection of local recurrence should be considered in patients with increased PSA.
Collapse
Affiliation(s)
- A M Weidner
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim.
| | | | | | | | | | | | | |
Collapse
|
45
|
|
46
|
Giannarini G, Petralia G, Thoeny HC. Potential and limitations of diffusion-weighted magnetic resonance imaging in kidney, prostate, and bladder cancer including pelvic lymph node staging: a critical analysis of the literature. Eur Urol 2011; 61:326-40. [PMID: 22000497 DOI: 10.1016/j.eururo.2011.09.019] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 09/16/2011] [Indexed: 12/12/2022]
Abstract
CONTEXT Diagnosis, staging, and treatment monitoring are still suboptimal for most genitourinary tumours. Diffusion-weighted magnetic resonance imaging (DW-MRI) has already shown promise as a noninvasive imaging modality in the early detection of microstructural and functional changes in several pathologies of various organs. OBJECTIVE To assess the potential and limitations of DW-MRI in the management of patients with kidney, prostate, and bladder cancer. EVIDENCE ACQUISITION A nonsystematic literature search using the Medline/PubMed and Embase databases for full-length papers reporting on DW-MRI for kidney, prostate, and bladder cancer was performed up to August 1, 2011. Only those articles with complete data reporting on DW-MRI applications with potential implications in solving commonly encountered clinical challenges relating to tumour detection, staging, and treatment monitoring were finally examined. EVIDENCE SYNTHESIS For kidney tumours DW-MRI is a reasonable alternative to conventional cross-sectional imaging to detect and characterise focal renal lesions, especially in patients with impaired renal function. For prostate cancer, DW-MRI applied in addition to conventional T2-weighted and contrast-enhanced magnetic resonance imaging (MRI) improves tumour detection and localisation. In addition, it has shown promise for the assessment of tumour aggressiveness and for treatment monitoring during active surveillance, radiation therapy, and focal therapy. For bladder cancer, DW-MRI may improve the performance of conventional T2-weighted and contrast-enhanced MRI in the work-up of bladder cancer, helping to differentiate non-muscle-invasive from muscle-invasive tumours. For pelvic lymph nodes, initial results showed the potential to improve nodal staging of prostate and bladder cancer compared with conventional cross-sectional imaging. CONCLUSIONS DW-MRI holds promise to ameliorate the management of patients with kidney, prostate, and bladder cancer including pelvic lymph node staging. Current limitations include the lack of standardisation of the technique across multiple centres and the still limited expertise.
Collapse
Affiliation(s)
- Gianluca Giannarini
- Department of Urology, University Hospital of Bern, Inselspital, Bern, Switzerland
| | | | | |
Collapse
|