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Park SY, Woo S, Park KJ, Westphalen AC. A pictorial essay of PI-RADS pearls and pitfalls: toward less ambiguity and better practice. Abdom Radiol (NY) 2024; 49:3190-3205. [PMID: 38704782 DOI: 10.1007/s00261-024-04273-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/02/2024] [Accepted: 03/03/2024] [Indexed: 05/07/2024]
Abstract
Prostate Imaging Reporting and Data System (PI-RADS) was designed to standardize the interpretation of multiparametric magnetic resonance imaging (MRI) of the prostate, aiding in assessing the probability of clinically significant prostate cancer. By providing a structured scoring system, it enables better risk stratification, guiding decisions regarding the need for biopsy and subsequent treatment options. In this article, we explore both the strengths and weaknesses of PI-RADS, offering insights into its updated diagnostic performance and clinical applications, while also addressing potential pitfalls using diverse, representative MRI cases.
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Affiliation(s)
- Sung Yoon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Department of Radiology, University of Washington, 1959 NE Pacific St., 2nd Floor, Seattle, WA, 98195, USA.
| | - Sungmin Woo
- Department of Radiology, NYU Langone Health, New York, NY, 10016, USA
| | - Kye Jin Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Antonio C Westphalen
- Department of Radiology, University of Washington, 1959 NE Pacific St., 2nd Floor, Seattle, WA, 98195, USA
- Department of Urology, University of Washington, 1959 NE Pacific St., 2nd Floor, Seattle, WA, 98195, USA
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific St., 2nd Floor, Seattle, WA, 98195, USA
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Kobayashi M, Matsuoka Y, Uehara S, Tanaka H, Fujiwara M, Nakamura Y, Ishikawa Y, Fukuda S, Waseda Y, Tanaka H, Yoshida S, Fujii Y. Utility of positive core number on MRI-ultrasound fusion targeted biopsy in combination with PI-RADS scores for predicting unexpected extracapsular extension of clinically localized prostate cancer. Int J Urol 2024; 31:739-746. [PMID: 38468553 DOI: 10.1111/iju.15451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/20/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES To evaluate the utility of magnetic resonance imaging (MRI) and MRI-ultrasound fusion targeted biopsy (TB) for predicting unexpected extracapsular extension (ECE) in clinically localized prostate cancer (CLPC). METHODS This study enrolled 89 prostate cancer patients with one or more lesions showing a Prostate Imaging-Reporting and Data System (PI-RADS) score ≥3 but without morphological abnormality in the prostatic capsule on pre-biopsy MRI. All patients underwent TB and systematic biopsy followed by radical prostatectomy (RP). Each lesion was examined by 3-core TB, taking cores from each third of the lesion. The preoperative variables predictive of ECE were explored by referring to RP specimens in the lesion-based analysis. RESULTS Overall, 186 lesions, including 81 (43.5%), 73 (39.2%), and 32 (17.2%) with PI-RADS 3, 4, and 5, respectively, were analyzed. One hundred and twenty-two lesions (65.6%) were diagnosed as cancer on TB, and ECE was identified in 33 (17.7%) on the RP specimens. The positive TB core number was ≤2 in 129 lesions (69.4%) and three in 57 lesions (30.6%). On the multivariate analysis, PI-RADS ≥4 (p = 0.049, odds ratio [OR] = 2.39) and three positive cores on TB (p = 0.005, OR = 3.07) were independent predictors of ECE. Lesions with PI-RADS ≥4 and a positive TB core number of 3 had a significantly higher rate of ECE than those with PI-RADS 3 and a positive TB core number ≤2 (37.5% vs. 7.8%, p < 0.001). CONCLUSIONS Positive TB core number in combination with PI-RADS scores is helpful to predict unexpected ECE in CLPC.
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Affiliation(s)
- Masaki Kobayashi
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Urology, Saitama Cancer Center, Ina, Japan
| | - Sho Uehara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Tanaka
- Department of Radiology, Ochanomizu Surugadai Clinic, Tokyo, Japan
| | - Motohiro Fujiwara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Nakamura
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yudai Ishikawa
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shohei Fukuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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Marvaso G, Isaksson LJ, Zaffaroni M, Vincini MG, Summers PE, Pepa M, Corrao G, Mazzola GC, Rotondi M, Mastroleo F, Raimondi S, Alessi S, Pricolo P, Luzzago S, Mistretta FA, Ferro M, Cattani F, Ceci F, Musi G, De Cobelli O, Cremonesi M, Gandini S, La Torre D, Orecchia R, Petralia G, Jereczek-Fossa BA. Can we predict pathology without surgery? Weighing the added value of multiparametric MRI and whole prostate radiomics in integrative machine learning models. Eur Radiol 2024:10.1007/s00330-024-10699-3. [PMID: 38507053 DOI: 10.1007/s00330-024-10699-3] [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: 12/01/2023] [Revised: 01/29/2024] [Accepted: 02/18/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To test the ability of high-performance machine learning (ML) models employing clinical, radiological, and radiomic variables to improve non-invasive prediction of the pathological status of prostate cancer (PCa) in a large, single-institution cohort. METHODS Patients who underwent multiparametric MRI and prostatectomy in our institution in 2015-2018 were considered; a total of 949 patients were included. Gradient-boosted decision tree models were separately trained using clinical features alone and in combination with radiological reporting and/or prostate radiomic features to predict pathological T, pathological N, ISUP score, and their change from preclinical assessment. Model behavior was analyzed in terms of performance, feature importance, Shapley additive explanation (SHAP) values, and mean absolute error (MAE). The best model was compared against a naïve model mimicking clinical workflow. RESULTS The model including all variables was the best performing (AUC values ranging from 0.73 to 0.96 for the six endpoints). Radiomic features brought a small yet measurable boost in performance, with the SHAP values indicating that their contribution can be critical to successful prediction of endpoints for individual patients. MAEs were lower for low-risk patients, suggesting that the models find them easier to classify. The best model outperformed (p ≤ 0.0001) clinical baseline, resulting in significantly fewer false negative predictions and overall was less prone to under-staging. CONCLUSIONS Our results highlight the potential benefit of integrative ML models for pathological status prediction in PCa. Additional studies regarding clinical integration of such models can provide valuable information for personalizing therapy offering a tool to improve non-invasive prediction of pathological status. CLINICAL RELEVANCE STATEMENT The best machine learning model was less prone to under-staging of the disease. The improved accuracy of our pathological prediction models could constitute an asset to the clinical workflow by providing clinicians with accurate pathological predictions prior to treatment. KEY POINTS • Currently, the most common strategies for pre-surgical stratification of prostate cancer (PCa) patients have shown to have suboptimal performances. • The addition of radiological features to the clinical features gave a considerable boost in model performance. Our best model outperforms the naïve model, avoiding under-staging and resulting in a critical advantage in the clinic. •Machine learning models incorporating clinical, radiological, and radiomics features significantly improved accuracy of pathological prediction in prostate cancer, possibly constituting an asset to the clinical workflow.
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Affiliation(s)
- Giulia Marvaso
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Maria Giulia Vincini
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Paul Eugene Summers
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Matteo Pepa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Corrao
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Marco Rotondi
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Federico Mastroleo
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- University of Piemonte Orientale, Novara, Italy
| | - Sara Raimondi
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Sarah Alessi
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Pricolo
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano Luzzago
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Alessandro Mistretta
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Matteo Ferro
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Cattani
- Medical Physics Unit, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Ceci
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Nuclear Medicine, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Gennaro Musi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Marta Cremonesi
- Radiation Research Unit, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Davide La Torre
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- SKEMA Business School, Université Côte d'Azur, Sophia Antipolis, France
| | - Roberto Orecchia
- Scientific Directorate, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Xiao VG, Kresnanto J, Moses DA, Pather N. Quantitative MRI in the Local Staging of Prostate Cancer: A Systematic Review and Meta-Analysis. J Magn Reson Imaging 2024; 59:255-296. [PMID: 37165923 DOI: 10.1002/jmri.28742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Local staging of prostate cancer (PCa) is important for treatment planning. Radiologist interpretation using qualitative criteria is variable with high specificity but low sensitivity. Quantitative methods may be useful in the diagnosis of extracapsular extension (ECE). PURPOSE To assess the performance of quantitative MRI markers for detecting ECE. STUDY TYPE Systematic review and meta-analysis. SUBJECTS 4800 patients from 28 studies with histopathologically confirmed PCa on radical prostatectomy were pooled for meta-analysis. Patients from 46 studies were included for systematic review. FIELD STRENGTH/SEQUENCE Diffusion-weighted, T2-weighted, and dynamic contrast-enhanced MRI at 1.5 T or 3 T. ASSESSMENT PubMed, Embase, Web of Science, Scopus, and Cochrane databases were searched to identify studies on diagnostic test accuracy or association of any quantitative MRI markers with ECE. Results extracted by two independent reviewers for tumor contact length (TCL) and mean apparent diffusion coefficient (ADC-mean) were pooled for meta-analysis, but not for other quantitative markers including radiomics due to low number of studies available. STATISTICAL TESTS Hierarchical summary receiver operating characteristic (HSROC) curves were computed for both TCL and ADC-mean, but summary operating points were computed for TCL only. Heterogeneity was investigated by meta-regression. Results were significant if P ≤ 0.05. RESULTS At the 10 mm threshold for TCL, summary sensitivity and specificity were 0.76 [95% confidence interval (CI) 0.71-0.81] and 0.68 [95% CI 0.63-0.73], respectively. At the 15 mm threshold, summary sensitivity and specificity were 0.70 [95% CI 0.53-0.83] and 0.74 [95% CI 0.60-0.84] respectively. The area under the HSROC curves for TCL and ADC-mean were 0.79 and 0.78, respectively. Significant sources of heterogeneity for TCL included timing of MRI relative to biopsy. DATA CONCLUSION Both 10 mm and 15 mm thresholds for TCL may be reasonable for clinical use. From comparison of the HSROC curves, ADC-mean may be superior to TCL at higher sensitivities. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Vieley G Xiao
- Medical Education, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
| | - Jordan Kresnanto
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
| | - Daniel A Moses
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Kensington, New South Wales, 2052, Australia
- Prince of Wales Hospital, Sydney, New South Wales, 2031, Australia
| | - Nalini Pather
- Medical Education, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
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5
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Choi MH, Kim DH, Lee YJ, Rha SE, Lee JY. Imaging features of the PI-RADS for predicting extraprostatic extension of prostate cancer: systematic review and meta-analysis. Insights Imaging 2023; 14:77. [PMID: 37156971 PMCID: PMC10167060 DOI: 10.1186/s13244-023-01422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/05/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES To systematically determine the diagnostic performance of each MRI feature of the PI-RADS for predicting extraprostatic extension (EPE) in prostate cancer. METHODS A literature search in the MEDLINE and EMBASE databases was conducted to identify original studies reporting the accuracy of each feature on MRI for the dichotomous diagnosis of EPE. The meta-analytic pooled diagnostic odds ratio (DOR), sensitivity, specificity, and their 95% confidence intervals (CIs) were obtained using a bivariate random-effects model. RESULTS After screening 1955 studies, 17 studies with a total of 3062 men were included. All six imaging features, i.e., bulging prostatic contour, irregular or spiculated margin, asymmetry or invasion of neurovascular bundle, obliteration of rectoprostatic angle, tumor-capsule interface > 10 mm, and breach of the capsule with evidence of direct tumor extension, were significantly associated with EPE. Breach of the capsule with direct tumor extension demonstrated the highest pooled DOR (15.6, 95% CI [7.7-31.5]) followed by tumor-capsule interface > 10 mm (10.5 [5.4-20.2]), asymmetry or invasion of neurovascular bundle (7.6 [3.8-15.2]), and obliteration of rectoprostatic angle (6.1 [3.8-9.8]). Irregular or spiculated margin showed the lowest pooled DOR (2.3 [1.3-4.2]). Breach of the capsule with direct tumor extension and tumor-capsule interface > 10 mm showed the highest pooled specificity (98.0% [96.2-99.0]) and sensitivity (86.3% [70.0-94.4]), respectively. CONCLUSIONS Among the six MRI features of prostate cancer, breach of the capsule with direct tumor extension and tumor-capsule interface > 10 mm were the most predictive of EPE with the highest specificity and sensitivity, respectively.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Hwan Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Young Joon Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Eun Rha
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Blasi F, Malouhi A, Cho CH, Nißler D, Berger FP, Grimm MO, Abubrig M, Teichgräber U, Franiel T. Staging accuracy of MRI of the prostate with special reference to the influence of the time of last ejaculation on the detection of seminal vesicle invasion. Clin Radiol 2023; 78:e425-e432. [PMID: 36849278 DOI: 10.1016/j.crad.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/09/2022] [Indexed: 01/25/2023]
Abstract
AIM To evaluate the Prostate Imaging Reporting and Data System, version 2.1 (PIRADS V2.1) criteria for seminal vesicle invasion (SVI) and examine whether the timing of last ejaculation influences the detection of SVI. MATERIALS AND METHODS The study population consisted of 68 patients (34 with SVI, 34 without SVI, matching groups by age and prostate volume) who underwent PIRADS V2.1-compliant multiparametric magnetic resonance imaging (MRI; 34 at 1.5 T, 34 at 3 T). Before the examination, the time of last ejaculation (38/68 ≤ 5 days, 30/68 > 5 days) was collected via a questionnaire. The five PIRADS V2.1 criteria for SVI with subsequent overall assessment were evaluated retrospectively by two independent examiners (examiner 1 with >10 years of experience, examiner 2 with 6 months of experience) in a single-blinded fashion for all patients using a questionnaire and a six-point scale (0 = no, 1 = very likely not, 2 = probably not, 3 = possible, 4 = probable, 5 = certain). RESULTS E1 achieved high specificity (100%) and positive predictive value (PPV; 100%) in the overall assessment, independent of the time of last ejaculation (sensitivity = 76.5%, negative predictive value [NPV] = 81%). The area under the curve (AUC) value was 0.882; for E2, it was 0.765. At ≤5 days, the AUC values of E1 and E2 differed significantly (0.867 versus 0.681, p=0.016), as did the diffusion restriction criterion (0.833 versus 0.681, p=0.028). E1 showed high AUC values independent of time. E2 had better values for all criteria at >5 days than at ≤5 days. There were no significant differences between the examiners in all observations at >5 days. CONCLUSION The PIRADS V2.1 criteria are well suited for an experienced examiner to detect SVI independent of time point. An inexperienced examiner will benefit from patients being abstinent >5 days prior to MRI.
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Affiliation(s)
- F Blasi
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany.
| | - A Malouhi
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - C-H Cho
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - D Nißler
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - F P Berger
- Clinic and Polyclinic for Urology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - M-O Grimm
- Clinic and Polyclinic for Urology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - M Abubrig
- Institute of Forensic Medicine, Pathology Section, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - U Teichgräber
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany
| | - T Franiel
- Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Germany
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Temporal changes of PIRADS scoring by radiologists and correlation to radical prostatectomy pathological outcomes. Prostate Int 2022; 10:188-193. [PMID: 36570646 PMCID: PMC9747593 DOI: 10.1016/j.prnil.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 12/27/2022] Open
Abstract
Purpose To assess temporal improvement of prostate image reporting and data system (PIRADS) 3-5 lesion correlation to histopathologic findings from radical prostatectomy (RP) in prostate cancer (PCa). Materials and methods A total of 1481 patients who underwent RP for biopsy-proven PCa between 2015 and 2019 were divided into 14 groups of 100 sequential readings for the evaluation of histopathological correlation with PIRADS readings. Temporal trends of PIRADS distribution and predictive performance for RP pathology were evaluated to assess underlying changes in prostate magnetic resonance imaging (MRI) interpretation by radiologists. Results PIRADS 4-5 lesions were significantly correlated with the increasing rates of Gleason Group (GG) upgrade (p = 0.044) and decreasing rate of GG downgrade (p = 0.016) over time. PIRADS ≥3 lesions read after median 2 years of experience were shown to independently predict intermediate-high-risk (GG ≥ 3) PCa (odds ratio 2.93, 95% confidence interval 1.00-8.54; P= 0.049) in RP pathology. Preoperative GG ≥ 3 biopsy lesions with PIRADS 4-5 lesions were significantly more susceptible to GG upgrade (P= 0.035) and GG ≥ 4 RP pathology (p = 0.003) in experienced reads, in contrast to insignificant findings in early readings (p = 0.588 and 0.248, respectively). Conclusion Preoperative MRI reports matched with RP pathology suggest an improved prediction of adverse pathology in PIRADS 3-5 lesions over time, suggesting a temporal change in PIRADS interpretation and predictive accuracy. Institutions with low volume experience should use caution in solely relying on MRI for predicting tumor characteristics. Future prospective trials and larger scale assessments are required to further validate our results.
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Caglic I, Sushentsev N, Shah N, Warren AY, Lamb BW, Barrett T. Integration of Prostate Biopsy Results with Pre-Biopsy Multiparametric Magnetic Resonance Imaging Findings Improves Local Staging of Prostate Cancer. Can Assoc Radiol J 2022; 73:515-523. [PMID: 35199583 DOI: 10.1177/08465371211073158] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To assess the added value of histological information for local staging of prostate cancer (PCa) by comparing the accuracy of multiparametric MRI alone (mpMRI) and mpMRI with biopsy Gleason grade (mpMRI+Bx). METHODS 133 consecutive patients who underwent preoperative 3T-MRI and subsequent radical prostatectomy for PCa were included in this single-centre retrospective study. mpMRI imaging was reviewed independently by two uroradiologists for the presence of extracapsular extension (ECE) and seminal vesicle invasion (SVI) on a 5-point Likert scale. For second reads, the radiologists received results of targeted fused MR/US biopsy (mpMRI+Bx) prior to re-staging. RESULTS The median patient age was 63 years (interquartile range (IQR) 58-67 years) and median PSA was 6.5 ng/mL (IQR 5.0-10.0 ng/mL). Extracapsular extension was present in 85/133 (63.9%) patients and SVI was present in 22/133 (16.5%) patients. For ECE prediction, mpMRI showed sensitivity and specificity of 63.5% and 81.3%, respectively, compared to 77.7% and 81.3% achieved by mpMRI+Bx. At an optimal cut-off value of Likert score ≥ 3, areas under the curves (AUCs) was .85 for mpMRI+Bx and .78 for mpMRI, P < .01. For SVI prediction, AUC was .95 for mpMRI+Bx compared to .92 for mpMRI; P = .20. Inter-reader agreement for ECE and SVI prediction was substantial for mpMRI (k range, .78-.79) and mpMRI+Bx (k range, .74-.79). CONCLUSIONS MpMRI+Bx showed superior diagnostic performance with an increased sensitivity for ECE prediction but no significant difference for SVI prediction. Inter-reader agreement was substantial for both protocols. Integration of biopsy information adds value when staging prostate mpMRI.
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Affiliation(s)
- Iztok Caglic
- CamPARI Prostate Cancer Group, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Radiology, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Faculty of Medicine, University of Ljubljana, Slovenia
| | - Nikita Sushentsev
- Department of Radiology, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Nimish Shah
- CamPARI Prostate Cancer Group, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Urology, 573020Addenbrooke's Hospital, Cambridge, UK
| | - Anne Y Warren
- CamPARI Prostate Cancer Group, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Pathology, 573020Addenbrooke's Hospital, Cambridge, UK
| | - Benjamin W Lamb
- CamPARI Prostate Cancer Group, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Urology, 573020Addenbrooke's Hospital, Cambridge, UK
| | - Tristan Barrett
- CamPARI Prostate Cancer Group, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Radiology, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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Wibmer AG, Nikolovski I, Chaim J, Lakhman Y, Lefkowitz RA, Sala E, Carlsson SV, Fine SW, Kattan MW, Hricak H, Vargas HA. Local Extent of Prostate Cancer at MRI versus Prostatectomy Histopathology: Associations with Long-term Oncologic Outcomes. Radiology 2021; 302:595-602. [PMID: 34931855 PMCID: PMC8893181 DOI: 10.1148/radiol.210875] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background It is unknown how the imperfect accuracy of MRI for local staging of prostate cancer relates to oncologic outcomes. Purpose To analyze how staging discordances between MRI and histopathologic evaluation relate to recurrence and survival after radical prostatectomy. Materials and Methods Health Insurance Portability and Accountability Act-compliant retrospective analysis of preprostatectomy T2-weighted prostate MRI (January 2001 to December 2006). Extraprostatic extension and seminal vesicle invasion were assessed by using five-point Likert scales; scores of 4 or higher were classified as positive. Biochemical recurrence (BCR), metastases, and prostate cancer-specific mortality rates were estimated with Kaplan-Meier and Cox models. Results A total of 2160 patients (median age, 60 years; interquartile range, 55-64 years) were evaluated. Among patients with histopathologic extraprostatic (pT3) disease (683 of 2160; 32%), those with organ-confined disease at MRI (384 of 683; 56%) experienced better outcomes than those with concordant extraprostatic disease at MRI and pathologic analysis: 15-year risk for BCR, 30% (95% CI: 22, 40) versus 68% (95% CI: 60, 75); risk for metastases, 14% (95% CI: 8.4, 24) versus 32% (95% CI: 26, 39); risk for prostate cancer-specific mortality, 3% (95% CI: 1, 6) versus 15% (95% CI: 9.5, 23) (P < .001 for all comparisons). Among patients with histopathologic organ-confined disease (pT2) (1477 of 2160; 68%), those with extraprostatic disease at MRI (102 of 1477; 7%) were at higher risk for BCR (27% [95% CI: 19, 37] vs 10% [95% CI: 8, 14]; P < .001), metastases (19% [95% CI: 6, 48] vs 3% [95% CI: 1, 6]; P < .001), and prostate cancer-specific mortality (2% [95% CI: 1, 9] vs 1% [95% CI: 0, 5]; P = .009) than those with concordant organ-confined disease at MRI and pathologic analysis. At multivariable analyses, tumor extent at MRI (hazard ratio range, 4.1-5.2) and histopathologic evaluation (hazard ratio range, 3.6-6.7) was associated with the risk for BCR, metastases, and prostate cancer-specific mortality (P < .001 for all analyses). Conclusion The local extent of prostate cancer at MRI is associated with oncologic outcomes after prostatectomy, independent of pathologic tumor stage. This might inform a strategy on how to integrate MRI into a clinical staging algorithm. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Gottlieb in this issue.
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10
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Li W, Sun Y, Wu Y, Lu F, Xu H. The Quantitative Assessment of Using Multiparametric MRI for Prediction of Extraprostatic Extension in Patients Undergoing Radical Prostatectomy: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:771864. [PMID: 34881183 PMCID: PMC8645791 DOI: 10.3389/fonc.2021.771864] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate the diagnostic performance of using quantitative assessment with multiparametric MRI (mpMRI) for prediction of extraprostatic extension (EPE) in patients with prostate cancer (PCa). METHODS We performed a computerized search of MEDLINE, Embase, Cochrane Library, Web of Science, and Google Scholar from inception until July 31, 2021. Summary estimates of sensitivity and specificity were pooled with the bivariate model, and quality assessment of included studies was performed with the Quality Assessment of Diagnostic Accuracy Studies-2. We plotted forest plots to graphically present the results. Multiple subgroup analyses and meta-regression were performed to explore the variate clinical settings and heterogeneity. RESULTS A total of 23 studies with 3,931 participants were included. The pooled sensitivity and specificity for length of capsular contact (LCC) were 0.79 (95% CI 0.75-0.83) and 0.77 (95% CI 0.73-0.80), for apparent diffusion coefficient (ADC) were 0.71 (95% CI 0.50-0.86) and 0.71 (95% CI 059-0.81), for tumor size were 0.62 (95% CI 0.57-0.67) and 0.75 (95% CI 0.67-0.82), and for tumor volume were 0.77 (95% CI 0.68-0.84) and 0.72 (95% CI 0.56-0.83), respectively. Substantial heterogeneity was presented among included studies, and meta-regression showed that publication year (≤2017 vs. >2017) was the significant factor in studies using LCC as the quantitative assessment (P=0.02). CONCLUSION Four quantitative assessments of LCC, ADC, tumor size, and tumor volume showed moderate to high diagnostic performance of predicting EPE. However, the optimal cutoff threshold varied widely among studies and needs further investigation to establish.
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Affiliation(s)
- Wei Li
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Yuan Sun
- Department of Burn and Plastic Surgery, 71st Group Army Hospital of People’s Liberation Army of China, Xuzhou, China
| | - Yiman Wu
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Feng Lu
- Department of Radiology, Wuxi No. 2 People’s Hospital, Wuxi, China
| | - Hongtao Xu
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
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11
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Li W, Dong A, Hong G, Shang W, Shen X. Diagnostic performance of ESUR scoring system for extraprostatic prostate cancer extension: A meta-analysis. Eur J Radiol 2021; 143:109896. [PMID: 34416449 DOI: 10.1016/j.ejrad.2021.109896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE We aimed to evaluate the diagnostic performance of the European Society of Urogenital Radiology (ESUR) scoring system for detection of extraprostatic extension (EPE) in prostate cancer (PCa) by performing a meta-analysis. MATERIALS AND METHODS A literature search of MEDLINE, EMBASE, Cochrane Library, Web of Science, and Google Scholar was performed to identify relevant studies from January 2012 to December 2020. We included diagnostic accuracy studies using ESUR scoring system for detection of EPE, and with prostatectomy histopathological results as the reference standard. Quality assessment was performed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The summary estimates of sensitivity and specificity were pooled using bivariate random-effects modeling. We conducted multiple subgroup analyses and meta-regression to explore varied clinical settings. RESULTS 10 studies with a total of 1698 participants were included in this meta-analysis. Pooled sensitivity and specificity were 0.71 (95% CI 0.61-0.80) and 0.76 (95% CI 0.67-0.84), respectively, with the area under ROC of 0.80 (95% CI 0.77-0.84). The Higgins I2 statistics demonstrated substantial heterogeneity in both sensitivity (I2 = 86.5%) and specificity (I2 = 91.6%), meta-regression revealed that the cutoff values (ESUR score ≥ 3 vs. ESUR score ≥ 4, P = 0.02) and malignancy rate (<40% vs. ≥40%, P = 0.04) were significant factors responsible for heterogeneity. Using endorectal coil and higher field strength (3.0 T) showed no additional benefit for EPE detection. CONCLUSION The evidence available for ESUR scoring system tends to show moderate diagnostic performance for detection of EPE, and the cutoff values (P = 0.02) and malignancy rate (P = 0.04) were significant factors contributed to the heterogeneity.
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Affiliation(s)
- Wei Li
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Anding Dong
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Guohui Hong
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China.
| | - Wenwen Shang
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Xiaocui Shen
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
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12
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Wibmer AG, Kattan MW, Alessandrino F, Baur ADJ, Boesen L, Franco FB, Bonekamp D, Campa R, Cash H, Catalá V, Crouzet S, Dinnoo S, Eastham J, Fennessy FM, Ghabili K, Hohenfellner M, Levi AW, Ji X, Løgager V, Margolis DJ, Moldovan PC, Panebianco V, Penzkofer T, Puech P, Radtke JP, Rouvière O, Schlemmer HP, Sprenkle PC, Tempany CM, Vilanova JC, Weinreb J, Hricak H, Shukla-Dave A. International Multi-Site Initiative to Develop an MRI-Inclusive Nomogram for Side-Specific Prediction of Extraprostatic Extension of Prostate Cancer. Cancers (Basel) 2021; 13:cancers13112627. [PMID: 34071842 PMCID: PMC8198352 DOI: 10.3390/cancers13112627] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/29/2021] [Accepted: 05/21/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To develop an international, multi-site nomogram for side-specific prediction of extraprostatic extension (EPE) of prostate cancer based on clinical, biopsy, and magnetic resonance imaging- (MRI) derived data. METHODS Ten institutions from the USA and Europe contributed clinical and side-specific biopsy and MRI variables of consecutive patients who underwent prostatectomy. A logistic regression model was used to develop a nomogram for predicting side-specific EPE on prostatectomy specimens. The performance of the statistical model was evaluated by bootstrap resampling and cross validation and compared with the performance of benchmark models that do not incorporate MRI findings. RESULTS Data from 840 patients were analyzed; pathologic EPE was found in 320/840 (31.8%). The nomogram model included patient age, prostate-specific antigen density, side-specific biopsy data (i.e., Gleason grade group, percent positive cores, tumor extent), and side-specific MRI features (i.e., presence of a PI-RADSv2 4 or 5 lesion, level of suspicion for EPE, length of capsular contact). The area under the receiver operating characteristic curve of the new, MRI-inclusive model (0.828, 95% confidence limits: 0.805, 0.852) was significantly higher than that of any of the benchmark models (p < 0.001 for all). CONCLUSIONS In an international, multi-site study, we developed an MRI-inclusive nomogram for the side-specific prediction of EPE of prostate cancer that demonstrated significantly greater accuracy than clinical benchmark models.
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Affiliation(s)
- Andreas G. Wibmer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (H.H.); (A.S.-D.)
- Correspondence: ; Tel.: +1-646-888-5409
| | - Michael W. Kattan
- Department of Quantitative Health Sciences in the Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (M.W.K.); (X.J.)
| | - Francesco Alessandrino
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (F.B.F.); (F.M.F.); (C.M.T.)
| | | | - Lars Boesen
- Herlev Gentofte University Hospital, 2730 Herlev, Denmark; (L.B.); (V.L.)
| | - Felipe Boschini Franco
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (F.B.F.); (F.M.F.); (C.M.T.)
| | - David Bonekamp
- DKFZ German Cancer Research Center, 69120 Heidelberg, Germany; (D.B.); (J.P.R.); (H.-P.S.)
| | - Riccardo Campa
- Department of Radiological Sciences, Oncology & Pathology, Sapienza University of Rome, 00185 Rome, Italy; (R.C.); (V.P.)
| | - Hannes Cash
- Charité University Hospital, 10117 Berlin, Germany; (A.D.J.B.); (H.C.); (T.P.)
- Department of Urology, University Magdeburg, 39120 Magdeburg, Germany
| | - Violeta Catalá
- Department of Radiology, Fundació Puigvert, 08025 Barcelona, Spain;
- Department of Uro-Radiology, Creu Blanca, 08034 Barcelona, Spain
| | - Sebastien Crouzet
- Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003 Lyon, France; (S.C.); (P.C.M.); (O.R.)
| | - Sounil Dinnoo
- Genitourinary and Women’s Imaging Departments, Lille University Hospital, 59037 Lille, France; (S.D.); (P.P.)
| | - James Eastham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Fiona M. Fennessy
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (F.B.F.); (F.M.F.); (C.M.T.)
| | - Kamyar Ghabili
- Department of Urology, Yale School of Medicine, New Haven, CT 06510, USA; (K.G.); (P.C.S.)
| | - Markus Hohenfellner
- Department of Urology, University Hospital of Heidelberg, 69120 Heidelberg, Germany;
| | - Angelique W. Levi
- Department of Pathology, Yale School of Medicine, New Haven, CT 06510, USA;
| | - Xinge Ji
- Department of Quantitative Health Sciences in the Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (M.W.K.); (X.J.)
| | - Vibeke Løgager
- Herlev Gentofte University Hospital, 2730 Herlev, Denmark; (L.B.); (V.L.)
| | - Daniel J. Margolis
- Weill Cornell Medicine, Weill Cornell Imaging, New York-Presbyterian Hospital, New York, NY 10021, USA;
| | - Paul C. Moldovan
- Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003 Lyon, France; (S.C.); (P.C.M.); (O.R.)
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology & Pathology, Sapienza University of Rome, 00185 Rome, Italy; (R.C.); (V.P.)
| | - Tobias Penzkofer
- Charité University Hospital, 10117 Berlin, Germany; (A.D.J.B.); (H.C.); (T.P.)
- Berlin Institute of Health (BIH), 10178 Berlin, Germany
| | - Philippe Puech
- Genitourinary and Women’s Imaging Departments, Lille University Hospital, 59037 Lille, France; (S.D.); (P.P.)
| | - Jan Philipp Radtke
- DKFZ German Cancer Research Center, 69120 Heidelberg, Germany; (D.B.); (J.P.R.); (H.-P.S.)
- Department of Urology, University Hospital of Heidelberg, 69120 Heidelberg, Germany;
| | - Olivier Rouvière
- Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003 Lyon, France; (S.C.); (P.C.M.); (O.R.)
- Faculté de Médecine Lyon Est, Université de Lyon, 69003 Lyon, France
| | - Heinz-Peter Schlemmer
- DKFZ German Cancer Research Center, 69120 Heidelberg, Germany; (D.B.); (J.P.R.); (H.-P.S.)
| | - Preston C. Sprenkle
- Department of Urology, Yale School of Medicine, New Haven, CT 06510, USA; (K.G.); (P.C.S.)
| | - Clare M. Tempany
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (F.B.F.); (F.M.F.); (C.M.T.)
| | - Joan C. Vilanova
- Clínica Girona, Institute Catalan of Health-IDI, University of Girona, 17004 Girona, Spain;
| | - Jeffrey Weinreb
- Department of Radiology, Yale School of Medicine, New Haven, CT 06510, USA;
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (H.H.); (A.S.-D.)
| | - Amita Shukla-Dave
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (H.H.); (A.S.-D.)
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Ito K, Chiba E, Oyama-Manabe N, Washino S, Manabe O, Miyagawa T, Hamamoto K, Hiruta M, Tanno K, Shinmoto H. Combining the Tumor Contact Length and Apparent Diffusion Coefficient Better Predicts Extraprostatic Extension of Prostate Cancer with Capsular Abutment: A 3 Tesla MR Imaging Study. Magn Reson Med Sci 2021; 21:477-484. [PMID: 33994494 PMCID: PMC9316129 DOI: 10.2463/mrms.mp.2020-0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To assess the diagnostic performance of the tumor contact length (TCL) and apparent diffusion coefficient (ADC) for predicting extraprostatic extension (EPE) of prostate cancer with capsular abutment (CA). Methods: Ninety-three patients with biopsy-proven prostate cancer underwent 3-Tesla MRI, including diffusion-weighted imaging (b value = 0, 2000 s/mm2) and radical prostatectomy. Two experienced radiologists, blinded to the clinicopathological data, retrospectively assessed the presence of CA on T2-weighted imaging (T2WI). TCL on T2WI and ADC values were measured on detecting CA in prostate cancer. We used the receiver operating characteristic curves to assess the diagnostic performance of TCL and ADC values for predicting EPE. Results: CA was present in 58 prostate cancers among 93 patients. The cut-off value for TCL was 6.9 mm, which yielded an area under the curve (AUC) of 0.75. This corresponded to a sensitivity, specificity, and accuracy of 84.2%, 61.5%, and 69.0%, respectively. The cut-off value for ADC was 0.63 × 10–3 mm2/s, which yielded an AUC of 0.76. This, in turn, corresponded to a sensitivity, specificity, and accuracy of 84.2%, 59.0%, and 67.2%, respectively. The combined cut-off value of TCL and ADC yielded an AUC of 0.82. The specificity (84.6%) and accuracy (81.0%) of the combined value were superior to their individual values (P < 0.05). Conclusion: A combination of TCL and ADC values provided high specificity and accuracy for detecting EPE of prostatic cancer with CA.
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Affiliation(s)
- Koichi Ito
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama
| | - Emiko Chiba
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama
| | - Satoshi Washino
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama
| | - Osamu Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama
| | - Tomoaki Miyagawa
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama
| | - Kohei Hamamoto
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama
| | - Masahiro Hiruta
- Department of Pathology, Jichi Medical University Saitama Medical Center, Saitama
| | - Keisuke Tanno
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, Tokorozawa
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14
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Saito K, Matsuoka Y, Toda K, Yoshida S, Yokoyama M, Yoshimura R, Kihara K, Fujii Y. Medium-term oncological and functional outcomes of hemi-gland brachytherapy using iodine-125 seeds for intermediate-risk unilateral prostate cancer. Brachytherapy 2021; 20:842-848. [PMID: 33883093 DOI: 10.1016/j.brachy.2021.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/24/2021] [Accepted: 03/07/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE To examine medium-term outcomes of hemi-gland low-dose-rate brachytherapy as a primary treatment for intermediate-risk prostate cancer. METHODS We recruited intermediate-risk unilateral prostate cancer patients for a prospective trial of hemi-gland brachytherapy. Twenty-four patients underwent hemi-gland iodine-125 seed implantation with a prescribed dose of 160 Gy. Serum prostate-specific antigen (PSA) was measured regularly and follow-up biopsy was scheduled after 2-3 years of treatment. When clinically needed afterward, for-cause biopsy was performed to confirm pathology. Treatment failure (TF)-free survival, which was defined as freedom from radical or systemic therapy, metastases, and cancer-specific mortality, was assessed, as was biochemical failure (BF)-free survival. Urinary and sexual functions were also evaluated. RESULTS Median follow-up duration was 61 months. Twenty-two patients (92%) exhibited a declining trend or decreased value of PSA for 12 months or longer after the treatment. Follow-up biopsy in the initial triennium and for-cause biopsy in the subsequent triennium were performed in 16 and four patients, respectively, and cancer was found from the treated lobe in one patient (4% of the cohort) and significant cancer was found from untreated lobes in four patients (17%) in total. Secondary treatments were performed in six patients successfully. Five-year freedom from BF, TF, and metastasis was 71%, 90%, and 100%, respectively. The International Prostate Symptom Score significantly deteriorated at 3 months and reversed itself afterward. The International Index of Erectile Function 5 had no significant decrease. CONCLUSIONS Hemi-gland low-dose-rate brachytherapy provides favorable medium-term oncological outcomes with genito-urinary functional preservation for men with intermediate-risk unilateral prostate cancer.
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Affiliation(s)
- Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
| | - Kazuma Toda
- Department of Radiology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Ryoichi Yoshimura
- Department of Radiology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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15
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Wang H, Ruan M, Wang H, Li X, Hu X, Liu H, Zhou B, Song G. Predictive model containing PI-RADS v2 score for postoperative seminal vesicle invasion among prostate cancer patients. Transl Androl Urol 2021; 10:584-593. [PMID: 33718061 PMCID: PMC7947466 DOI: 10.21037/tau-20-989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Seminal vesicle invasion (SVI) is considered to be one of most adverse prognostic findings in prostate cancer, affecting the biochemical progression-free survival and disease-specific survival. Multiparametric magnetic resonance imaging (mpMRI) has shown excellent specificity in diagnosis of SVI, but with poor sensitivity. The aim of this study is to create a model that includes the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score to predict postoperative SVI in patients without SVI on preoperative mpMRI. Methods A total of 262 prostate cancer patients without SVI on preoperative mpMRI who underwent radical prostatectomy (RP) at our institution from January 2012 to July 2019 were enrolled retrospectively. The prostate-specific antigen levels in all patients were <10 ng/mL. Univariate and multivariate logistic regression analyses were used to assess factors associated with SVI, including the PI-RADS v2 score. A regression coefficient-based model was built for predicting SVI. The receiver operating characteristic curve was used to assess the performance of the model. Results SVI was reported on the RP specimens in 30 patients (11.5%). The univariate and multivariate analyses revealed that biopsy Gleason grade group (GGG) and the PI-RADS v2 score were significant independent predictors of SVI (all P<0.05). The area under the curve of the model was 0.746 (P<0.001). The PI-RADS v2 score <4 and Gleason grade <8 yielded only a 1.8% incidence of SVI with a high negative predictive value of 98.2% (95% CI, 93.0-99.6%). Conclusions The PI-RADS v2 score <4 in prostate cancer patients with prostate-specific antigen level <10 ng/mL is associated with a very low risk of SVI. A model based on biopsy Gleason grade and PI-RADS v2 score may help to predict SVI and serve as a tool for the urologists to make surgical plans.
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Affiliation(s)
- Hao Wang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center of China, Beijing, China
| | - Mingjian Ruan
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center of China, Beijing, China
| | - He Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xueying Li
- Department of Statistics, Peking University First Hospital, Beijing, China
| | - Xuege Hu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center of China, Beijing, China
| | - Hua Liu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center of China, Beijing, China
| | - Binyi Zhou
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center of China, Beijing, China
| | - Gang Song
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center of China, Beijing, China
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16
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Kim TH, Woo S, Han S, Suh CH, Ghafoor S, Hricak H, Vargas HA. The Diagnostic Performance of the Length of Tumor Capsular Contact on MRI for Detecting Prostate Cancer Extraprostatic Extension: A Systematic Review and Meta-Analysis. Korean J Radiol 2020; 21:684-694. [PMID: 32410407 PMCID: PMC7231615 DOI: 10.3348/kjr.2019.0842] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/06/2020] [Accepted: 02/09/2020] [Indexed: 01/23/2023] Open
Affiliation(s)
- Tae Hyung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Naval Pohang Hospital, Pohang, Korea
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
| | - Sangwon Han
- Department of Nuclear Medicine, Armed Forces Daejeon Hospital, Daejeon, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| | - Soleen Ghafoor
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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17
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Gomez-Iturriaga A, Büchser D, Miguel IS, Marban M, Urresola A, Ezquerro A, Gil A, Suarez F, Gonzalez A, Mairata E, Martinez-Indart L, Cacicedo J, Couñago F, Mínguez P, Casquero F. MRI detected extaprostatic extension (EPE) in prostate cancer: Do all T3a patients have the same outcomes? Clin Transl Radiat Oncol 2020; 24:135-139. [PMID: 32875127 PMCID: PMC7451735 DOI: 10.1016/j.ctro.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/11/2020] [Indexed: 10/31/2022] Open
Abstract
MRI-detected T3a prostate cancer is a heterogeneous disease. This post-hoc analysis of a prospective trial found that patients with T3a disease presenting obliteration of the recto-prostatic angle, contact-asymmetry of neuro-vascular bundle and periprostatic fat invasion, may be at higher risk of biochemical failure and metastases.
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Affiliation(s)
- A Gomez-Iturriaga
- Hospital Universitario Cruces/Biocruces Bizkaia Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - D Büchser
- Hospital Universitario Cruces/Biocruces Bizkaia Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - I San Miguel
- Hospital Universitario Cruces/Biocruces Bizkaia Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - M Marban
- Hospital Universitario Cruces/Biocruces Bizkaia Health Research Institute, Radiation Oncology, Barakaldo, Spain.,Hospital Universitario Cruces/Biocruces Bizkaia Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - A Urresola
- Hospital Universitario Cruces/Biocruces Bizkaia Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - A Ezquerro
- Hospital Universitario Cruces/Biocruces Bizkaia Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - A Gil
- Hospital Universitario Cruces/Biocruces Bizkaia Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - F Suarez
- Hospital Universitario Cruces/Biocruces Bizkaia Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - A Gonzalez
- Hospital Universitario Cruces/Biocruces Bizkaia Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - E Mairata
- Hospital Universitario Cruces/Biocruces Bizkaia Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - L Martinez-Indart
- Hospital Universitario Cruces/Biocruces Health Research Institute, Clinical Epidemiology Unit, Barakaldo, Spain
| | - J Cacicedo
- Hospital Universitario Cruces/Biocruces Bizkaia Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - F Couñago
- Department of Radiation Oncology, Hospital Universitario Quirón salud Madrid, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - P Mínguez
- Hospital Universitario Cruces/Biocruces Bizkaia Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - F Casquero
- Hospital Universitario Cruces/Biocruces Bizkaia Health Research Institute, Radiation Oncology, Barakaldo, Spain
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Magnetta MJ, Catania R, Girometti R, Westphalen AC, Borhani AA, Furlan A. Prostate MRI: staging and decision-making. Abdom Radiol (NY) 2020; 45:2143-2153. [PMID: 32047994 DOI: 10.1007/s00261-020-02431-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Multi-parametric prostate MRI (mpMRI) plays a critical role in the diagnosis, staging, and evaluation of treatment response in patients with prostate cancer. Radiologists, through an accurate and standardized interpretation of mpMRI, can clinically stage prostate cancer and help to risk stratify patients who may benefit from more invasive treatment or exclude patients who may be harmed by overtreatment. The purpose of this article is to describe key findings to accurately stage prostate cancer with mpMRI and to describe the contexts in which mpMRI is best applied.
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Affiliation(s)
- Michael J Magnetta
- Division of Abdominal Radiology, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
- Division of Abdominal Radiology, Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Roberta Catania
- Division of Abdominal Radiology, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
- Institute of Radiology, Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital, S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, UD, Italy
| | - Antonio C Westphalen
- Departments of Radiology and Biomedical Imaging, and Urology, Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, USA
| | - Amir A Borhani
- Division of Abdominal Radiology, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alessandro Furlan
- Division of Abdominal Radiology, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA.
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Matsuoka Y, Uehara S, Yoshida S, Tanaka H, Tanaka H, Kijima T, Yokoyama M, Ishioka J, Saito K, Fujii Y. Value of extra-target prostate biopsy for the detection of magnetic resonance imaging-missed adverse pathology according to the Prostate Imaging Reporting and Data System scores: Spatial analysis using magnetic resonance-ultrasound fusion images. Int J Urol 2020; 27:760-766. [PMID: 32594578 DOI: 10.1111/iju.14295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/25/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To clarify who benefits from extra-target sampling of systematic prostate biopsy to detect magnetic resonance imaging-missed significant cancer and upgrading, when concurrently carried out with magnetic resonance imaging-ultrasound fusion targeted biopsy. METHODS Targeted biopsy and systematic biopsy were carried out in 301 men with Prostate Imaging Reporting and Data System scores ≥3. All score ≥3 regions were designated as targets. According to patients' highest Prostate Imaging Reporting and Data System scores, spatial relations between targets and biopsy-proven cancer were investigated to identify magnetic resonance imaging-missed pathology. RESULTS Overall, targeted biopsy and systematic biopsy detected significant cancer in 56.5% and 46.5%, respectively (P < 0.001). Significant cancer was detected only by systematic biopsy in 7.0%, and only outside targets in 5.0%. Upgrading by systematic biopsy was observed in 16.3%, and occurred outside targets in 11.0%. On multivariate analysis, the highest Prostate Imaging Reporting and Data System 4 was predictive for significant cancer only outside targets (odds ratio 5.81, P = 0.002) and for upgrading derived from outside targets (odds ratio 2.64, P = 0.012). According to the scores of 3, 4 and 5, significant cancer was identified only outside targets in 1.0%, 11.2% and 2.9%, respectively (P = 0.003 for Prostate Imaging Reporting and Data System 3 vs 4; P = 0.019 for Prostate Imaging Reporting and Data System 4 vs 5), and upgrading occurred in 6.1%, 18.4% and 8.6%, respectively (P = 0.009 and 0.040). CONCLUSIONS Men with the highest Prostate Imaging Reporting and Data System score 4 receive the largest benefit from extra-target biopsy for magnetic resonance imaging-missed significant cancer detection and upgrading. In men with a score of 3, less adverse pathology is missed without extra-target biopsy. These findings suggest prostate biopsy strategy could be tailored according to Prostate Imaging Reporting and Data System scores.
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Affiliation(s)
- Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Uehara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Tanaka
- Department of Radiology, Ochanomizu Surugadai Clinic, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshiki Kijima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junichiro Ishioka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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20
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Song G, Ruan M, Wang H, Lin Z, Wang X, Li X, Li P, Wang Y, Zhou B, Hu X, Liu H, Wang H, Guo Y. Predictive model using prostate MRI findings can predict candidates for nerve sparing radical prostatectomy among low-intermediate risk prostate cancer patients. Transl Androl Urol 2020; 9:437-444. [PMID: 32420149 PMCID: PMC7215049 DOI: 10.21037/tau.2020.01.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background In order to improve postoperative functional outcome, including urinary continence and erectile function, nerve sparing surgery is recommended for patients with clinically localized prostate cancer (PCa). However, due to poor diagnosis accuracy at the preoperative stage, upstaging occurs in a considerable proportion of patients. Multiparametric magnetic resonance imaging (mpMRI) and the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) have recently shown excellent performance in diagnosis and staging of PCa. The aim of this study was to develop a predictive model based on PI-RADS v2 for postoperative upstaging in patients with low-intermediate risk PCa. Methods The medical records of 314 patients with low-intermediate risk PCa [prostate-specific antigen (PSA) level ≤20 ng/mL, Gleason score (GS) <8, and clinical stage < T3] who underwent preoperative mpMRI and radical prostatectomy in the Department of Urology, Peking University First Hospital between January 2012 and July 2019 were reviewed retrospectively. Clinicopathological characteristics were collected. All MRI reports were done at our institution as part of routine clinical practice before prostate biopsy and there was no re-reporting occurred. Using PI-RADS v2, the mpMRI results were assigned to three groups: “negative”, “suspicious”, and “positive”. Multivariate logistic regression analysis was used to assess factors associated with postoperative pathological upstaging, defined as the presence of pT3 at final pathology. A regression coefficient based model for predicting postoperative upstaging was constructed and internally validated using 1,000 bootstrap resamples. The performance of the model was assessed using the area under the receiver operating characteristic curve (AUC). With the optimal cutoff point the performance of the model was assessed through analysis of sensitivity, specificity, positive predictive value, and negative predictive value. Results Upstaging was observed in 119 (37.9%) patients. The univariate and multivariate analyses revealed that PSA density, biopsy Gleason grade group (GGG), and mpMRI findings were significantly independent predictors for postoperative upstaging (all P<0.05). A predictive model showing very favorable calibration characteristics and higher accuracy than the single variables was constructed (AUC =0.74; P<0.001). At the optimal cutoff point, the model demonstrated a sensitivity and negative predictive value of 87.4% and 87.0%, respectively. Conclusions PI-RADS v2 assessment proved to be one of the most valuable predictors for postoperative upstaging in patients with low-intermediate risk PCa. The predictive model, based on PI-RADS v2 assessment, PSA density, and biopsy GGG, may help to select suitable candidates for nerve sparing radical prostatectomy among patients with low-intermediate risk PCa.
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Affiliation(s)
- Gang Song
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Urological Cancer Center of China, Beijing 100034, China
| | - Mingjian Ruan
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Urological Cancer Center of China, Beijing 100034, China
| | - He Wang
- Department of Radiology, Peking University First Hospital, Beijing 100034, China
| | - Zhiyong Lin
- Department of Radiology, Peking University First Hospital, Beijing 100034, China
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, Beijing 100034, China
| | - Xueying Li
- Department of Statistics, Peking University First Hospital, Beijing 100034, China
| | - Peng Li
- Department of Ultrasound, Peking University First Hospital, Beijing 100034, China
| | - Yandong Wang
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Urological Cancer Center of China, Beijing 100034, China.,Department of Urology, the People's Hospital of Guizhou Province, Guiyang 550002, China
| | - Binyi Zhou
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Urological Cancer Center of China, Beijing 100034, China
| | - Xuege Hu
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Urological Cancer Center of China, Beijing 100034, China
| | - Hua Liu
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Urological Cancer Center of China, Beijing 100034, China
| | - Hao Wang
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Urological Cancer Center of China, Beijing 100034, China
| | - Yinglu Guo
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Urological Cancer Center of China, Beijing 100034, China
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21
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Abreu-Gomez J, Walker D, Alotaibi T, McInnes MDF, Flood TA, Schieda N. Effect of observation size and apparent diffusion coefficient (ADC) value in PI-RADS v2.1 assessment category 4 and 5 observations compared to adverse pathological outcomes. Eur Radiol 2020; 30:4251-4261. [PMID: 32211965 DOI: 10.1007/s00330-020-06725-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/03/2019] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare observation size and apparent diffusion coefficient (ADC) values in Prostate Imaging Reporting and Data System (PI-RADS) v2.1 category 4 and 5 observations to adverse pathological features. MATERIALS AND METHODS With institutional review board approval, 267 consecutive men with 3-T MRI before radical prostatectomy (RP) between 2012 and 2018 were evaluated by two blinded radiologists who assigned PI-RADS v2.1 scores. Discrepancies were resolved by consensus. A third blinded radiologist measured observation size and ADC (ADC.mean, ADC.min [lowest ADC within an observation], ADC.ratio [ADC.mean/ADC.peripheral zone {PZ}]). Size and ADC were compared to pathological stage and Gleason score (GS) using t tests, ANOVA, Pearson correlation, and receiver operating characteristic (ROC) analysis. RESULTS Consensus review identified 267 true positive category 4 and 5 observations representing 83.1% (222/267) PZ and 16.9% (45/267) transition zone (TZ) tumors. Inter-observer agreement for PI-RADS v2.1 scoring was moderate (K = 0.45). Size was associated with extra-prostatic extension (EPE) (19 ± 8 versus 14 ± 6 mm, p < 0.001) and seminal vesicle invasion (SVI) (24 ± 9 versus 16 ± 7 mm, p < 0.001). Size ≥ 15 mm optimized the accuracy for EPE with area under the ROC curve (AUC) and sensitivity/specificity of 0.68 (CI 0.62-0.75) and 63.2%/65.6%. Size ≥ 19 mm optimized the accuracy for SVI with AUC/sensitivity/specificity of 0.75 (CI 0.66-0.83)/69.4%/70.6%. ADC metrics were not associated with pathological stage. Larger observation size (p = 0.032), lower ADC.min (p = 0.010), and lower ADC.ratio (p = 0.010) were associated with higher GS. Size correlated better to higher Gleason scores (p = 0.002) compared to ADC metrics (p = 0.09-0.11). CONCLUSION Among PI-RADS v2.1 category 4 and 5 observations, size was associated with higher pathological stage whereas ADC metrics were not. Size, ADC.minimum, and ADC.ratio differed in tumors stratified by Gleason score. KEY POINTS • Among PI-RADS category 4 and 5 observations, size but not ADC can differentiate between tumors by pathological stage. • An observation size threshold of 15 mm and 19 mm optimized the accuracy for diagnosis of extra-prostatic extension and seminal vesicle invasion. • Among PI-RADS category 4 and 5 observations, size, ADC.minimum, and ADC.ratio differed comparing tumors by Gleason score.
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Affiliation(s)
- Jorge Abreu-Gomez
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, C1 Radiology, Ottawa, Ontario, K1Y 4E9, Canada
| | - Daniel Walker
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, C1 Radiology, Ottawa, Ontario, K1Y 4E9, Canada
| | - Tareq Alotaibi
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, C1 Radiology, Ottawa, Ontario, K1Y 4E9, Canada
| | - Matthew D F McInnes
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, C1 Radiology, Ottawa, Ontario, K1Y 4E9, Canada
| | - Trevor A Flood
- Department of Anatomical Pathology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, C1 Radiology, Ottawa, Ontario, K1Y 4E9, Canada.
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Multiparametric MRI - local staging of prostate cancer and beyond. Radiol Oncol 2019; 53:159-170. [PMID: 31103999 PMCID: PMC6572496 DOI: 10.2478/raon-2019-0021] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background Accurate local staging is critical for treatment planning and prognosis in patients with prostate cancer (PCa). The primary aim is to differentiate between organ-confined and locally advanced disease with the latter carrying a worse clinical prognosis. Multiparametric MRI (mpMRI) is the imaging modality of choice for the local staging of PCa and has an incremental value in assessing pelvic nodal disease and bone involvement. It has shown superior performance compared to traditional staging based on clinical nomograms, and provides additional information on the site and extent of disease. MRI has a high specificity for diagnosing extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node (LN) metastases, however, sensitivity remains poor. As a result, extended pelvic LN dissection remains the gold standard for assessing pelvic nodal involvement, and there has been recent progress in developing advanced imaging techniques for more distal staging. Conclusions T2W-weighted imaging is the cornerstone for local staging of PCa. Imaging at 3T and incorporating both diffusion weighted and dynamic contrast enhanced imaging can further increase accuracy. "Next generation" imaging including whole body MRI and PET-MRI imaging using prostate specific membrane antigen (68Ga-PSMA), has shown promising for assessment of LN and bone involvement as compared to the traditional work-up using bone scintigraphy and body CT.
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23
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Li W, Xin C, Zhang L, Dong A, Xu H, Wu Y. Comparison of diagnostic performance between two prostate imaging reporting and data system versions: A systematic review. Eur J Radiol 2019; 114:111-119. [DOI: 10.1016/j.ejrad.2019.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
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Bai K, Sun Y, Li W, Zhang L. Apparent diffusion coefficient in extraprostatic extension of prostate cancer: a systematic review and diagnostic meta-analysis. Cancer Manag Res 2019; 11:3125-3137. [PMID: 31114355 PMCID: PMC6489658 DOI: 10.2147/cmar.s191738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/07/2019] [Indexed: 12/30/2022] Open
Abstract
Objective: To evaluate the diagnostic performance of apparent diffusion coefficient (ADC) for local staging of prostate cancer. Methods: Databases of Web of Science, MEDLINE (Ovid and PubMed), Cochrane Library, EMBASE, and Google Scholar were searched up to May 31, 2018, with language restricted to English. All studies concerning multiparametric magnet resonance imaging (mpMRI) with ADC for detection of extracapsular extension (ECE, T3a) and/or extraprostatic extension (EPE, overall stage of T3) were identified by two reviewers independently, and quality of included studies was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2 tool. True positive, false positive, false negative and true negative of each study were extracted to reconstruct the 2×2 tables for evaluating diagnostic accuracy. Summary estimates of sensitivity, specificity, and corresponding 95% CIs were calculated with bivariate model and hierarchical summary receiver operating characteristic model, then presented in forest plots. Multiple subgroup analyses and meta-regression were performed, and publication bias was evaluated with Deeks funnel. Results: A total of 18 studies were included, with 6 involved ECE and 12 for EPE. Pooled sensitivity was 80.5% (95% CI 76.5-83.9%) with specificity of 69.1% (95% CI 62.3-75.2%). Multiple subgroup analyses showed that if ADC and length of capsular contact are regarded as independent predictors, pooled sensitivity was 85% (95% CI 77-90%) and 81.1% (95% CI 76.0-85.3%), with specificity of 70.8% (95% CI 56.3-82.0%) and 66.6% (95% CI 57.6-74.5%), respectively. Meta-regression demonstrated that there was no substantially significant difference in types of coil, magnet field strength (1.5T versus 3.0T), and analysis method (per-lesion versus per-patient). Conclusion: By introducing ADC to MRI, we could obtain favorable sensitivity for diagnostic performance of EPE, but with a little decreased specificity.
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Affiliation(s)
- Koudi Bai
- Department of Radiology, Yancheng First Peoples’ Hospital, Yancheng City, People’s Republic of China
| | - Yuan Sun
- Department of Orthopedics, No.97 Hospital of People’s Liberation Army of China, Xuzhou City, People’s Republic of China
| | - Wei Li
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng City, People’s Republic of China
| | - Lanlan Zhang
- Department of Pediatrics, Yancheng Maternal and Child Health Hospital, Yancheng City, People’s Republic of China
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Prostate Imaging Reporting and Data System in prostate cancer staging and planning for radical prostatectomy. Wideochir Inne Tech Maloinwazyjne 2019; 14:262-270. [PMID: 31118993 PMCID: PMC6528114 DOI: 10.5114/wiitm.2019.83869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/16/2019] [Indexed: 02/04/2023] Open
Abstract
Introduction The Prostate Imaging Reporting and Data System (PI-RADS) was mainly developed for the purposes of prostate cancer (PCa) detection. However, its widespread use suggests that it may play a role in a preoperative workup prior to endoscopic radical prostatectomy (ERP). Aim To evaluate the prognostic value of PI-RADS in predicting extraprostatic extension (EPE) and its influence on surgical planning of ERP. Material and methods The analysis involved data of 154 consecutive prostate cancer patients, in whom multiparametric 3.0T magnetic resonance imaging (mpMRI) was performed before ERP. Standard descriptive assessment of mpMRI images was compared with the PI-RADS system with respect to prostate cancer staging and subsequent potential surgical template adjustment. Results PI-RADS significantly outperformed the standard way of mpMRI reporting in staging (AUC = 0.615 vs. 0.552, p = 0.036) with PI-RADS 5 established as the best threshold. After reevaluation of imaging, the initial surgical plan was modified based on mpMRI in terms of feasibility and extent of neurovascular bundle preservation during ERP on 96 (31.2%) sides, while on the remaining 212 (68.8%) sides the templates were left unchanged. Decisions based on mpMRI were not associated with increased risk of a positive surgical margin (PSM). Conclusions The PI-RADS outperforms the standard staging method using mpMRI and may assist the decision-making process regarding the extent of resection during ERP without increasing the risk of PSM.
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26
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Caglic I, Povalej Brzan P, Warren AY, Bratt O, Shah N, Barrett T. Defining the incremental value of 3D T2-weighted imaging in the assessment of prostate cancer extracapsular extension. Eur Radiol 2019; 29:5488-5497. [PMID: 30887192 PMCID: PMC6719333 DOI: 10.1007/s00330-019-06070-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/05/2018] [Accepted: 01/07/2019] [Indexed: 12/12/2022]
Abstract
Objectives To assess the added value of 3D T2-weighted imaging (T2WI) over conventional 2D T2WI in diagnosing extracapsular extension (ECE). Methods Seventy-five patients undergoing 3-T MRI before radical prostatectomy were included. PI-RADS ≥ 4 lesions were assessed for ECE on 2D T2W images using a 5-point Likert scale (1 = no ECE, 5 = definite ECE) and the length of tumour prostatic capsular contact. A second read using 3D T2W images and reformats evaluated ECE and the maximal 3D capsular contact length and surface. Results One hundred six lesions were identified at MRI. ECE was confirmed by histology in 54% (57/106) of lesions and 64% (48/75) of patients. Sensitivity and specificity for 3D T2 reads were 75.4% versus 64.9% (p = 0.058), respectively, and 83.7% versus 85.7% (p = 0.705) for 2D T2 reads, respectively. 3D T2W reads showed significantly higher mean subjective Likert scores of 3.7 ± 1.4 versus 3.3 ± 1.4 (p = 0.001) in ECE-positive lesions and lower mean Likert score of 1.5 ± 1 versus 1.6 ± 0.9 (p = 0.27) in ECE-negative lesions compared with 2D T2W reads. 3D contact significantly increased sensitivity from 59.6 to 73.7% (p = 0.03), whilst maintaining the same specificity of 87.8% (p = 1). High-grade group tumours (≥ Gleason 4 + 3) showed significantly higher ECE prevalence than low-grade tumours (88% versus 44%, p < 0.001) and a positive predictive value (PPV) for ECE of 90.9% with ≥ 5 mm of contact versus PPV of 90.4% at ≥ 12.5 mm for lower grade tumours. Conclusions 3D T2WI significantly increases sensitivity and confidence in calling ECE. The capsular contact length threshold differed between low- and high-grade cancers. Key Points • 3D capsular contact length and 3D surface contact significantly increased sensitivity in diagnosing ECE. • 3D T2W reads significantly increased reader confidence in calling ECE. • Thresholds for capsular contact length differed between low-grade and high-grade cancers. Electronic supplementary material The online version of this article (10.1007/s00330-019-06070-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Iztok Caglic
- Department of Radiology, Norfolk & Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UY, UK. .,Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK. .,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.
| | - Petra Povalej Brzan
- University of Maribor, Faculty of Health Sciences, Maribor, Slovenia.,University of Maribor, Faculty of Electrical Engineering and Computer Science, Maribor, Slovenia
| | - Anne Y Warren
- Department of Histopathology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Ola Bratt
- Department of Urology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Nimish Shah
- Department of Urology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.,CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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27
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Low PI-RADS assessment category excludes extraprostatic extension (≥pT3a) of prostate cancer: a histology-validated study including 301 operated patients. Eur Radiol 2019; 29:5478-5487. [PMID: 30887199 PMCID: PMC6719329 DOI: 10.1007/s00330-019-06092-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/31/2019] [Accepted: 02/08/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To evaluate whether low PI-RADS v2 assessment categories are effective at excluding extraprostatic extension (EPE) of prostate cancer (≥pT3a PCa). METHODS The local institutional ethics committee approved this retrospective analysis of 301 consecutive PCa patients. Patients were classified as low- or intermediate/high-risk based on clinical parameters and underwent pre-surgical multiparametric magnetic resonance imaging. A PI-RADS v2 assessment category and ESUR EPE score were assigned for each lesion by two readers working in consensus. Histopathologic analysis of the whole-mount radical prostatectomy specimen was the reference standard. Univariate and multivariate analyses were performed to evaluate the association of PI-RADS v2 assessment category with final histology ≥pT3a PCa. RESULTS For a PI-RADS v2 assessment category threshold of 3, the overall performance for ruling out (sensitivity, negative predictive value, negative likelihood ratio) ≥pT3a PCa was 99%/98%/0.04 and was similar in both the low-risk (96%/97%/0.12; N = 137) and the intermediate/high-risk groups (100%/100%/0.0; N = 164). In univariate analysis, all clinical and tumor characteristics except age were significantly associated with ≥pT3a PCa. In multivariate analysis, PI-RADS v2 assessment categories ≤ 3 had a protective effect relative to categories 4 and 5. The inclusion of ESUR EPE score improved the AUC of ≥pT3a PCa prediction (from 0.73 to 0.86, p = 0.04 in the overall cohort). The impact of PI-RADS v2 assessment category is reflected in a nomogram derived on the basis of our cohort. CONCLUSIONS In our cohort, low PI-RADS v2 assessment categories of 3 or less confidently ruled out the presence of ≥pT3a PCa irrespective of clinical risk group. KEY POINTS • Our analysis of 301 mp-MRI and RARP specimens showed that the addition of PI-RADS v2 assessment categories to clinical parameters improves the exclusion of ≥pT3a (extraprostatic) prostate cancer. • PI-RADS v2 assessment categories of 1 to 3 are useful for excluding ≥pT3a prostate cancer with a NPV of 98%; such patients can be considered as candidates for less invasive approaches. • The ability to exclude ≥pT3a prostate cancer may improve confidence in choosing nerve-sparing surgery or in avoiding pelvic nodal dissections, and similarly for patients undergoing radiotherapy, in adopting short-course adjuvant hormonal therapy or foregoing prophylactic nodal irradiation.
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Schiavina R, Chessa F, Borghesi M, Gaudiano C, Bianchi L, Corcioni B, Castellucci P, Ceci F, Ceravolo I, Barchetti G, Del Monte M, Campa R, Catalano C, Panebianco V, Nanni C, Fanti S, Minervini A, Porreca A, Brunocilla E. State-of-the-art imaging techniques in the management of preoperative staging and re-staging of prostate cancer. Int J Urol 2018; 26:18-30. [DOI: 10.1111/iju.13797] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/18/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Riccardo Schiavina
- Department of Urology; University of Bologna; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Francesco Chessa
- Department of Urology; University of Bologna; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Marco Borghesi
- Department of Urology; University of Bologna; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Caterina Gaudiano
- Radiology Unit; Department of Diagnostic Medicine and Prevention; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Lorenzo Bianchi
- Department of Urology; University of Bologna; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Beniamino Corcioni
- Radiology Unit; Department of Diagnostic Medicine and Prevention; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Paolo Castellucci
- Metropolitan Nuclear Medicine; St. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Francesco Ceci
- Metropolitan Nuclear Medicine; St. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
- Ahmanson Translational Imaging Division; Department of Molecular and Medical Pharmacology; University of California at Los Angeles; Los Angeles California USA
| | - Isabella Ceravolo
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Giovanni Barchetti
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Maurizio Del Monte
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Riccardo Campa
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Carlo Catalano
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Valeria Panebianco
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Cristina Nanni
- Metropolitan Nuclear Medicine; St. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Stefano Fanti
- Metropolitan Nuclear Medicine; St. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Andrea Minervini
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Angelo Porreca
- Department of Robotic Urological Surgery; Abano Terme Hospital; Abano Terme Italy
| | - Eugenio Brunocilla
- Department of Urology; University of Bologna; St. Orsola-Malpighi Hospital; Bologna Italy
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Abstract
PURPOSE OF REVIEW With the increasing incidence of low-to-intermediate risk of prostate cancer (PCa) by the introduction of prostate-specific antigen (PSA) screening, focal therapy has become one of the promising treatment options in the world. In Asia, same movement are occurring using several technologies including cryoablation, high-intensity focused ultrasound, brachytherapy and irreversible electroporation. However, these are still not common strategies to treat organ-confined PCa. The purpose of this review is to summarize the most updated experience and future direction of focal therapy in Asian countries. RECENT FINDINGS The prevalence and diagnosis of PCa are increasing in Asian countries. This increase is related to various factors including the widespread implementation of PSA testing and lifestyle changes to more Westernized diets. With the increasing detection rate of early stage PCa, overdetection and overtreatment are recognized even in Asia. In this setting, accumulating data on multiparametric MRI and MRI-targeted biopsy as well as MRI-transrectal ultrasound (TRUS) fusion biopsy suggest the potential in improving the detection of clinically significant PCa in Asia. Furthermore, targeted focal therapy has emerged as a promising treatment strategy aiming for both providing oncological outcome and maintaining functional preservation in many Asian countries. SUMMARY At present, focal therapy is not a current standard choice for the treatment of localized PCa in Asian countries. However, with the increase of localized PCa and patient's preference for less invasive treatment with preservation of organ-function, focal therapy should become a definite treatment option for localized PCa in Asia.
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30
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Ishioka J, Matsuoka Y, Uehara S, Yasuda Y, Kijima T, Yoshida S, Yokoyama M, Saito K, Kihara K, Numao N, Kimura T, Kudo K, Kumazawa I, Fujii Y. Computer-aided diagnosis of prostate cancer on magnetic resonance imaging using a convolutional neural network algorithm. BJU Int 2018; 122:411-417. [DOI: 10.1111/bju.14397] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Junichiro Ishioka
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Yoh Matsuoka
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Sho Uehara
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Yosuke Yasuda
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Toshiki Kijima
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Soichiro Yoshida
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Minato Yokoyama
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Kazutaka Saito
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Kazunori Kihara
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Noboru Numao
- Department of Urology; Cancer Institute Hospital; Japanese Foundation for Cancer Research; Tokyo Japan
| | - Tomo Kimura
- Department of Radiology; Ochanomizu Surugadai Clinic; Tokyo Japan
| | - Kosei Kudo
- Department of Information and Communication Engineering; Tokyo Institute of Technology; Tokyo Japan
| | - Itsuo Kumazawa
- Laboratory for Future Interdisciplinary Research of Science and Technology; Tokyo Institute of Innovative Research; Tokyo Japan
| | - Yasuhisa Fujii
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
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31
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Park SY, Cho NH, Jung DC, Oh YT. Prostate Imaging-Reporting and Data System Version 2: Beyond Prostate Cancer Detection. Korean J Radiol 2018. [PMID: 29520176 PMCID: PMC5840047 DOI: 10.3348/kjr.2018.19.2.193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The main purpose of Prostate Imaging-Reporting and Data System Version 2 (PI-RADSv2) is to effectively detect clinically significant prostate cancers (csPCa) using multiparametric magnetic resonance imaging. Since the first introduction of PI-RADSv2, researchers have validated its diagnostic performance in identifying csPCa, and these promising data have influenced biopsy and treatment schemes. However, in this article, we focused on the potential of PI-RADSv2 in relation to various aspects of PCa such as Gleason score, tumor volume, extraprostatic extension, lymph node metastasis, and postoperative biochemical recurrence, beyond prostate cancer detection.
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Affiliation(s)
- Sung Yoon Park
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Nam Hoon Cho
- Department of Pathology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Dae Chul Jung
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Young Taik Oh
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
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32
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Wang J, Wu CJ, Bao ML, Zhang J, Shi HB, Zhang YD. Using support vector machine analysis to assess PartinMR: A new prediction model for organ-confined prostate cancer. J Magn Reson Imaging 2018; 48:499-506. [PMID: 29437268 DOI: 10.1002/jmri.25961] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/19/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Jing Wang
- Center for Medical Device Evaluation, CFDA; Beijing China
| | - Chen-Jiang Wu
- Department of Radiology; First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Mei-Ling Bao
- Department of Pathology; First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Jing Zhang
- Department of Radiology; First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Hai-Bin Shi
- Department of Radiology; First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Yu-Dong Zhang
- Department of Radiology; First Affiliated Hospital with Nanjing Medical University; Nanjing China
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33
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Abstract
Prostate cancer is the most common male malignant tumor in Germany, which thus places growing demands on differentiated imaging and risk-adapted therapeutic approaches. Multiparametric MRI (mpMRI) of the prostate enables reliable detection of clinically significant cancers and is currently the leading imaging modality for the detection, characterization, and local staging of prostate cancer. According to the German S3 guideline, mpMRI of the prostate is currently primarily recommended in patients with previous negative TRUS biopsies and persisting tumor suspicion. The serial use of mpMRI in the pretherapeutic setting can support individual therapy planning of patients with locally advanced prostate cancer in the near future.
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