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Armstrong WR, Kishan AU, Booker KM, Grogan TR, Elashoff D, Lam EC, Clark KJ, Steinberg ML, Fendler WP, Hope TA, Nickols NG, Czernin J, Calais J. Impact of Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography on Prostate Cancer Salvage Radiotherapy Management: Results from a Prospective Multicenter Randomized Phase 3 Trial (PSMA-SRT NCT03582774). Eur Urol 2024; 86:52-60. [PMID: 38290964 DOI: 10.1016/j.eururo.2024.01.012] [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: 07/18/2023] [Revised: 12/12/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Both imaging and several prognostic factors inform the planning of salvage radiotherapy (SRT). Prostate-specific membrane antigen positron emission tomography (PSMA-PET) can localize disease unseen by other imaging modalities. The main objective of the study was to evaluate the impact of PSMA-PET on biochemical recurrence-free survival rate after SRT. METHODS This prospective randomized, controlled, phase 3 clinical trial randomized 193 patients with biochemical recurrence of prostate cancer after radical prostatectomy to proceed with SRT (control arm, n = 90) or undergo a PSMA-PET/computed tomography (CT) scan prior to SRT planning (investigational arm, n = 103) from June 2018 to August 2020. Any other approved imaging modalities were allowed in both arms (including fluciclovine-PET). This is a secondary endpoint analysis: impact of PSMA-PET on SRT planning. Case-report forms were sent to referring radiation oncologists to collect the management plans before randomization and after completion of SRT. The relative frequency (%) of management changes within each arm were compared using chi-square and Fisher's exact tests. KEY FINDINGS AND LIMITATIONS The delivered SRT plan was available in 178/193 patients (92.2%;76/90 control [84.4%] and 102/103 PSMA-PET [99%]). Median prostate-specific antigen levels at enrollment was 0.30 ng/ml (interquartile range [IQR] 0.19-0.91) in the control arm and 0.23 ng/ml (IQR 0.15-0.54) in the PSMA-PET arm. Fluciclovine-PET was used in 33/76 (43%) in the control arm. PSMA-PET localized recurrence(s) in 38/102 (37%): nine of 102 (9%) outside of the pelvis (M1), 16/102 (16%) in the pelvic LNs (N1, with or without local recurrence), and 13/102 (13%) in the prostate fossa only. There was a 23% difference (95% confidence interval [CI] 9-35%, p = 0.002) of frequency of major changes between the control arm (22% [17/76]) and the PSMA-PET intervention arm (45%[46/102]). Of the major changes in the intervention group, 33/46 (72%) were deemed related to PSMA-PET. There was a 17.6% difference (95% CI 5.4-28.5%, p = 0.005) of treatment escalation frequency between the control arm (nine of 76 [12%]) and the intervention arm (30/102 [29%]). Treatment de-escalation occurred in the control and intervention arms in eight of 76 (10.5%) and 12/102 (11.8%) patients, and mixed changes in zero of 76 (0%) and four of 102 (3.9%) patients, respectively. CONCLUSIONS AND CLINICAL IMPLICATIONS In this prospective randomized phase 3 study, PSMA-PET findings provided information that initiated major management changes to SRT planning in 33/102 (33%) patients. The final readout of the primary endpoint planned in 2025 may provide evidence on whether these changes result in improved outcomes. PATIENT SUMMARY Prostate-specific membrane antigen positron emission tomography leads to management changes in one-third of patients receiving salvage radiotherapy for post-radical prostatectomy biochemical recurrence of prostate cancer.
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Affiliation(s)
- Wesley R Armstrong
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; UCLA-Caltech Medical Scientist Training Program, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Kiara M Booker
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Tristan R Grogan
- Department of Medicine Statistics Core (DOMStat), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - David Elashoff
- Department of Medicine Statistics Core (DOMStat), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ethan C Lam
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kevyn J Clark
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Wolfgang P Fendler
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK) - University Hospital Essen, Essen, Germany
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Nicholas G Nickols
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA; Department of Radiation Oncology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Johannes Czernin
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA.
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Baboudjian M, Uleri A, Beauval JB, Touzani A, Diamand R, Roche JB, Lacetera V, Lechevallier E, Roumeguère T, Simone G, Benamran D, Fourcade A, Fiard G, Peltier A, Ploussard G. MRI lesion size is more important than the number of positive biopsy cores in predicting adverse features and recurrence after radical prostatectomy: implications for active surveillance criteria in intermediate-risk patients. Prostate Cancer Prostatic Dis 2024; 27:318-322. [PMID: 37452146 DOI: 10.1038/s41391-023-00693-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/06/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION To determine associations between prostate cancer (PCa) tumor burden measured on biopsy or multiparametric magnetic resonance imaging (mpMRI) and outcomes in intermediate-risk (IR) International Society of Urological Pathology (ISUP) grade 2 men managed with primary radical prostatectomy (RP). METHODS This retrospective, multicenter study was conducted in eight referral centers. The cohort included IR PCa patients who had ISUP 2 at biopsy. We defined biopsy tumor burden as low/high based on the absence/presence of more than 25% positive cores. Tumor burden on imaging was defined as low/high based on maximum lesion diameter, <15 mm and ≥15 mm at mpMRI, respectively. The histological endpoint of the study was adverse features at RP, defined as ≥pT3a stage and/or lymph node invasion and/or ISUP ≥3 at final pathology. The clinical endpoint was biochemical recurrence (BCR) after RP. RESULTS A total of 698 IR patients was included, of whom 335 (48%) had adverse features. In multivariate logistic regression analysis, there was no statistical association between tumor burden at biopsy and adverse features (p = 0.7). Tumor size ≥15 mm at mpMRI was significantly associated with adverse pathology (OR 1.65, 95%CI 1.14-2.39; p = 0.01). No significant association was observed between tumor burden at biopsy and BCR (p = 0.4). Tumor size ≥15 mm at mpMRI was significantly associated with BCR (HR 1.96, 95% CI 1.01-3.80; p = 0.04). CONCLUSIONS Our data support extending the inclusion criteria to ISUP 2 men with >25% positive cores, provided they have a low tumor size at mpMRI (<15 mm). Prospective studies should be performed to validate these findings.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France.
- Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France.
- Department of Urology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France.
| | - Alessandro Uleri
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | | | - Alae Touzani
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France
| | - Romain Diamand
- Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Vito Lacetera
- Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Eric Lechevallier
- Department of Urology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Thierry Roumeguère
- Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Daniel Benamran
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Alexandre Fourcade
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
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Riedel A, Michael M, Grünberg J, Mehralivand S, Böehm K, Hachtel J, Platzek I, Sommer U, Baunacke M, Thomas C, Borkowetz A. The Role of Multiparametric MRI (mpMRI) in the Prediction of Adverse Prostate Cancer Pathology in Radical Prostatectomy Specimen. Urol Int 2024; 108:146-152. [PMID: 38246150 DOI: 10.1159/000536256] [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: 10/14/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Prostate cancer (PCa) risk stratification is essential in guiding therapeutic decision. Multiparametric magnetic resonance tomography (mpMRI) holds promise in the prediction of adverse pathologies (AP) after prostatectomy (RP). This study aims to identify clinical and imaging markers in the prediction of adverse pathology. METHODS Patients with PCa, diagnosed by targeted biopsy after mpMRI and undergoing RP, were included. The predictive accuracy of mpMRI for extraprostatic extension (ECE), seminal vesicle infiltration (SVI), and lymph node positivity was calculated from the final histopathology. RESULTS 846 patients were involved. Independent risk parameters include imaging findings such as ECE (OR 3.12), SVI (OR 2.55), and PI-RADS scoring (4: OR 2.01 and 5: OR 4.34). mpMRI parameters such as ECE, SVI, and lymph node metastases showed a high prognostic accuracy (73.28% vs. 95.35% vs. 93.38%) with moderate sensitivity compared to the final histopathology. The ROC analysis of our combined scoring system (D'Amico classification, PSA density, and MRI risk factors) improves the prediction of adverse pathology (AUC: 0.73 vs. 0.69). CONCLUSION Our study supports the use of mpMRI for comprehensive pretreatment risk assessment in PCa. Due to the high accuracy of factors like ECE, SVI, and PI-RADS scoring, utilizing mpMRI data enabled accurate prediction of unfavorable pathology after RP.
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Affiliation(s)
- Andreas Riedel
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany,
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Tuebingen, Germany,
| | - Marlene Michael
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Jenny Grünberg
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Sherif Mehralivand
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Katharina Böehm
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Jakob Hachtel
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Ivan Platzek
- Department of Radiology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Ulrich Sommer
- Department of Pathology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Martin Baunacke
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Christian Thomas
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Angelika Borkowetz
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus Dresden, Dresden, Germany
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Duque-Santana V, Diaz-Gavela A, Recio M, Guerrero LL, Peña M, Sanchez S, López-Campos F, Thuissard IJ, Andreu C, Sanz-Rosa D, Achard V, Gómez-Iturriaga A, Molina Y, Del Cerro Peñalver E, Couñago F. Jorge clinical study: 10-year outcomes of risk-adapted radiotherapy defined by multiparametric MRI for prostate cancer. World J Urol 2023; 41:3829-3838. [PMID: 37966505 DOI: 10.1007/s00345-023-04682-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/08/2023] [Indexed: 11/16/2023] Open
Abstract
PURPOSE To analyze the 10-year biochemical relapse-free survival (BRFS), locoregional relapse-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS) in patients diagnosed with localized prostate adenocarcinoma treated with radiotherapy (RT) ± androgen deprivation therapy (ADT), according to the risk groups based on multiparametric magnetic resonance imaging (mpMRI) instead of digital rectal exam (DRE). METHODS We retrospectively evaluated 140 consecutive patients diagnosed with localized prostate adenocarcinoma, stratified into different risk groups-low (LR), intermediate (IR), and high (HR) by mpMRI results. RESULTS After a median follow-up of 104 months, in LR group (n = 15), 10-year BRFS was 86.7%, 10-year LRFS was 86.7%, 10-year MFS was 93.3%, and 10-year OS was 100%. In IR group (n = 80), 10-year BRFS was 80.5%, 10-year LRFS was 86.1%, 10-year MFS was 92.6%, and 10-year OS was 76%. In HR group (n = 45), 10-year BRFS was 72.8%, 10-year LRFS was 78.7%, 10-year MFS was 82.1%, and 10-year OS was 77% (2 deaths from prostate cancer). According to mpMRI results, 36 (25.7%) patients change the risk group and 125 (89.28%) patients change the TNM stage. There was a trend for higher metastatic relapse in patients who switched from IR to HR (due to mpMRI) versus the patients who remained in the IR (20%, vs. 1.81% p = 0.059). Multivariate analysis showed that locoregional relapse was strongly associated with distant relapse (OR = 9.28; 95%CI: 2.60-33.31). There were no cases of acute grade 3 toxicity. Late grade 3 genitourinary, gastrointestinal, and sexual toxicity were 2.8%, 0.7%, and 1.2%, respectively. CONCLUSION This is the first study with a 10-year median follow-up of patients diagnosed with localized prostate cancer treated with radiotherapy according to the risk groups established by mpMRI. Our findings show that mpMRI is a key tool to diagnose and establish risk groups in these patients, to optimize their treatment.
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Affiliation(s)
- Victor Duque-Santana
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid y Hospital La Luz, Universidad Europea de Madrid, Madrid, Spain
| | - Ana Diaz-Gavela
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid y Hospital La Luz, Universidad Europea de Madrid, Madrid, Spain
| | - Manuel Recio
- Department of Radiology, Hospital Universitario Quironsalud Madrid, Madrid, Spain
| | - Luis Leonardo Guerrero
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid y Hospital La Luz, Universidad Europea de Madrid, Madrid, Spain
| | - Marina Peña
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid y Hospital La Luz, Universidad Europea de Madrid, Madrid, Spain
| | - Sofia Sanchez
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid y Hospital La Luz, Universidad Europea de Madrid, Madrid, Spain
| | - Fernando López-Campos
- Department of Radiation Oncology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Israel J Thuissard
- Department of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Cristina Andreu
- Department of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - David Sanz-Rosa
- Department of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Vérane Achard
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | | | - Yolanda Molina
- Department of Medical Physics, Hospital Universitario Quirónsalud Madrid, Madrid, Spain
| | - Elia Del Cerro Peñalver
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid y Hospital La Luz, Universidad Europea de Madrid, Madrid, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital San Francisco de Asís y La Milagrosa, Clinical Director, National Chair of Research and Clinical Trials, GenesisCare, Madrid, Spain.
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Abd Ali F, Sievert KD, Eisenblaetter M, Titze B, Hansen T, Barth PJ, Titze U. MRI-Guided Targeted and Systematic Prostate Biopsies as Prognostic Indicators for Prostate Cancer Treatment Decisions. Cancers (Basel) 2023; 15:3915. [PMID: 37568731 PMCID: PMC10416861 DOI: 10.3390/cancers15153915] [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: 06/27/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The standard procedure for the diagnosis of prostate carcinoma involves the collection of 10-12 systematic biopsies (SBx) from both lobes. MRI-guided targeted biopsies (TBx) from suspicious foci increase the detection rates of clinically significant (cs) PCa. We investigated the extent to which the results of the TBx predicted the tumor board treatment decisions. SBx and TBx were acquired from 150 patients. Risk stratifications and recommendations for interventional therapy (prostatectomy and radiotherapy) or active surveillance were established by interdisciplinary tumor boards. We analyzed how often TBx alone were enough to correctly classify the tumors as well as to indicate interventional therapy and how often the findings of SBx were crucial for therapy decisions. A total of 28/39 (72%) favorable risk tumors were detected in TBx, of which 11/26 (42%) very-low-risk tumors were not detected and 8/13 (62%) low-risk tumors were undergraded. A total of 36/44 (82%) intermediate-risk PCa were present in TBx, of which 4 (9%) were underdiagnosed as a favorable risk tumor. A total of 12/13 (92%) high-risk carcinomas were detected and correctly grouped in TBx. The majority of csPCa were identified by the sampling of TBx alone. The tumor size was underestimated in a proportion of ISUP grade 1 tumors. Systematic biopsy sampling is therefore indicated for the next AS follow-up in these cases.
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Affiliation(s)
- Furat Abd Ali
- Bielefeld University, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Department of Urology, 32756 Detmold, Germany; (F.A.A.); (K.-D.S.)
| | - Karl-Dietrich Sievert
- Bielefeld University, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Department of Urology, 32756 Detmold, Germany; (F.A.A.); (K.-D.S.)
| | - Michel Eisenblaetter
- Bielefeld University, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Department of Diagnostic and Interventional Radiology, 32756 Detmold, Germany;
| | - Barbara Titze
- Bielefeld University, Medical School and University Medical Center OWL, Department of Pathology, Klinikum Lippe Detmold, 32756 Detmold, Germany;
| | - Torsten Hansen
- MVZ for Histology, Cytology and Molecular Diagnostics Trier GmbH, 54296 Trier, Germany;
| | - Peter J. Barth
- University of Münster, Gerhard-Domagk-Institute of Pathology, Münster University Hospital, 48149 Münster, Germany;
| | - Ulf Titze
- Bielefeld University, Medical School and University Medical Center OWL, Department of Pathology, Klinikum Lippe Detmold, 32756 Detmold, Germany;
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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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Dahan J, Delouya G, Lambert C, Olivié DAR, Billiard JS, Taussky D. Findings on Diagnostic Magnetic Resonance Imaging Before Radiotherapy for Prostate Cancer. Can Assoc Radiol J 2023; 74:382-387. [PMID: 36325740 DOI: 10.1177/08465371221137278] [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] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Pre-treatment diagnostic magnetic resonance imaging (MRI) is used in prostate cancer detection and staging; however, little is known about its potential for radiotherapy treatment decision, or its prognostic value. We investigated the findings on pre-treatment MRI and its potential influence on treatment decisions, and its ability to predict biochemical recurrence in patients treated with radiotherapy. METHODS Files of patients treated by radiotherapy from 2014 to 2022 were searched for if they had had an MRI within 12 months before radiotherapy. Prostate Imaging Reporting & Data System (PI-RADS) score, index lesion diameter and the presence of organ confined disease or extra-prostatic extension were correlated with their Cancer of the Prostate Risk Assessment (CAPRA) score. Distribution of radiological and clinical features between groups were estimated using a chi-squared test. RESULTS Out of 1280 patients, 314 (24.5%) had an MRI. The distribution depended on the treatment received: 22.5% who received low-dose rate (LDR) brachytherapy as monotherapy, 24.0% treated with high-dose rate (HDR) boost and 32.0% treated with external-beam radiotherapy (EBRT) (P = .017). The CAPRA score significantly correlated with the PI-RADS score (r = .342, P < .01) and the diameter of the index lesion (r = .473, P < .01). A clinically significant number of 22% patients with CAPRA ≤ 3 disease presented with lesions ≥15 mm and were less likely to be treated with LDR monotherapy (P < .01). 39 patients had a recurrence, only 5 had an MRI: 4 had a lesion of ≥20 mm and 3 a seminal vesicle invasion. CONCLUSION More than twenty percent of patients with CAPRA ≤3 presented on MRI a ≥15 mm lesion. An MRI could potentially affect treatment choice, and although exploratory our results suggest an important prognostic potential.
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Affiliation(s)
- Johanna Dahan
- Department of Radiation Oncology, 5622Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Guila Delouya
- Department of Radiation Oncology, 5622Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
- CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Carole Lambert
- Department of Radiation Oncology, 5622Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
- CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Damien A R Olivié
- Department of Radiology, 5622Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Jean-Sébastien Billiard
- Department of Radiology, 5622Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Daniel Taussky
- Department of Radiation Oncology, 5622Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
- CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
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Cassin J, Walker PM, Blanc J, Asuncion A, Bardet F, Cormier L, Loffroy R, Cochet A. Role of magnetic resonance imaging for preoperative prediction of early biochemical failure in localized prostate cancer. Quant Imaging Med Surg 2023; 13:1440-1452. [PMID: 36915312 PMCID: PMC10006114 DOI: 10.21037/qims-22-472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 11/02/2022] [Indexed: 01/09/2023]
Abstract
Background The purpose of our study was to assess preoperative clinical biological and Magnetic Resonance Imaging (MRI) predictive factors of early biochemical failure (BF), defined as persistence of significant post-operative plasmatic prostate specific antigen (PSA) level after radical prostatectomy (RP) in patients with localized prostate cancer (PCa). Methods In a retrospective cohort study we included 142 patients from our university hospital with newly diagnosed PCa, who underwent 3T multiparametric MRI prior to RP. Only the MRI target lesions [Prostate Imaging Reporting and Data System (PIRADS) ≥3] with histological correspondence were considered significant. Clinical, biological, MRI and pathological preoperative data were studied. We performed univariate and multivariate logistic regression analysis to identify significant parameters associated with early BF. Results Early BF occurred in 14% of patients (20/142). Patients with BF had higher PSA level at diagnosis, Gleason score, number of positive biopsies, size of the largest positive biopsy and higher National Comprehensive Cancer Network (NCCN) risk score (P<0.001 for all). According to MRI, they also had higher T stage and a higher size of capsular contact (P<0.001 for all). In contrast, there was no difference concerning neither ADC value, perfusion profile and zonal location of the index lesion. In multivariate analysis, the best combination of predictive factors of early BF was the association of preoperative Gleason score ≥4+3 [odds ratio (OR) =6.8 (1.4-32.5); P=0.002] and T stage ≥3 on preoperative MRI [OR =17.4 (3.2-94.9); P<0.001] with an area under the curve (AUC) of 0.89 [99% confidence interval (CI): 0.77-1], a negative predictive value of 94% and a positive predictive value of 75%. Conclusions Combination of simple preoperative biomarkers as Gleason score and T stage according to MRI accurately stratify the risk of early BF following RP. These results emphasize the pivotal role of preoperative MRI for the management of localized PCa.
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Affiliation(s)
- Jeremy Cassin
- Department of Vascular & Interventional Radiology, University Hospital of Dijon, Dijon, France
| | - Paul Michael Walker
- Department of Magnetic Resonance Spectroscopy, University Hospital of Dijon, Dijon, France.,ImVIA, EA7535, University of Burgundy, Dijon, France
| | - Julie Blanc
- Department of Statistics, Centre Georges-François Leclerc, Dijon, France
| | - Audrey Asuncion
- Department of Vascular & Interventional Radiology, University Hospital of Dijon, Dijon, France
| | - Florian Bardet
- Department of Urology, University Hospital of Dijon, Dijon, France
| | - Luc Cormier
- Department of Urology, University Hospital of Dijon, Dijon, France
| | - Romaric Loffroy
- Department of Vascular & Interventional Radiology, University Hospital of Dijon, Dijon, France.,ImVIA, EA7535, University of Burgundy, Dijon, France
| | - Alexandre Cochet
- Department of Magnetic Resonance Spectroscopy, University Hospital of Dijon, Dijon, France.,ImVIA, EA7535, University of Burgundy, Dijon, France
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9
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Rasing MJA, Peters M, van Son M, Moerland MA, Eppinga W, van de Pol SMG, Noteboom J, Lagendijk J, van der Voort van Zyp JRN. Recurrence characteristics after focal salvage HDR brachytherapy in prostate cancer. Radiother Oncol 2023; 180:109495. [PMID: 36708924 DOI: 10.1016/j.radonc.2023.109495] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Radiorecurrent prostate cancer is often confined to the prostate, predominantly near the index lesion. The purpose of this study was to look at recurrence characteristics in patients treated with focal salvage high dose-rate (HDR) brachytherapy. MATERIALS AND METHODS Patients treated with MRI-guided HDR brachytherapy, with a single fraction of 19 Gy from July 2013 to October 2021 as focal salvage treatment, were prospectively included in the current study. Imaging data were collected regarding the occurrence of local, regional and distant recurrences, including location of local recurrences (LR) in relation to the HDR radiotherapy field. RESULTS One hundred seventy-five patients were included after focal salvage HDR brachytherapy (median follow-up 36 months (IQR 23-50)). Three-years biochemical recurrence-free survival, LR-free survival, in-field LR-free survival, out-of-field LR-free survival, any-recurrence-free survival and ADT-free survival were 43% (95%CI 34%-52%), 51% (41%-61%), 70% (61%-80%), 92% (88%-97%), 42% (32%-52%) and 86% (80%-92%), respectively. Larger GTV-size and shorter PSA doubling time were associated with in-field LR in multivariable analysis. CONCLUSION After focal salvage HDR brachytherapy with a dose of 1x19 Gy for local prostate cancer recurrence, subsequent recurrences are mostly local and in-field.
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Affiliation(s)
- Marnix J A Rasing
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Max Peters
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Marieke van Son
- Department of Urology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Marinus A Moerland
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Wietse Eppinga
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Sandrine M G van de Pol
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Juus Noteboom
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Jan Lagendijk
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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10
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Hutten R, Khouri A, Parsons M, Tward A, Wilson T, Peterson J, Morrell G, Dechet C, O'Neil B, Schmidt B, Kokeny K, Lloyd S, Cannon D, Tward J, Sanchez A, Johnson S. The Clinical Significance of Maximum Tumor Diameter on MRI in Men Undergoing Radical Prostatectomy or Definitive Radiotherapy for Locoregional Prostate Cancer. Clin Genitourin Cancer 2022; 20:e453-e459. [PMID: 35787979 DOI: 10.1016/j.clgc.2022.06.010] [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: 04/27/2022] [Revised: 05/26/2022] [Accepted: 06/11/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Maximum tumor diameter (MTD) on pretreatment magnetic resonance imaging (MRI) has the potential to further risk stratify for men with prostate cancer (PCa) prior to definitive local therapy. We aim to evaluate the prognostic impact of radiographic maximum tumor diameter (MTD) in men with localized prostate cancer. PATIENTS AND METHODS From a single-center retrospective cohort of men receiving definitive treatment for PCa (radical prostatectomy [RP] or radiotherapy [RT]) with available pretreatment MRI, we conducted univariable and multivariable Cox proportional-hazards models for progression using clinical variables including age, NCCN risk group, radiographic extracapsular extension (ECE), radiographic seminal vesical invasion (SVI), and MTD. RP and RT cohorts were analyzed separately. Covariates were used in a classification and regression tree (CART) analysis and progression-free survival was estimated with the Kaplan-Meier method and groups were compared using log-rank tests. RESULTS The cohort included 631 patients (n = 428 RP, n = 203 RT). CART analysis identified 4 prognostic groups for patients treated with RP and 2 prognostic groups in those treated with RT. In the RP cohort, NCCN low/intermediate risk group patients with MTD>=15 mm had significantly worse PFS than those with MTD <= 14 mm, and NCCN high-risk patients with radiographic ECE had significantly worse PFS than those without ECE. In the RT cohort, PFS was significantly worse in the cohort with MTD >= 23 mm than those <= 22 mm. CONCLUSION Radiographic MTD may be a useful prognostic factor for patients with locoregional prostate cancer. This is the first study to illustrate that the importance of pretreatment tumor size may vary based on treatment modality.
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Affiliation(s)
- Ryan Hutten
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Ashley Khouri
- University of Utah School of Medicine, Salt Lake City, UT
| | - Matthew Parsons
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Alex Tward
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Trevor Wilson
- University of Utah School of Medicine, Salt Lake City, UT
| | - John Peterson
- University of Utah School of Medicine, Salt Lake City, UT
| | - Glen Morrell
- Department of Radiology and Imaging Services, University of Utah, Salt Lake City, UT
| | - Christopher Dechet
- Division of Urology, Department of Surgery, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Brock O'Neil
- Division of Urology, Department of Surgery, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Bogdana Schmidt
- Division of Urology, Department of Surgery, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Kristine Kokeny
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Shane Lloyd
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Donald Cannon
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Jonathan Tward
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Alejandro Sanchez
- Division of Urology, Department of Surgery, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Skyler Johnson
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT.
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11
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Seomun G, Ban S, Park J. Identifying the knowledge structure of electromagnetic fields and health research: Text network analysis and topic modeling. PLoS One 2022; 17:e0273005. [PMID: 35976897 PMCID: PMC9384997 DOI: 10.1371/journal.pone.0273005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background With technological and scientific advancement, people are being increasingly exposed to electromagnetic fields, particularly from portable devices such as mobile phones. However, there is currently no consensus regarding the health effects of electromagnetic field exposure, despite the large amount of research conducted on this topic. This study aimed to understand the knowledge structure and trend of electromagnetic field and health research through text network analysis and topic modeling. Methods PubMed, Embase, and Cochrane were searched, and 3,880 articles published before June 2021 were identified. We explored the main keywords and research topics regarding electromagnetic fields and human health by constructing a network of keywords. A social network analysis program was used to analyze the data, visualize the network, and perform topic modeling. Results Four keywords, “exposure,” “effect,” “cell,” and “cancer,” were highly correlated to other keywords and formed each colony in the knowledge structure of research on electromagnetic fields and health. Five topics were derived from topic modeling: cell research, research on the adaption of MRI, health effects of mobile phones, pain therapy, and exposure measurement. Cell research has been continuously performed, and many studies have been conducted on the health effects of mobile phones since 2000. Conclusions These findings will assist in gaining insights into and understanding changes in research on the health effects of electromagnetic fields, and suggest important areas and directions for future research.
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Affiliation(s)
- GyeongAe Seomun
- College of Nursing, Korea University, BK21FOUR R&E Center for Learning Health, Systems, Korea University, Seoul, Republic of Korea
| | - Suyeon Ban
- College of Nursing, Korea University, BK21FOUR R&E Center for Learning Health, Systems, Korea University, Seoul, Republic of Korea
| | - Jinkyung Park
- College of Nursing, Chonnam National University, Gwangju, Republic of Korea
- * E-mail:
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12
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Fernandes MC, Yildirim O, Woo S, Vargas HA, Hricak H. The role of MRI in prostate cancer: current and future directions. MAGMA (NEW YORK, N.Y.) 2022; 35:503-521. [PMID: 35294642 PMCID: PMC9378354 DOI: 10.1007/s10334-022-01006-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/16/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
There has been an increasing role of magnetic resonance imaging (MRI) in the management of prostate cancer. MRI already plays an essential role in the detection and staging, with the introduction of functional MRI sequences. Recent advancements in radiomics and artificial intelligence are being tested to potentially improve detection, assessment of aggressiveness, and provide usefulness as a prognostic marker. MRI can improve pretreatment risk stratification and therefore selection of and follow-up of patients for active surveillance. MRI can also assist in guiding targeted biopsy, treatment planning and follow-up after treatment to assess local recurrence. MRI has gained importance in the evaluation of metastatic disease with emerging technology including whole-body MRI and integrated positron emission tomography/MRI, allowing for not only better detection but also quantification. The main goal of this article is to review the most recent advances on MRI in prostate cancer and provide insights into its potential clinical roles from the radiologist's perspective. In each of the sections, specific roles of MRI tailored to each clinical setting are discussed along with its strengths and weakness including already established material related to MRI and the introduction of recent advancements on MRI.
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Affiliation(s)
- Maria Clara Fernandes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Onur Yildirim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
| | - Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
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13
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Ratnani P, Dovey Z, Parekh S, Sobotka S, Shukla D, Davis A, Roshandel R, Wagaskar V, Jambor I, Lundon DJ, Wiklund P, Kyprianou N, Menon M, Tewari A. Prostate MRI percentage tumor involvement or "PI-RADS percent" as a predictor of adverse surgical pathology. Prostate 2022; 82:970-983. [PMID: 35437769 DOI: 10.1002/pros.24344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study assesses magnetic resonance imaging (MRI) prostate % tumor involvement or "PI-RADs percent" as a predictor of adverse pathology (AP) after surgery for localized prostate cancer (PCa). Two separate variables, "All PI-RADS percent" (APP) and "Highest PI-RADS percent" (HPP), are defined as the volume of All PI-RADS 3-5 score lesions on MRI and the volume of the Highest PI-RADS 3-5 score lesion each divided by TPV, respectively. METHOD An analysis was done of an IRB approved prospective cohort of 557 patients with localized PCa who had targeted biopsy of MRI PIRADs 3-5 lesions followed by RARP from April 2015 to May 2020 performed by a single surgeon at a single center. AP was defined as ISUP GGG ≥3, pT stage ≥T3 and/or LNI. Univariate and multivariable analyses were used to evaluate APP and HPP at predicting AP with other clinical variables such as Age, PSA at surgery, Race, Biopsy GGG, mpMRI ECE and mpMRI SVI. Internal and External Validation demonstrated predicted probabilities versus observed probabilities. RESULTS AP was reported in 44.5% (n = 248) of patients. Multivariable regression showed both APP (odds ratio [OR]: 1.10, 95% confidence interval [CI]: 1.04-1.14, p = 0.0007) and HPP (OR: 1.10; 95% CI: 1.04-1.16; p = 0.0007) were significantly associated with AP with individual area under the operating curves (AUCs) of 0.6142 and 0.6229, respectively, and AUCs of 0.8129 and 0.8124 when incorporated in models including preoperative PSA and highest biopsy GGG. CONCLUSIONS Increasing PI-RADS Percent was associated with a higher risk of AP, and both APP and HPP may have clinical utility as predictors of AP in GGG 1 and 2 patients being considered for AS. PATIENT SUMMARY Using PIRADs percent to predict AP for presurgical patients may help risk stratification, and for low and low volume intermediate risk patients, may influence treatment decisions.
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Affiliation(s)
- Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Zach Dovey
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Sneha Parekh
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Devki Shukla
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Avery Davis
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Reza Roshandel
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Vinayak Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Ivan Jambor
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Dara J Lundon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
- Department of Urology, Karolinska University Hospital Solna, Sweden
| | - Natasha Kyprianou
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Mani Menon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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14
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Kamal O, Foster BR, Young DJ, Hansel DE, Coakley FV. MRI appearance of BRCA-associated prostate cancer. Clin Imaging 2022; 84:135-139. [DOI: 10.1016/j.clinimag.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/30/2022] [Accepted: 02/08/2022] [Indexed: 12/28/2022]
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15
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Bratt O. Integrating magnetic resonance imaging and prostate-specific membrane antigen positron emission tomography/computed tomography results into prostate cancer treatment decision making. BJU Int 2021; 129:3-4. [PMID: 34967997 DOI: 10.1111/bju.15560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Ola Bratt
- Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
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16
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Groen VH, Haustermans K, Pos FJ, Draulans C, Isebaert S, Monninkhof EM, Smeenk RJ, Kunze-Busch M, de Boer JCJ, van der Voort van Zijp J, Kerkmeijer LGW, van der Heide UA. Patterns of Failure Following External Beam Radiotherapy With or Without an Additional Focal Boost in the Randomized Controlled FLAME Trial for Localized Prostate Cancer. Eur Urol 2021; 82:252-257. [PMID: 34953603 DOI: 10.1016/j.eururo.2021.12.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/12/2021] [Accepted: 12/08/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Focal dose escalation in external beam radiotherapy (EBRT) showed an increase in 5-yr biochemical disease-free survival in the Focal Lesion Ablative Microboost in Prostate Cancer (FLAME) trial. OBJECTIVE To analyze the effect of a focal boost to intraprostatic lesions on local failure-free survival (LFS) and regional + distant metastasis-free survival (rdMFS). DESIGN, SETTING, AND PARTICIPANTS Patients with intermediate- or high-risk localized prostate cancer were included in FLAME, a phase 3, multicenter, randomized controlled trial. INTERVENTION Standard treatment of 77 Gy to the entire prostate in 35 fractions was compared to an additional boost to the macroscopic tumor of up to 95 Gy during EBRT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS LFS and rdMFS, measured via any type of imaging, were compared between the treatment arms using Kaplan-Meier and Cox regression analyses. Dose-response curves were created for local failure (LF) and regional + distant metastatic failure (rdMF) using logistic regression. RESULTS AND LIMITATIONS A total of 571 patients were included in the FLAME trial. Over median follow-up of 72 mo (interquartile range 58-86), focal boosting decreased LF (hazard ratio [HR] 0.33, 95% confidence interval [CI] 0.14-0.78) and rdMF (HR 0.58, 95% CI 0.35-0.93). Dose-response curves showed that a greater dose to the tumor resulted in lower LF and rdMF rates. CONCLUSIONS A clear dose-response relation for LF and rdMF was observed, suggesting that adequate focal dose escalation to intraprostatic lesions prevents undertreatment of the primary tumor, resulting in an improvement rdMF. PATIENT SUMMARY Radiotherapy is a treatment option for high-risk prostate cancer. The FLAME trial has shown that a high dose specifically targeted at the tumor within the prostate will result in better disease outcome, with less likelihood of regional and distant disease spread. The FLAME trial is registered on ClinicalTrials.gov as NCT01168479.
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Affiliation(s)
- Veerle H Groen
- Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Floris J Pos
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cédric Draulans
- Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Sofie Isebaert
- Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Evelyn M Monninkhof
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Robert J Smeenk
- Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Martina Kunze-Busch
- Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | | - Linda G W Kerkmeijer
- Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands; Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
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17
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Stabile A, Mazzone E, Cirulli GO, De Cobelli F, Grummet J, Thoeny HC, Emberton M, Pokorny M, Pinto PA, Taneja SS. Association Between Multiparametric Magnetic Resonance Imaging of the Prostate and Oncological Outcomes after Primary Treatment for Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Oncol 2021; 4:519-528. [PMID: 33384275 DOI: 10.1016/j.euo.2020.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/10/2020] [Accepted: 11/27/2020] [Indexed: 12/25/2022]
Abstract
CONTEXT The diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) for prostate cancer (PCa) diagnosis has been extensively explored. Little is known about the prognostic value of mpMRI suspicion scores and other quantitative mpMRI information. OBJECTIVE To systematically review the current literature assessing the relationship between pretreatment mpMRI and oncological outcomes after primary treatment for PCa to assess the role of mpMRI as a prognostic tool. EVIDENCE ACQUISITION A computerized bibliographic search of MEDLINE/PubMed, EMBASE, Scopus, and the Cochrane Library CENTRAL databases was performed for all studies assessing the relationship between mpMRI and oncological outcomes after primary treatment for PCa. The review protocol is registered in the PROSPERO database (CRD42020209899). EVIDENCE SYNTHESIS A total of six studies were included. Reliable evidence is still limited in this field. The Prostate Imaging-Reporting and Data System (PI-RADS) score was an independent predictor of biochemical recurrence (BCR) after radical prostatectomy (RP) in the majority of the studies included. The tumor volume at mpMRI was not significantly associated with BCR after RP for PCa. Data on disease progression and PCa-specific mortality are limited. Heterogeneity among the studies was substantial. CONCLUSIONS The review shows that PI-RADS scores provide information on the future likelihood of cancer recurrence or progression, at least for men undergoing RP. We are of the view that this information should be taken into account to identify men at higher risk of unfavorable outcomes. PATIENT SUMMARY A higher Prostate Imaging-Reporting and Data System score for magnetic resonance imaging of the prostate seems to be positively associated with oncological failure in prostate cancer and should be incorporated into future risk models.
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Affiliation(s)
- Armando Stabile
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Elio Mazzone
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe O Cirulli
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jeremy Grummet
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Harriet C Thoeny
- Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland
| | - Mark Emberton
- UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Morgan Pokorny
- Department of Urology, Auckland City Hospital, Auckland, New Zealand
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Samir S Taneja
- Department of Urologic Oncology, NYU Langone Medical Center, New York, NY, USA
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18
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Moving Beyond the Hazard Ratio to Personalized Therapy: Is it Prime Time? Int J Radiat Oncol Biol Phys 2020; 108:903-904. [DOI: 10.1016/j.ijrobp.2020.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 07/31/2020] [Accepted: 08/06/2020] [Indexed: 11/20/2022]
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Delgadillo R, Ford JC, Abramowitz MC, Dal Pra A, Pollack A, Stoyanova R. The role of radiomics in prostate cancer radiotherapy. Strahlenther Onkol 2020; 196:900-912. [PMID: 32821953 PMCID: PMC7545508 DOI: 10.1007/s00066-020-01679-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/07/2020] [Indexed: 12/24/2022]
Abstract
"Radiomics," as it refers to the extraction and analysis of a large number of advanced quantitative radiological features from medical images using high-throughput methods, is perfectly suited as an engine for effectively sifting through the multiple series of prostate images from before, during, and after radiotherapy (RT). Multiparametric (mp)MRI, planning CT, and cone beam CT (CBCT) routinely acquired throughout RT and the radiomics pipeline are developed for extraction of thousands of variables. Radiomics data are in a format that is appropriate for building descriptive and predictive models relating image features to diagnostic, prognostic, or predictive information. Prediction of Gleason score, the histopathologic cancer grade, has been the mainstay of the radiomic efforts in prostate cancer. While Gleason score (GS) is still the best predictor of treatment outcome, there are other novel applications of quantitative imaging that are tailored to RT. In this review, we summarize the radiomics efforts and discuss several promising concepts such as delta-radiomics and radiogenomics for utilizing image features for assessment of the aggressiveness of prostate cancer and its outcome. We also discuss opportunities for quantitative imaging with the advance of instrumentation in MRI-guided therapies.
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Affiliation(s)
- Rodrigo Delgadillo
- Department of Radiation Oncology, University of Miami Miller School of Medicine, 1121 NW 14th St, 33136, Miami, FL, USA
| | - John C Ford
- Department of Radiation Oncology, University of Miami Miller School of Medicine, 1121 NW 14th St, 33136, Miami, FL, USA
| | - Matthew C Abramowitz
- Department of Radiation Oncology, University of Miami Miller School of Medicine, 1121 NW 14th St, 33136, Miami, FL, USA
| | - Alan Dal Pra
- Department of Radiation Oncology, University of Miami Miller School of Medicine, 1121 NW 14th St, 33136, Miami, FL, USA
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine, 1121 NW 14th St, 33136, Miami, FL, USA
| | - Radka Stoyanova
- Department of Radiation Oncology, University of Miami Miller School of Medicine, 1121 NW 14th St, 33136, Miami, FL, USA.
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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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