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Abou Heidar N, El-Doueihi R, Merhe A, Ramia P, Bustros G, Yacoubian A, Jaafar R, Nasr R. The role of pre-biopsy mpMRI in lymph node staging for prostate cancer. Urologia 2021; 89:64-69. [PMID: 33985388 DOI: 10.1177/03915603211016805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Prostate cancer (PCa) staging is an integral part in the management of prostate cancer. The gold standard for diagnosing lymph node invasion is a surgical lymphadenectomy, with no superior imaging modality available at the clinician's disposal. Our aim in this study is to identify if a pre-biopsy multiparametric MRI (mpMRI) can provide enough information about pelvic lymph nodes in intermediate and high risk PCa patients, and whether it can substitute further cross sectional imaging (CSI) modalities of the abdomen and pelvis in these risk categories. METHODS Patients with intermediate and high risk prostate cancer were collected between January 2015 and June 2019, while excluding patients who did not undergo a pre-biopsy mpMRI or a CSI. Date regarding biopsy result, PSA, MRI results, CSI imaging results were collected. Using Statistical Package for the Social Sciences (SPSS) version 24.0, statistical analysis was conducted using the Cohen's Kappa agreement for comparison of mpMRI with CSI. McNemar's test and receiver operator curve (ROC) curve were used for comparison of sensitivity of both tests when comparing to the gold standard of lymphadenectomy. RESULTS A total of 143 patients fit the inclusion criteria. We further stratified our patients into according to PSA level and Gleason score. Overall, agreement between mpMRI and all CSI was 0.857. When stratifying patients based on Gleason score and PSA, the higher the grade or PSA, the higher agreement between mpMRI and CSI. The sensitivity of mpMRI (73.7%) is similar to CSI (68.4%). When comparing CSI sensitivity to that of mpMRI, no significant difference was present by utilizing the McNemar test and very similar receiver operating characteristic curve. CONCLUSION A pre-biopsy mpMRI can potentially substitute further cross sectional imaging in our cohort of patients. However, larger prospective studies are needed to confirm our findings.
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Affiliation(s)
- Nassib Abou Heidar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Robert El-Doueihi
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Merhe
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Paul Ramia
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gerges Bustros
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aline Yacoubian
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rola Jaafar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Nasr
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Kilic M, Coskun B, Vural M, Musaoglu A, Esen T, Balbay MD. The clinical impact of Prostate Imaging-Reporting and Data System classification in patients with haemospermia undergoing multiparametric magnetic resonance imaging of the prostate. Andrologia 2021; 53:e14041. [PMID: 33694277 DOI: 10.1111/and.14041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 11/28/2022] Open
Abstract
In this study, we evaluated the role of the Prostate Imaging-Reporting and Data System (PI-RADS) classification of multiparametric magnetic resonance imaging (mpMRI) to determine the likelihood of prostate cancer (PCa) in patients with haemospermia. Fifty-one patients presenting with haemospermia between 2018 and 2020 were included in this retrospective study. Forty-two of the patients (82.4%) were over 40 years, and the median prostate-specific antigen (PSA) level was 1.4 ng/ml. Fourteen of the patients (27.5%) had recurrent haemospermia. All patients underwent mpMRI, and assessments were classified according to PI-RADS v2. The mpMRI revealed PI-RADS one to four lesions in 10 (19.6%), 30 (58.8%), 6 (11.8%) and 5 (9.8%) patients respectively. One patient with PI-RADS 3 and five with PI-RADS 4 lesions underwent cognitive fusion prostate biopsy depending on MRI findings, and two patients with PI-RADS 4 lesions were diagnosed with PCa. Patients with haemospermia and risk factors, that is aged over 40 years, a high PSA level or familial history of PCa, need a more thorough evaluation with mpMRI.
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Affiliation(s)
- Mert Kilic
- Department of Urology, VKF American Hospital, Istanbul, Turkey
| | - Bilgen Coskun
- Department of Radiology, VKF American Hospital, Istanbul, Turkey
| | - Metin Vural
- Department of Radiology, VKF American Hospital, Istanbul, Turkey
| | - Ahmet Musaoglu
- Department of Urology, VKF American Hospital, Istanbul, Turkey
| | - Tarik Esen
- Department of Urology, VKF American Hospital, Istanbul, Turkey.,Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Mevlana Derya Balbay
- Department of Urology, VKF American Hospital, Istanbul, Turkey.,Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
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Abstract
MR imaging is an important part of prostate cancer diagnosis. Variations in quality and skill in general practice mean results are not as impressive as they were in academic centers. This observation provides an impetus to improve the method. Improved quality assurance will likely result in better outcomes. Improved characterization of clinically significant prostate cancer may assist in making MR imaging more useful. Improved methods of registering MR imaging with transrectal ultrasound imaging and robotic arms controlling the biopsy can reduce the impact of inexperienced operators and make the entire system of MR imaging-guided biopsies more robust.
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Affiliation(s)
- Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B69, Bethesda, MD 20892, USA
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B69, Bethesda, MD 20892, USA.
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Zhang Q, Zang S, Zhang C, Fu Y, Lv X, Zhang Q, Deng Y, Zhang C, Luo R, Zhao X, Wang W, Wang F, Guo H. Comparison of 68Ga-PSMA-11 PET-CT with mpMRI for preoperative lymph node staging in patients with intermediate to high-risk prostate cancer. J Transl Med 2017; 15:230. [PMID: 29115970 PMCID: PMC5688809 DOI: 10.1186/s12967-017-1333-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/20/2017] [Indexed: 01/22/2023] Open
Abstract
Background To evaluate the diagnostic value of 68Ga-PSMA-11 PET-CT with multiparametric magnetic resonance imaging (mpMRI) for lymph node (LN) staging in patients with intermediate- to high-risk prostate cancer (PCa) undergoing radical prostatectomy (RP) with pelvic lymph node dissection (PLND). Methods We retrospectively identified 42 consecutive patients with intermediate- to high-risk PCa according to D′Amico and without concomitant cancer. Preoperative 68Ga-PSMA-11 PET-CT, pelvic mpMRI and subsequent robot assisted laparoscopic RP with PLND were performed in all patients. Results Among 42 patients assessed, the preoperative PSA value, Gleason score, pT stage and intraprostatic PCa volume of patients with LN metastases were all significantly higher than those without metastases (P = 0.029, 0.028, 0.004, respectively). The average maximum standardized uptake value (SUV) of 68Ga-PSMA-11 PET-CT positive PCa of patients with or without LN metastases were 13.10 (range 6.12–51.75) and 7.22 (range 5.4–11.2), respectively (P < 0.001). 68Ga-PSMA-11 PET-CT and pelvic mpMRI had the ability of succeed on preoperative definite accurate diagnosis and accurate localization of primary PCa in all 42 patients. Fifteen patients (35.71%) had a pN1 stage. 51 positive LN were found. Both 68Ga-PSMA-11 PET-CT and pelvic mpMRI displayed brillient patient-based and region-based sensitivity, specificity, negative predictive value and positive predictive value. There was no statistical difference for the detection of LNMs according to the diameter of the LNMs between 68Ga-PSMA-11 PET-CT and mpMRI in this study. Conclusions Both 68Ga-PSMA-11 PET-CT and mpMRI performed great value for LN staging in patients with intermediate- to high-risk PCa undergoing RP with PLND. However, despite excellent performance of 68Ga-PSMA-11 PET-CT, it cannot replace mpMRI that remains excellent for lymph node staging.
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Affiliation(s)
- Qing Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China
| | - Shiming Zang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Chengwei Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China
| | - Yao Fu
- Department of Pathology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Xiaoyu Lv
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China
| | - Qinglei Zhang
- Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Yongming Deng
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China
| | - Chuan Zhang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Rui Luo
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Xiaozhi Zhao
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China
| | - Wei Wang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
| | - Hongqian Guo
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China.
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