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Bruccoliere A, Tran V, Helo N, Awal A, Stroever S, de Riese WTW. Novel clinical risk calculator for improving cancer predictability of mpMRI fusion biopsy in prostates. Int Urol Nephrol 2024:10.1007/s11255-024-04037-1. [PMID: 38578393 DOI: 10.1007/s11255-024-04037-1] [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: 01/18/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Prostate Imaging-Reporting and Data System (PI-RADS) assists in evaluating lesions on multiparametric magnetic resonance imaging (mpMRI), but there are still ongoing efforts in improving the predictive value for the presence of clinically significant PCa (csPCa) with a Gleason grade group ≥ 2 on Fusion-Biopsy. This pilot study intends to propose an easily implementable method for augmenting predictability of csPCa for PI-RADS. METHODS A cohort of 151 consecutive patients underwent mpMRI Fusion and random US Biopsy as a result of having at least one PI-RADS lesion grade 3-5 between January 1, 2019 and December 31, 2022. A single radiologist reads all films in this study applying PI-RADS V2. RESULTS Of the 151 consecutive patients, 49 had a highest lesion of PI-RADS 3, 82 had a highest lesion of PI-RADS 4, and 20 had a highest lesion of PI-RADS 5. For each respective group, 12, 42, and 18 patients had proven csPCa. Two predictive models for csPCa were created by employing a logistical regression with parameters readily available to providers. The models had an AUC of 0.8133 and 0.8206, indicating promising effective models. CONCLUSION PI-RADS classification has relevant predictability problems for grades 3 and 4. By applying the presented risk calculators, patients with PI-RADS 3 and 4 are better stratified, and thus, a significant number of patients can be spared biopsies with potential complications, such as infection and bleeding. The presented predictive models may be a valuable diagnostic tool, adding additional information in the clinical decision-making process for biopsies.
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Affiliation(s)
- Anthony Bruccoliere
- School of Medicine, Department of Urology, Texas Tech University Health Sciences Center, 3601-4 Street STOP 7260, Lubbock, TX, 79430-7260, USA
| | - Vivie Tran
- School of Medicine, Department of Urology, Texas Tech University Health Sciences Center, 3601-4 Street STOP 7260, Lubbock, TX, 79430-7260, USA
| | - Naseem Helo
- Department of Radiology, University Medical Center, Lubbock, TX, 79415, USA
| | - Abdul Awal
- School of Medicine, Texas Tech University Health Sciences Center, Clinical Research Institute, Lubbock, TX, 79415, USA
| | - Stephanie Stroever
- School of Medicine, Texas Tech University Health Sciences Center, Clinical Research Institute, Lubbock, TX, 79415, USA
| | - Werner T W de Riese
- School of Medicine, Department of Urology, Texas Tech University Health Sciences Center, 3601-4 Street STOP 7260, Lubbock, TX, 79430-7260, USA.
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Kwe J, Baunacke M, Boehm K, Platzek I, Thomas C, Borkowetz A. PI-RADS upgrading as the strongest predictor for the presence of clinically significant prostate cancer in patients with initial PI-RADS-3 lesions. World J Urol 2024; 42:84. [PMID: 38363332 PMCID: PMC10873230 DOI: 10.1007/s00345-024-04776-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Unclear lesions on multiparametric magnetic resonance tomography (mpMRI) are challenging for the indication of biopsy in patients with clinical suspicion of prostate cancer (PCa). The aim of this study is the validation of the detection rate of clinically significant PCa (csPCa) in patients with PI-RADS 3 findings and to determine the appropriate follow-up strategy. METHODS In this retrospective single-center study, patients with maximum PI-RADS 3 lesions underwent targeted MRI/ultrasound-fusion biopsy (tPbx) combined with systematic 12-core biopsy (sPbx) and follow-up mpMRI with further control biopsy. We assessed the evolution of MRI findings (PI-RADS, volume of the lesion), clinical parameters and histopathology in follow-up MRI and biopsies. The primary objective is the detection rate of csPCa, defined as ISUP ≥ 2 findings. RESULTS A total of 126 patients (median PSA 6.65 ng/ml; median PSA-density (PSAD) 0.13 ng/ml2) were included. The initial biopsy identified low-risk PCa in 24 cases (19%). During follow-up biopsy, 22.2% of patients showed PI-RADS upgrading (PI-RADS > 3), and 29 patients (23%) exhibited a tumor upgrading. Patients with PI-RADS upgrading had a higher risk of csPCa compared to those without PI-RADS upgrading (42.9% vs. 9.18%, p < 0.05). PI-RADS upgrading was identified as an independent predictor for csPCa in follow-up biopsy (OR 16.20; 95% CI 1.17-224.60; p = 0.038). CONCLUSION Patients with stable PI-RADS 3 findings may not require a follow-up biopsy. Instead, it is advisable to schedule an MRI, considering that PI-RADS upgrading serves as an independent predictor for csPCa.
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Affiliation(s)
- Jeremy Kwe
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Martin Baunacke
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Katharina Boehm
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Ivan Platzek
- Department of Radiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Angelika Borkowetz
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
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Lucarelli NM, Villanova I, Maggialetti N, Greco S, Tarantino F, Russo R, Trabucco SMR, Stabile Ianora AA, Scardapane A. Quantitative ADC: An Additional Tool in the Evaluation of Prostate Cancer? J Pers Med 2023; 13:1378. [PMID: 37763146 PMCID: PMC10533005 DOI: 10.3390/jpm13091378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Prostate cancer is one of the most common tumors among the male population. Magnetic resonance imaging (MRI), standardized by the PI-RADS version 2.1 scoring system, has a fundamental role in detecting prostate cancer and evaluating its aggressiveness. Diffusion-weighted imaging sequences and apparent diffusion coefficient values, in particular, are considered fundamental for the detection and characterization of lesions. In 2016 the International Society of Urological Pathology introduced a new anatomopathological 5-grade scoring system for prostate cancer. The aim of this study is to evaluate the correlation between quantitative apparent diffusion coefficient values (ADC) derived from diffusion-weighted imaging (DWI) sequences and the International Society of Urological Pathology (ISUP) and PI-RADS groups. Our retrospective study included 143 patients with 154 suspicious lesions, observed on prostate magnetic resonance imaging and compared with the histological results of the biopsy. We observed that ADC values can aid in discriminating between not clinically significant (ISUP 1) and clinically significant (ISUP 2-5) prostate cancers. In fact, ADC values were lower in ISUP 5 lesions than in negative lesions. We also found a correlation between ADC values and PI-RADS groups; we noted lower ADC values in the PI-RADS 5 and PI-RADS 4 groups than in the PI-RADS 3 group. In conclusion, quantitative apparent diffusion coefficient values can be useful to assess the aggressiveness of prostate cancer.
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Affiliation(s)
- Nicola Maria Lucarelli
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.M.L.); (I.V.); (N.M.); (S.G.); (R.R.); (A.A.S.I.); (A.S.)
| | - Ilaria Villanova
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.M.L.); (I.V.); (N.M.); (S.G.); (R.R.); (A.A.S.I.); (A.S.)
| | - Nicola Maggialetti
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.M.L.); (I.V.); (N.M.); (S.G.); (R.R.); (A.A.S.I.); (A.S.)
| | - Sara Greco
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.M.L.); (I.V.); (N.M.); (S.G.); (R.R.); (A.A.S.I.); (A.S.)
| | - Francesca Tarantino
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.M.L.); (I.V.); (N.M.); (S.G.); (R.R.); (A.A.S.I.); (A.S.)
| | - Roberto Russo
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.M.L.); (I.V.); (N.M.); (S.G.); (R.R.); (A.A.S.I.); (A.S.)
| | - Senia Maria Rosaria Trabucco
- Section of Molecular Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Amato Antonio Stabile Ianora
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.M.L.); (I.V.); (N.M.); (S.G.); (R.R.); (A.A.S.I.); (A.S.)
| | - Arnaldo Scardapane
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.M.L.); (I.V.); (N.M.); (S.G.); (R.R.); (A.A.S.I.); (A.S.)
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Pachetti E, Colantonio S. 3D-Vision-Transformer Stacking Ensemble for Assessing Prostate Cancer Aggressiveness from T2w Images. Bioengineering (Basel) 2023; 10:1015. [PMID: 37760117 PMCID: PMC10525095 DOI: 10.3390/bioengineering10091015] [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: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/20/2023] [Indexed: 09/29/2023] Open
Abstract
Vision transformers represent the cutting-edge topic in computer vision and are usually employed on two-dimensional data following a transfer learning approach. In this work, we propose a trained-from-scratch stacking ensemble of 3D-vision transformers to assess prostate cancer aggressiveness from T2-weighted images to help radiologists diagnose this disease without performing a biopsy. We trained 18 3D-vision transformers on T2-weighted axial acquisitions and combined them into two- and three-model stacking ensembles. We defined two metrics for measuring model prediction confidence, and we trained all the ensemble combinations according to a five-fold cross-validation, evaluating their accuracy, confidence in predictions, and calibration. In addition, we optimized the 18 base ViTs and compared the best-performing base and ensemble models by re-training them on a 100-sample bootstrapped training set and evaluating each model on the hold-out test set. We compared the two distributions by calculating the median and the 95% confidence interval and performing a Wilcoxon signed-rank test. The best-performing 3D-vision-transformer stacking ensemble provided state-of-the-art results in terms of area under the receiving operating curve (0.89 [0.61-1]) and exceeded the area under the precision-recall curve of the base model of 22% (p < 0.001). However, it resulted to be less confident in classifying the positive class.
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Affiliation(s)
- Eva Pachetti
- “Alessandro Faedo” Institute of Information Science and Technologies (ISTI), National Research Council of Italy (CNR), 56127 Pisa, Italy;
- Department of Information Engineering (DII), University of Pisa, 56122 Pisa, Italy
| | - Sara Colantonio
- “Alessandro Faedo” Institute of Information Science and Technologies (ISTI), National Research Council of Italy (CNR), 56127 Pisa, Italy;
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Nicola R, Bittencourt LK. PI-RADS 3 lesions: a critical review and discussion of how to improve management. Abdom Radiol (NY) 2023; 48:2401-2405. [PMID: 37160472 DOI: 10.1007/s00261-023-03929-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/11/2023]
Abstract
Since the publication of PI-RADS v1 in 2012, the debate regarding the question of how to manage PI-RADS 3 lesions has been mostly unsolved. However, based on our review of the current literature we discuss possible solutions and improvements to the original classification, factors such as PSAD (Prostate Specific Antigen Density), age, and tumor volume, in the decision of whether to proceed with a biopsy or not.
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Affiliation(s)
- Refky Nicola
- Division of Abdominal Radiology, SUNY-Upstate Medical University, 750 East Adams St, Syracuse, NY, 13210, USA.
| | - Leonardo Kayat Bittencourt
- School of Medicine, Abdominal Imaging, Case Western University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
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Woernle A, Dickinson L, Lelie S, Pendse D, Heffernan Ho D, Ramachandran N, Kirkham A, Von Stempel C, Punwani S, Wah So C, Withington J, Grey A, Collins T, Maffei D, Haider A, Freeman A, Emberton M, Piper JW, Moore CM, Hines J, Orczyk C, Allen C, Giganti F. A semi-automated software program to assess the impact of second reads in prostate MRI for equivocal lesions: results from a UK tertiary referral centre. Eur J Radiol 2023; 162:110796. [PMID: 37003197 DOI: 10.1016/j.ejrad.2023.110796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023]
Abstract
PURPOSE To investigate the utility of a prostate magnetic resonance imaging (MRI) second read using a semi-automated software program in the one-stop clinic, where patients undergo multiparametric MRI, review and biopsy planning in one visit. We looked at concordance between readers for patients with equivocal scans and the possibility for biopsy deferral in this group. METHODS We present data from 664 consecutive patients. Scans were reported by seven different expert genitourinary radiologists using dedicated software (MIM®) and a Likert scale. All scans were rescored by another expert genitourinary radiologist using a customised workflow for second reads that includes annotated biopsy contours for accurate visual targeting. The number of scans in which a biopsy could have been deferred using biopsy results and prostate specific antigen density was assessed. Gleason score ≥ 3 + 4 was considered clinically significant disease. Concordance between first and second reads for equivocal scans (Likert 3) was evaluated. RESULTS A total of 209/664 (31%) patients scored Likert 3 on first read, 128 of which (61%) were concordant after second read. 103/209 (49%) of patients with Likert 3 scans were biopsied, with clinically significant disease in 31 (30%) cases. Considering Likert 3 scans that were both downgraded and biopsied using the workflow-generated biopsy contours, 25/103 (24%) biopsies could have been deferred. CONCLUSIONS Implementing a semi-automated workflow for accurate lesion contouring and targeting biopsies is helpful during the one-stop clinic. We observed a reduction of indeterminate scans after second reading and almost a quarter of biopsies could have been deferred, reducing the potential biopsy-related side effects.
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Affiliation(s)
- Alexandre Woernle
- Faculty of Medical Sciences, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Louise Dickinson
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | | | - Doug Pendse
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Daniel Heffernan Ho
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Navin Ramachandran
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Conrad Von Stempel
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Centre for Medical Imaging, University College London, London, UK
| | - Chun Wah So
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - John Withington
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | - Alistair Grey
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | - Thomas Collins
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | - Davide Maffei
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Aiman Haider
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | | | - Caroline M Moore
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | - John Hines
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; North East London Cancer Alliance & North Central London Cancer Alliance Urology, London, UK
| | - Clément Orczyk
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK.
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Clevert DA, Beyer G, Nieß H, Schlenker B. Ultrasound-New Techniques Are Extending the Applications. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:41-47. [PMID: 36519209 DOI: 10.3238/arztebl.m2022.0380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/16/2022] [Accepted: 11/14/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Sonography is often the first imaging procedure to be used in diagnostic investigation of the abdomen. The aim of this article is to provide a new interdisciplinary overview of recent groundbreaking advances in this modality. METHODS A selective survey of the literature in PubMed was conducted. The literature search was carried out in 2021-2022 and included publications over the period 2004-2022. RESULTS The novel sonographic software techniques can be divided into algorithms that deal with conventional B-scan optimization and new programs that extend the scope of sonographic examination. The latter include elastography, contrast-enhanced sonography, and image fusion in combination with other cross-sectional imaging modalities. Elastography can be used to assess the presence of steatosis, fibrosis, or cirrhosis in patients with liver disease. One study reported diagnostic accuracy of 84-87% for the diagnosis of significant fibrosis (F2), 89-91% for the diagnosis of severe fibrosis (F3), and 92-93% for the diagnosis of liver cirrhosis (F4). Contrast-enhanced sonography is used for evaluation of tumors and trauma. A prospective multicenter study found sensitivity of 95.8% for the characterization of malignant lesions and specificity of 83.1% for benign lesions. Image fusion has the potential to improve the diagnostic assessment of parenchymatous organs, vascular conditions, and the prostate. CONCLUSION With continuous improvement of the B-scan and the development of high-frequency probes and novel investigation techniques, sonography has become established as an increasingly autonomous examination procedure.
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Affiliation(s)
- Dirk-André Clevert
- Department of Radiology, Interdisciplinary Ultrasound-Center, University Hospital of Ludwig-Maximilians-Universität Munich, Germany; Medical Department III,Interdisciplinary Ultrasound-Center, University Hospital of Ludwig-Maximilians-Universität Munich, Germany; Department of General, Visceral and Transplantation Surgery, University Hospital of Ludwig-Maximilians-Universität Munich, Germany; University Hospital of Ludwig-Maximilians-Universität Munich, 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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Huang C, Qiu F, Jin D, Wei X, Chen Z, Wang X, Zhao X, Guo L, Pu J, Hou J, Huang Y. New Diagnostic Model for Clinically Significant Prostate Cancer in Biopsy-Naïve Men With PIRADS 3. Front Oncol 2022; 12:908956. [PMID: 35860546 PMCID: PMC9289138 DOI: 10.3389/fonc.2022.908956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThe aim of this study was to explore a new model of clinical decision-making to predict the occurrence of clinically significant prostate cancer (csPCa).Patients and MethodsThe demographic and clinical characteristics of 152 patients were recorded. Prostate-specific antigen (PSA), PSA density (PSAD), adjusted PSAD of peripheral zone (aPSADPZ), and peripheral zone volume ratio (PZ ratio) were calculated and subjected to receiver operating characteristic (ROC) curve analysis. The calibration and discrimination abilities of new nomograms were verified with calibration curve and area under the ROC curve (AUC). The clinical benefits of these models were evaluated by decision curve analysis and clinical impact curves.ResultsThe AUCs of PSA, PSAD, aPSADPZ, and PZ ratio were 0.521, 0.645, 0.745, and 0.717 for prostate cancer (PCa) diagnosis, while the corresponding values were 0.590, 0.678, 0.780, and 0.731 for csPCa diagnosis, respectively. All nomograms displayed higher net benefit and better overall calibration than the scenarios for predicting the occurrence of csPCa. The new model significantly improved the diagnostic accuracy of csPCa (0.865 vs. 0.741, p = 0.0284) compared with the base model. In addition, the new model was better than the base model for predicting csPCa in the low or medium probability while the number of patients with csPCa predicted by the new model was in good agreement with the actual number of patients with csPCa in the high-risk threshold.ConclusionsThis study demonstrates that aPSADPZ has a higher predictive accuracy for csPCa diagnosis than the conventional indicators. Including aPSADPZ, PZ ratio, and age can improve csPCa diagnosis and avoid unnecessary biopsies.
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Affiliation(s)
- Chen Huang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Qiu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Di Jin
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuedong Wei
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zongxin Chen
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ximing Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaojun Zhao
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Linchuan Guo
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jinxian Pu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianquan Hou
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuhua Huang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Yuhua Huang,
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Considering Predictive Factors in the Diagnosis of Clinically Significant Prostate Cancer in Patients with PI-RADS 3 Lesions. Life (Basel) 2021; 11:life11121432. [PMID: 34947963 PMCID: PMC8708599 DOI: 10.3390/life11121432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
The use of multi-parametric magnetic resonance imaging (mpMRI) in conjunction with the Prostate Imaging Reporting and Data System (PI-RADS) is standard practice in the diagnosis, surveillance, and staging of prostate cancer. The risk associated with lesions graded at a PI-RADS score of 3 is ambiguous. Further characterization of the risk associated with PI-RADS 3 lesions would be useful in guiding further work-up and intervention. This study aims to better characterize the utility of PI-RADS 3 and associated risk factors in detecting clinically significant prostate cancer. From a prospectively maintained IRB-approved dataset of all veterans undergoing mpMRI fusion biopsy at the Southeastern Louisiana Veterans Healthcare System, we identified a cohort of 230 PI-RADS 3 lesions from a dataset of 283 consecutive UroNav-guided biopsies in 263 patients from October 2017 to July 2020. Clinically significant prostate cancer (Gleason Grade ≥ 2) was detected in 18 of the biopsied PI-RADS 3 lesions, representing 7.8% of the overall sample. Based on binomial analysis, PSA densities of 0.15 or greater were predictive of clinically significant disease, as was PSA. The location of the lesion within the prostate was not shown to be a statistically significant predictor of prostate cancer overall (p = 0.87), or of clinically significant disease (p = 0.16). The majority of PI-RADS 3 lesions do not represent clinically significant disease; therefore, it is possible to reduce morbidity through biopsy. PSA density is a potential adjunctive factor in deciding which patients with PI-RADS 3 lesions require biopsy. Furthermore, while the risk of prostate cancer for African-American men has been debated in the literature, our findings indicate that race is not predictive of identifying prostate cancer, with comparable Gleason grade distributions on histology between races.
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Lee CH, Tan TW, Tan CH. Multiparametric MRI in Active Surveillance of Prostate Cancer: An Overview and a Practical Approach. Korean J Radiol 2021; 22:1087-1099. [PMID: 33856136 PMCID: PMC8236356 DOI: 10.3348/kjr.2020.1224] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/08/2020] [Accepted: 01/08/2021] [Indexed: 12/26/2022] Open
Abstract
MRI has become important for the detection of prostate cancer. MRI-guided biopsy is superior to conventional systematic biopsy in patients suspected with prostate cancer. MRI is also increasingly used for monitoring patients with low-risk prostate cancer during active surveillance. It improves patient selection for active surveillance at diagnosis, although its role during follow-up is unclear. We aim to review existing evidence and propose a practical approach for incorporating MRI into active surveillance protocols.
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Affiliation(s)
- Chau Hung Lee
- Department of Radiology, Tan Tock Seng Hospital, Singapore
| | - Teck Wei Tan
- Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Cher Heng Tan
- Department of Radiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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Combination of Peri-Tumoral and Intra-Tumoral Radiomic Features on Bi-Parametric MRI Accurately Stratifies Prostate Cancer Risk: A Multi-Site Study. Cancers (Basel) 2020; 12:cancers12082200. [PMID: 32781640 PMCID: PMC7465024 DOI: 10.3390/cancers12082200] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Prostate cancer (PCa) influences its surrounding habitat, which tends to manifest as different phenotypic appearances on magnetic resonance imaging (MRI). This region surrounding the PCa lesion, or the peri-tumoral region, may encode useful information that can complement intra-tumoral information to enable better risk stratification. Purpose: To evaluate the role of peri-tumoral radiomic features on bi-parametric MRI (T2-weighted and Diffusion-weighted) to distinguish PCa risk categories as defined by D’Amico Risk Classification System. Materials and Methods: We studied a retrospective, HIPAA-compliant, 4-institution cohort of 231 PCa patients (n = 301 lesions) who underwent 3T multi-parametric MRI prior to biopsy. PCa regions of interest (ROIs) were delineated on MRI by experienced radiologists following which peri-tumoral ROIs were defined. Radiomic features were extracted within the intra- and peri-tumoral ROIs. Radiomic features differentiating low-risk from: (1) high-risk (L-vs.-H), and (2) (intermediate- and high-risk (L-vs.-I + H)) lesions were identified. Using a multi-institutional training cohort of 151 lesions (D1, N = 116 patients), machine learning classifiers were trained using peri- and intra-tumoral features individually and in combination. The remaining 150 lesions (D2, N = 115 patients) were used for independent hold-out validation and were evaluated using Receiver Operating Characteristic (ROC) analysis and compared with PI-RADS v2 scores. Results: Validation on D2 using peri-tumoral radiomics alone resulted in areas under the ROC curve (AUCs) of 0.84 and 0.73 for the L-vs.-H and L-vs.-I + H classifications, respectively. The best combination of intra- and peri-tumoral features resulted in AUCs of 0.87 and 0.75 for the L-vs.-H and L-vs.-I + H classifications, respectively. This combination improved the risk stratification results by 3–6% compared to intra-tumoral features alone. Our radiomics-based model resulted in a 53% accuracy in differentiating L-vs.-H compared to PI-RADS v2 (48%), on the validation set. Conclusion: Our findings suggest that peri-tumoral radiomic features derived from prostate bi-parametric MRI add independent predictive value to intra-tumoral radiomic features for PCa risk assessment.
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Kızılay F, Çelik S, Sözen S, Özveren B, Eskiçorapçı S, Özgen M, Özen H, Akdoğan B, Aslan G, Narter F, Çal Ç, Türkeri L. Correlation of Prostate-Imaging Reporting and Data Scoring System scoring on multiparametric prostate magnetic resonance imaging with histopathological factors in radical prostatectomy material in Turkish prostate cancer patients: a multicenter study of the Urooncology Association. Prostate Int 2020; 8:10-15. [PMID: 32257972 PMCID: PMC7125386 DOI: 10.1016/j.prnil.2020.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/20/2019] [Accepted: 01/06/2020] [Indexed: 12/30/2022] Open
Abstract
Background Histopathological features after radical prostatectomy (RP) provide important information for the prognosis of prostate cancer (PCa). The possible correlations between Prostate-Imaging Reporting and Data Scoring System (PIRADS) scores in multiparametric magnetic resonance imaging (mpMRI) may also be predictive for prognosis. In this study, we aimed to evaluate the correlation of PIRADS scores with histopathological data. Methods A total of 177 patients who underwent preoperative mpMRI and RP for PCa from eight institutions were included in the study. Correlation of PIRADS score in preoperative mpMRI with adverse histopathological factors in RP specimen was investigated using univariate and multivariate analyses. Results The relationship between PIRADS score and postoperative extracapsular extension, lymphovascular invasion, and seminal vesicle involvement was significant (P < 0.001, P = 0.032, and P = 0.007, respectively). Although the PIRADS score was significantly correlated with the number of dissected lymph nodes (p = 0.026), it had no significant correlation with the number of positive nodes (P = 0.611). Total Gleason score, extracapsular extension, seminal vesicle invasion, and number of lymph nodes were found to be independent factors, which correlated with high PIRADS scores in ordinal logistic regression analysis. Conclusion PIRADS scoring system in mpMRI showed a statistically significant correlation with adverse histopathological factors in RP specimen. A higher PIRADS score may help to predict a higher Gleason score, indicating clinically important PCa as well as poor prognotic factors such as extracapsular extension, lymphovascular invasion, and seminal vesicle invasion that may indicate a higher risk of recurrence and the need for additional treatment.
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Affiliation(s)
- Fuat Kızılay
- Ege University, Department of Urology, Izmir, Turkey
| | - Serdar Çelik
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Izmir, Turkey
| | - Sinan Sözen
- Gazi University, Department of Urology, Ankara, Turkey
| | | | | | | | - Haluk Özen
- Hacettepe University, Department of Urology, Ankara, Turkey
| | - Bülent Akdoğan
- Hacettepe University, Department of Urology, Ankara, Turkey
| | - Güven Aslan
- Dokuz Eylül University, Department of Urology, Izmir, Turkey
| | | | - Çağ Çal
- Ege University, Department of Urology, Izmir, Turkey
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Chaloupka M, Bischoff R, Pfitzinger P, Lellig E, Ledderose S, Buchner A, Schlenker B, Stief C, Clevert DA, Apfelbeck M. Detection of Gleason 6 prostate cancer in patients with clinically significant prostate cancer on multiparametric magnetic resonance imaging. Clin Hemorheol Microcirc 2019; 73:105-111. [DOI: 10.3233/ch-199223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- M. Chaloupka
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - R. Bischoff
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - P. Pfitzinger
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - E. Lellig
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - S. Ledderose
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - A. Buchner
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - B. Schlenker
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - C. Stief
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - D.-A. Clevert
- Department of Clinical Radiology, Interdisciplinary Ultrasound-Center, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - M. Apfelbeck
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
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