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Patel KR, van der Heide UA, Kerkmeijer LGW, Schoots IG, Turkbey B, Citrin DE, Hall WA. Target Volume Optimization for Localized Prostate Cancer. Pract Radiat Oncol 2024:S1879-8500(24)00148-6. [PMID: 39019208 DOI: 10.1016/j.prro.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/17/2024] [Accepted: 06/26/2024] [Indexed: 07/19/2024]
Abstract
Historically, the treatment of prostate cancer has required little anatomic information beyond the location of the prostate gland and adjacent seminal vesicles. Radiation therapy has classically been prescribed to the whole prostate due to the high frequency of multifocal cancer in surgical specimens and the inability to localize the precise boundaries of individual tumor foci on imaging. The development of prostate magnetic resonance imaging (MRI) and positron emission tomography (PET) using prostate-specific radiotracers has ushered in an era in which radiation oncologists are able to localize and focally dose-escalate high-risk volumes in the prostate gland. Recent phase III data have demonstrated that incorporating focal dose escalation improves biochemical control without significantly increasing toxicity. However, many questions remain regarding the optimal target volume definition and prescription strategy to implement this practice. In this review we summarize the currently available literature on image-based focal target delineation with MRI and PET. Our review includes a summary of the available data on anatomic patterns of spread to inform clinical judgement for the definition of clinical target volumes. Key knowledge gaps are identified and suggestions for novel implementation strategies are provided.
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Affiliation(s)
- Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD.
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivo G Schoots
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - William A Hall
- Froedtert and the Medical College of Wisconsin, Milwaukee, WI
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Duan L, Liu Z, Wan F, Dai B. Advantage of whole-mount histopathology in prostate cancer: current applications and future prospects. BMC Cancer 2024; 24:448. [PMID: 38605339 PMCID: PMC11007899 DOI: 10.1186/s12885-024-12071-6] [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: 11/11/2023] [Accepted: 02/29/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Whole-mount histopathology (WMH) has been a powerful tool to investigate the characteristics of prostate cancer. However, the latest advancement of WMH was yet under summarization. In this review, we offer a comprehensive exposition of current research utilizing WMH in diagnosing and treating prostate cancer (PCa), and summarize the clinical advantages of WMH and outlines potential on future prospects. METHODS An extensive PubMed search was conducted until February 26, 2023, with the search term "prostate", "whole-mount", "large format histology", which was limited to the last 4 years. Publications included were restricted to those in English. Other papers were also cited to contribute a better understanding. RESULTS WMH exhibits an enhanced legibility for pathologists, which improved the efficacy of pathologic examination and provide educational value. It simplifies the histopathological registration with medical images, which serves as a convincing reference standard for imaging indicator investigation and medical image-based artificial intelligence (AI). Additionally, WMH provides comprehensive histopathological information for tumor volume estimation, post-treatment evaluation, and provides direct pathological data for AI readers. It also offers complete spatial context for the location estimation of both intraprostatic and extraprostatic cancerous region. CONCLUSIONS WMH provides unique benefits in several aspects of clinical diagnosis and treatment of PCa. The utilization of WMH technique facilitates the development and refinement of various clinical technologies. We believe that WMH will play an important role in future clinical applications.
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Affiliation(s)
- Lewei Duan
- Department of Urology, Fudan University Shanghai Cancer Center, 200032, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
- Shanghai Genitourinary Cancer Institute, 200032, Shanghai, China
| | - Zheng Liu
- Department of Urology, Fudan University Shanghai Cancer Center, 200032, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
- Shanghai Genitourinary Cancer Institute, 200032, Shanghai, China
| | - Fangning Wan
- Department of Urology, Fudan University Shanghai Cancer Center, 200032, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China.
- Shanghai Genitourinary Cancer Institute, 200032, Shanghai, China.
| | - Bo Dai
- Department of Urology, Fudan University Shanghai Cancer Center, 200032, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China.
- Shanghai Genitourinary Cancer Institute, 200032, Shanghai, China.
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Marinescu IM, Spohn SKB, Kiefer S, Bronsert P, Ceci L, Holzschuh J, Sigle A, Jilg CA, Rühle A, Sprave T, Nicolay NH, Winzer R, Rehm J, Kotzerke J, Hölscher T, Grosu AL, Ruf J, Benndorf M, Zamboglou C. Intraindividual Comparison Between [18F] PSMA-1007 PET/CT and Multiparametric MRI for Radiotherapy Planning in Primary Prostate Cancer Patients. Front Oncol 2022; 12:880042. [PMID: 35912219 PMCID: PMC9329567 DOI: 10.3389/fonc.2022.880042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/25/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Accurate detection and segmentation of the intraprostatic gross tumor volume (GTV) is pivotal for radiotherapy (RT) in primary prostate cancer (PCa) since it influences focal therapy target volumes and the patients’ cT stage. The study aimed to compare the performance of multiparametric resonance imaging (mpMRI) with [18F] PSMA-1007 positron emission tomography (PET) for intraprostatic GTV detection as well as delineation and to evaluate their respective influence on RT concepts. Materials and Methods In total, 93 patients from two German University Hospitals with [18F] PSMA-1007-PET/CT and MRI (Freiburg) or [18F] PSMA-1007-PET/MRI (Dresden) were retrospectively enrolled. Validated contouring techniques were applied for GTV-PET and -MRI segmentation. Absolute tumor volume and cT status were determined for each imaging method. The PCa distribution from histopathological reports based on biopsy cores and surgery specimen was used as reference in terms of laterality (unilateral vs. bilateral). Results In the Freiburg cohort (n = 84), mpMRI and PET detected in median 2 (range: 1–5) and 3 (range: 1–8) GTVs, respectively (p < 0.01). The median GTV-MRI was significantly smaller than the GTV-PET, measuring 2.05 vs. 3.65 ml (p = 0.0005). PET had a statistically significant higher concordance in laterality with surgery specimen compared to mpMRI (p = 0.04) and biopsy (p < 0.01), respectively. PSMA PET led to more cT2c and cT3b stages, whereas cT3a stage was more pronounced in mpMRI. Based on the cT stage derived from mpMRI and PET information, 21 and 23 as well as 59 and 60 patients, respectively, were intermediate- and high-risk according to the National Comprehensive Cancer Network (NCCN) v1.2022 criteria. In the Dresden cohort (n = 9), similar results were observed. Conclusion Intraprostatic GTV segmentation based on [18F] PSMA-1007 PET results in more and larger GTVs compared to mpMRI. This influences focal RT target volumes and cT stage definition, but not the NCCN risk group.
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Affiliation(s)
- Ioana M. Marinescu
- Department of Radiation Oncology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg im Breisgau, Germany
- *Correspondence: Ioana M. Marinescu,
| | - Simon K. B. Spohn
- Department of Radiation Oncology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg im Breisgau, Germany
| | - Selina Kiefer
- Institute for Surgical Pathology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Peter Bronsert
- Institute for Surgical Pathology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Lara Ceci
- Department of Radiation Oncology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg im Breisgau, Germany
| | - Julius Holzschuh
- Department of Radiation Oncology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg im Breisgau, Germany
| | - August Sigle
- Department of Urology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Cordula A. Jilg
- Department of Urology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Alexander Rühle
- Department of Radiation Oncology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg im Breisgau, Germany
| | - Tanja Sprave
- Department of Radiation Oncology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg im Breisgau, Germany
| | - Nils H. Nicolay
- Department of Radiation Oncology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg im Breisgau, Germany
| | - Robert Winzer
- Department of Nuclear Medicine, Faculty of Medicine, University of Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, Dresden, Germany
| | - Jana Rehm
- Department of Nuclear Medicine, Faculty of Medicine, University of Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, Dresden, Germany
| | - Jörg Kotzerke
- Department of Nuclear Medicine, Faculty of Medicine, University of Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, Dresden, Germany
| | - Tobias Hölscher
- German Cancer Consortium (DKTK), Partner Site Dresden, Dresden, Germany
- Department of Radiation Oncology, Faculty of Medicine, University of Dresden, Dresden, Germany
| | - Anca L. Grosu
- Department of Radiation Oncology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg im Breisgau, Germany
| | - Juri Ruf
- Department of Nuclear Medicine, Medical Center—University of Freiburg, University of Freiburg, Faculty of Medicine, Freiburg im Breisgau, Germany
| | - Matthias Benndorf
- Department of Radiology, Medical Center—University of Freiburg, University of Freiburg, Faculty of Medicine, Freiburg im Breisgau, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg im Breisgau, Germany
- Tumorbank Comprehensive Cancer Center Freiburg, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- German Oncology Center, European University Cyprus, Limassol, Cyprus
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Giganti F, Allen C, Stavrinides V, Stabile A, Haider A, Freeman A, Pashayan N, Punwani S, Emberton M, Moore CM, Kirkham A. Tumour growth rates of prostate cancer during active surveillance: is there a difference between MRI-visible low and intermediate-risk disease? Br J Radiol 2022; 95:20210321. [PMID: 34233491 PMCID: PMC8978245 DOI: 10.1259/bjr.20210321] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the changes in lesion volume on serial multiparametric magnetic resonance (mpMRI) during active surveillance for prostate cancer. METHODS A total of 160 patients with a targeted biopsy-confirmed visible lesion on mpMRI, stratified by low- and intermediate-risk disease (Gleason Grade Group 1 vs Gleason Grade Group 2), were analysed. The % change per year was calculated using the formula: [(final volume/initial volume) exp (1/interval between scans in years)]-1. RESULTS There was no significant difference in the annual median percentage change between Gleason Grade Group 1 (18%) and Gleason Grade Group 2 (23%) disease (p = 0.16), and between ≤ 10% (23%) and > 10% (22%) of Gleason pattern 4 (p = 0.78).Assuming a spherical lesion, these changes corresponded to annual increases in mean tumour diameter of 6% and 7% for Gleason Grade Group 1 and Gleason Grade Group 2 respectively, which may be less than the interscan variability of serial mpMRI. CONCLUSION In an active surveillance cohort, we did not see a significant difference in the annual growth rate of Gleason Grade Group 1 and 2 tumours. ADVANCES IN KNOWLEDGE In patients on active surveillance, the measured growth rates for visible tumours in Gleason Grade Groups 1 and 2 were similar. The annual growth rate was small in most cases and this may have implications for the MRI follow-up interval in active surveillance.
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Affiliation(s)
| | - Clare Allen
- Department of Radiology, 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
| | - Nora Pashayan
- Department of Applied Health Research, University College London, London, UK
| | | | - Mark Emberton
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | | | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
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Zamboglou C, Spohn SKB, Adebahr S, Huber M, Kirste S, Sprave T, Gratzke C, Chen RC, Carl EG, Weber WA, Mix M, Benndorf M, Wiegel T, Baltas D, Jenkner C, Grosu AL. PSMA-PET/MRI-Based Focal Dose Escalation in Patients with Primary Prostate Cancer Treated with Stereotactic Body Radiation Therapy (HypoFocal-SBRT): Study Protocol of a Randomized, Multicentric Phase III Trial. Cancers (Basel) 2021; 13:cancers13225795. [PMID: 34830950 PMCID: PMC8616152 DOI: 10.3390/cancers13225795] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/08/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023] Open
Abstract
Technical advances in radiotherapy (RT) treatment planning and delivery have substantially changed RT concepts for primary prostate cancer (PCa) by (i) enabling a reduction of treatment time, and by (ii) enabling safe delivery of high RT doses. Several studies proposed a dose-response relationship for patients with primary PCa and especially in patients with high-risk features, as dose escalation leads to improved tumor control. In parallel to the improvements in RT techniques, diagnostic imaging techniques like multiparametric magnetic resonance imaging (mpMRI) and positron-emission tomography targeting prostate-specific-membrane antigen (PSMA-PET) evolved and enable an accurate depiction of the intraprostatic tumor mass for the first time. The HypoFocal-SBRT study combines ultra-hypofractionated RT/stereotactic body RT, with focal RT dose escalation on intraprostatic tumor sides by applying state of the art diagnostic imaging and most modern RT concepts. This novel strategy will be compared with moderate hypofractionated RT (MHRT), one option for the curative primary treatment of PCa, which has been proven by several prospective trials and is recommended and carried out worldwide. We suspect an increase in relapse-free survival (RFS), and we will assess quality of life in order to detect potential changes.
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Affiliation(s)
- Constantinos Zamboglou
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.Z.); (S.A.); (S.K.); (T.S.); (A.L.G.)
- German Cancer Consortium (DKTK), Partner Site Freiburg, 79106 Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany
- German Oncology Center, European University of Cyprus, Limassol 4108, Cyprus
| | - Simon K. B. Spohn
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.Z.); (S.A.); (S.K.); (T.S.); (A.L.G.)
- German Cancer Consortium (DKTK), Partner Site Freiburg, 79106 Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany
- Correspondence:
| | - Sonja Adebahr
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.Z.); (S.A.); (S.K.); (T.S.); (A.L.G.)
- German Cancer Consortium (DKTK), Partner Site Freiburg, 79106 Freiburg, Germany
| | - Maria Huber
- Clinical Trials Unit, Faculty of Medicine, Medical Center, University of Freiburg, 79110 Freiburg, Germany; (M.H.); (C.J.)
| | - Simon Kirste
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.Z.); (S.A.); (S.K.); (T.S.); (A.L.G.)
- German Cancer Consortium (DKTK), Partner Site Freiburg, 79106 Freiburg, Germany
| | - Tanja Sprave
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.Z.); (S.A.); (S.K.); (T.S.); (A.L.G.)
- German Cancer Consortium (DKTK), Partner Site Freiburg, 79106 Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany;
| | - Ronald C. Chen
- Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS 66160, USA;
| | | | - Wolfgang A. Weber
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany;
| | - Michael Mix
- Department of Nuclear Medicine, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany;
| | - Matthias Benndorf
- Department of Radiology, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany;
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, 89081 Ulm, Germany;
| | - Dimos Baltas
- Division of Medical Physics, Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Carolin Jenkner
- Clinical Trials Unit, Faculty of Medicine, Medical Center, University of Freiburg, 79110 Freiburg, Germany; (M.H.); (C.J.)
| | - Anca L. Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.Z.); (S.A.); (S.K.); (T.S.); (A.L.G.)
- German Cancer Consortium (DKTK), Partner Site Freiburg, 79106 Freiburg, Germany
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