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Multiparametric MRI for Staging of Prostate Cancer: A Multicentric Analysis of Predictive Factors to Improve Identification of Extracapsular Extension before Radical Prostatectomy. Cancers (Basel) 2022; 14:cancers14163966. [PMID: 36010963 PMCID: PMC9406654 DOI: 10.3390/cancers14163966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/29/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary In this multicentric study, we tested the accuracy of multiparametric magnetic resonance imaging (mpMRI) in detecting extracapsular extension (ECE) out of the prostate in order to plan surgical sparing of neurovascular bundles in radical prostatectomy. Univariate and multivariate logistic regression analyses were performed to identify other risk factors for ECE. We found that it has a good ability to exclude extracapsular extension but a poor ability to identify it correctly. Risk factors other than mpMRI that predicted ECE were as follows: prostatic specific antigen, digital rectal examination, ratio of positive cores, and biopsy grade group. We suggest that using mpMRI exclusively should not be recommended to decide on surgical approaches. Abstract The correct identification of extracapsular extension (ECE) of prostate cancer (PCa) on multiparametric magnetic resonance imaging (mpMRI) is crucial for surgeons in order to plan the nerve-sparing approach in radical prostatectomy. Nerve-sparing strategies allow for better outcomes in preserving erectile function and urinary continence, notwithstanding this can be penalized with worse oncologic results. The aim of this study was to assess the ability of preoperative mpMRI to predict ECE in the final prostatic specimen (PS) and identify other possible preoperative predictive factors of ECE as a secondary end-point. We investigated a database of two high-volume hospitals to identify men who underwent a prostate biopsy with a pre-biopsy mpMRI and a subsequent RP. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI in predicting ECE were calculated. A univariate analysis was performed to find the association between image staging and pathological staging. A multivariate logistic regression was performed to investigate other preoperative predictive factors. A total of 1147 patients were selected, and 203 out of the 1147 (17.7%) patients were classified as ECE according to the mpMRI. ECE was reported by pathologists in 279 out of the 1147 PS (24.3%). The PPV was 0.58, the NPV was 0.72, the sensitivity was 0.32, and the specificity was 0.88. The multivariate analysis found that PSA (OR 1.057, C.I. 95%, 1.016–1.100, p = 0.006), digital rectal examination (OR 0.567, C.I. 95%, 0.417–0.770, p = 0.0001), ratio of positive cores (OR 9.687, C.I. 95%, 3.744–25.006, p = 0.0001), and biopsy grade in prostate biopsy (OR 1.394, C.I. 95%, 1.025–1.612, p = 0.0001) were independent factors of ECE. The mpMRI has a great ability to exclude ECE, notwithstanding that low sensitivity is still an important limitation of the technique.
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Michael J, Neuzil K, Altun E, Bjurlin MA. Current Opinion on the Use of Magnetic Resonance Imaging in Staging Prostate Cancer: A Narrative Review. Cancer Manag Res 2022; 14:937-951. [PMID: 35256864 PMCID: PMC8898014 DOI: 10.2147/cmar.s283299] [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: 09/09/2021] [Accepted: 02/10/2022] [Indexed: 12/02/2022] Open
Abstract
Accurate staging is critical for treatment planning and prognosis in men with prostate Cancer. Prostate magnetic imaging resonance (MRI) may aid in the staging evaluation by verifying organ-confined status, assessing the status of the pelvic lymph nodes, and establishing the local extent of the tumor in patients being considered for therapy. MRI has a high specificity for diagnosing extracapsular extension, and therefore may impact the decision to perform nerve sparing prostatectomy, along with seminal vesicle invasion and lymph node metastases; however, its sensitivity remains limited. Current guidelines vary significantly regarding endorsing the use of MRI for staging locoregional disease. For high-risk prostate cancer, most guidelines recommend cross sectional imaging, including MRI, to evaluate for more extensive disease that may merit change in radiation field, extended androgen deprivation therapy, or guiding surgical planning. Although MRI offers reasonable performance characteristics to evaluate bone metastases, guidelines continue to support the use of bone scintigraphy. Emerging imaging technologies, including coupling positron emission tomography (PET) with MRI, have the potential to improve the accuracy of prostate cancer staging with the use of novel radiotracers.
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Affiliation(s)
- Jamie Michael
- University of North Carolina, School of Medicine, Chapel Hill, NC, USA
| | - Kevin Neuzil
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ersan Altun
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marc A Bjurlin
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Correspondence: Marc A Bjurlin, Associate Professor, Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, 2nd Floor, Chapel Hill, NC, USA, Email
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Ma S, Xie H, Wang H, Yang J, Han C, Wang X, Zhang X. Preoperative Prediction of Extracapsular Extension: Radiomics Signature Based on Magnetic Resonance Imaging to Stage Prostate Cancer. Mol Imaging Biol 2021; 22:711-721. [PMID: 31321651 DOI: 10.1007/s11307-019-01405-7] [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] [Indexed: 01/08/2023]
Abstract
PURPOSE To investigate and validate the potential role of a radiomics signature in predicting the side-specific probability of extracapsular extension (ECE) of prostate cancer (PCa). PROCEDURES The preoperative magnetic resonance imaging data of 238 prostatic samples from 119 enrolled PCa patients were retrospectively assessed. The samples with were randomized in a two-to-one ratio into training (n = 74) and validation (n = 45) datasets. The radiomics features were derived from T2-weighted images (T2WIs). The optimal radiomics features were identified from the least absolute shrinkage and selection operator (LASSO) logistic regression model and were used to construct a predictive radiomics signature via dimension reduction and selection approaches. The association between the radiomics signatures and pathological ECE status was explored. Receiver operating characteristic (ROC) analysis was used to assess the discriminatory ability of the signature. The calibration performance and clinical usefulness of the radiomics signature were subsequently assessed by calibration curve and decision curve analyses. RESULTS The proposed radiomics signature that incorporated 17 selected radiomics features was significantly associated with pathological ECE outcomes (P < 0.001) in both the training and validation datasets. The constructed model displayed good discrimination, with areas under the curve (AUC) of 0.906 (95 % confidence interval (CI), 0.847, 0.948) and 0.821 (95 % CI, 0.726, 0.894) for the training and validation datasets, respectively, and had a good calibration performance. The clinical utility of this model was confirmed through decision curve analysis. CONCLUSIONS The radiomics signature based on T2WIs showed the potential to predict the side-specific probability of pathological ECE status and can facilitate the preoperative individualized predictions for PCa patients.
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Affiliation(s)
- Shuai Ma
- Department of Radiology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Huihui Xie
- Department of Radiology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Huihui Wang
- Department of Radiology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Jiejin Yang
- Department of Radiology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Chao Han
- Department of Radiology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
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Griffiths L, Kotamarti S, Mikhail D, Sarcona J, Rastinehad AR, Villani R, Kreshover J, Hall SJ, Vira MA, Schwartz MJ, Richstone L. Extracapsular extension on multiparametric magnetic resonance imaging better predicts pT3 disease at radical prostatectomy compared to perineural invasion on biopsy. Can Urol Assoc J 2021; 15:261-266. [PMID: 33410741 DOI: 10.5489/cuaj.6909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Risk assessment for non-organ-confined prostate cancer (PCa) is important in the surgical planning for radical prostatectomy (RP). Perineural invasion (PNI) on prostate biopsy has been associated with adverse pathological outcomes at prostatectomy. Similarly, the identification of suspected extracapsular extension (ECE) on multiparametric magnetic resonance imaging (mpMRI) has been shown to predict non-organ-confined disease. However, no prior study has compared these factors in predicting adverse pathology at prostatectomy. We evaluated mpMRI ECE and prostate biopsy PNI on multivariable analysis to determine their ability to predict pathological stage at time of RP. METHODS We retrospectively investigated the prostatectomy database at our institution to identify men who underwent prostate biopsy with pre-biopsy mpMRI and subsequent RP from 2013-2017. Multivariable regression analysis was performed to compare the association of mpMRI ECE (mECE) and PNI on prostate biopsy on the likelihood of finding pT3 disease on pathology post-prostatectomy. RESULTS Of a total 454 RP between 2013 and 2017, 191 patients met our inclusion criteria. Stage pT2 and pT3+ were found in 120 (62.8%) and 71 (37.2%) patients, respectively. Patients with mECE had 4.84 cumulative odds of worse pathological stage on RP (p=0.045) compared to PNI on biopsy, which showed cumulative odds of 2.25 (p=0.048). When controlling only for those patients without PNI, mECE was still found to be a significant predictor of pT3 disease at RP (p=0.030); however, in patients without mECE, PNI was not significant (p=0.062). CONCLUSIONS While mECE and biopsy PNI were both associated with worse pathological stage on RP, mECE had significantly higher cumulative odds compared to PNI. The significant predictive ability of mECE adds further clinical value to the use of mpMRI in PCa management. While validation in a larger cohort is required, these factors have important clinical implications with regards to early diagnosis of advanced disease and surgical planning.
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Affiliation(s)
- Luke Griffiths
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States
| | - Srinath Kotamarti
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States.,Department of Urology, Maimonides Medical Center, Brooklyn, NY, United States
| | - David Mikhail
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States.,Department of Urology, Lenox Hill Hospital, New York, NY, United States
| | - Joseph Sarcona
- Department of Urology, Lenox Hill Hospital, New York, NY, United States
| | | | - Robert Villani
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States
| | - Jessica Kreshover
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States
| | - Simon J Hall
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States
| | - Manish A Vira
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States
| | - Michael J Schwartz
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States
| | - Lee Richstone
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States.,Department of Urology, Lenox Hill Hospital, New York, NY, United States
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Abstract
Currently there is a lot of interest in the use of a "biparametric" or "abbreviated" prostate MR protocol, which usually refers to removal of the dynamic contrast-enhanced (DCE) MRI, in the detection of clinically significant prostate cancer. In this article we describe the benefits of DCE as part of the PI-RADS lexicon, with particular reference to its role in PI-RADS V2 category 3 peripheral zone lesions. We also discuss the benefits of triplanar T2-weighted images, and finally discuss how a mpMRI protocol is of benefit in prostate cancer staging, in evaluating for local disease recurrence, and as a biomarker for neoadjuvant therapy response.
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Christophe C, Montagne S, Bourrelier S, Roupret M, Barret E, Rozet F, Comperat E, Coté JF, Lucidarme O, Cussenot O, Granger B, Renard-Penna R. Prostate cancer local staging using biparametric MRI: assessment and comparison with multiparametric MRI. Eur J Radiol 2020; 132:109350. [PMID: 33080549 DOI: 10.1016/j.ejrad.2020.109350] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/03/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The value of adding dynamic contrast-enhanced (DCE) imaging to T2-weighted (T2W) magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) to improve the detection and staging of prostate cancer (PCa) is unclear. The aim of this retrospective study was to compare the diagnostic performance of non-contrast biparametric MRI (bpMRI) with multiparametric MRI (mpMRI), for local staging of PCa. METHODS Ninety-two patients who underwent prostate MRI on a 3-Tesla MRI system before radical prostatectomy for PCa were included retrospectively. Four readers independently assigned a Likert score (ranging from 1 to 5) for predicting extra-prostatic extension (EPE) on T2W + DWI (bpMRI) and then on T2W + DWI + DCE imaging (mpMRI). MRI-based staging results were compared with radical prostatectomy histology. A prediction of EPE generalized linear mixed model was used to assess the added-value of DCE and discriminative power of staging accuracy by area under the receiver-operating curve (AUC ROC). RESULTS AUC was not significantly improved by DCE (mpMRI, AUC = 0.73 [95%CI: 0.655‒0.827] vs. bpMRI, AUC = 0.76 [95%CI: 0.681‒0.846]). After applying a selection procedure, only MRI criteria were retained in a multivariate model. The following criteria were significantly associated with local extension: localization in the peripheral zone (p < 0.001), maximal diameter of the lesion (<0.0001), curvilinear capsular contact on T2W (p < 0.0001), capsular irregularity on T2W (p < 0.0001), bulging on T2W (p < 0.001) and seminal vesicle hypo-signal (p < 0.001). CONCLUSION Use of bpMRI did not result in a decrease in local staging accuracy.
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Affiliation(s)
- Charlotte Christophe
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Sarah Montagne
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France; Academic Department of Radiology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Stéphanie Bourrelier
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Morgan Roupret
- Academic Department of Urology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France; Sorbonne Universités, GRC n° 5, Oncotype-Uro, Paris, France
| | - Eric Barret
- Montsouris Institute, Urology Department, Paris, F-75014, France
| | - François Rozet
- Montsouris Institute, Urology Department, Paris, F-75014, France
| | - Eva Comperat
- Sorbonne Universités, GRC n° 5, Oncotype-Uro, Paris, France; Academic Department of Pathology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Jean François Coté
- Academic Department of Pathology, Hôpital Pitié-Salpetrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Olivier Lucidarme
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Olivier Cussenot
- Sorbonne Universités, GRC n° 5, Oncotype-Uro, Paris, France; Academic Department of Urology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Benjamin Granger
- Department of Public Health, Pitié-Salpétrière Academic Hospital, AP-HP, Sorbonne Universités, AP-HP, CIC-P 1421, Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR 1136, CIC-1421, Hôpital Pitié Salpêtrière, AP-HP, Paris, France
| | - Raphaële Renard-Penna
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France; Academic Department of Radiology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France; Sorbonne Universités, GRC n° 5, Oncotype-Uro, Paris, France.
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Zhang F, Liu CL, Chen Q, Shao SC, Chen SQ. Accuracy of multiparametric magnetic resonance imaging for detecting extracapsular extension in prostate cancer: a systematic review and meta-analysis. Br J Radiol 2019; 92:20190480. [PMID: 31596123 DOI: 10.1259/bjr.20190480] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of multiparametric MRI (mpMRI) for detecting extracapsular extension (ECE) in patients with prostate cancer (PCa). METHODS AND MATERIALS We searched MEDLINE, PubMed, Embase and the Cochrane library up to December 2018. We included studies that used mpMRI to differentiate ECE from organ-confined PCa with a combination of T2 weighted imaging (T2WI), diffusion-weighted imaging, and dynamic contrast-enhanced MRI. All studies included had pathological diagnosis with radical prostatectomy. Two reviewers independently assessed the methodological quality of included studies by using Quality Assessment of Diagnostic Accuracy Studies 2 tool. We calculated pooled sensitivity, specificity, positive and negative predictive values, diagnostic odds ratios and receiver operating characteristic curve for mpMRI from 2 × 2 tables. RESULTS A total of 17 studies that comprised 3374 participants were included. The pooled data showed a sensitivity of 0.55 (95% confidence interval 0.43, 0.66]) and specificity of 0.87 (95% confidence interval 0.82, 0.91) for extracapsular extension detection in PCa. CONCLUSION First, our meta-analysis shows moderate sensitivity and high specificity for mpMRI to differentiate ECE from organ-confined prostate cancer before surgery. Second, our meta-analysis shows that mpMRI had no significant differences in performance compared with the former meta-analysis with use of T2WI alone or with additional functional MRI. ADVANCES IN KNOWLEDGE It is the first meta-analysis to evaluate the accuracy of mpMRI in combination of TWI, diffusion-weightedimaging and dynamiccontrast-enhanced-MRI for extracapsular extension detection.
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Affiliation(s)
- Fan Zhang
- Department of Radiology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215001, China
| | - Chen-Lu Liu
- Department of Radiology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215001, China
| | - Qian Chen
- Department of Radiology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215001, China
| | - Sheng-Chao Shao
- Department of Radiology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215001, China
| | - Shuang-Qing Chen
- Department of Radiology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215001, China
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Abstract
PURPOSE OF REVIEW Prostate focal therapy has the potential to preserve urinary and sexual function while eliminating clinically significant cancer in a subset of men with low-volume, organ-confined prostate cancer. This systematic review aims to examine current evidence to determine the efficacy and safety of focal therapy for standard clinical application. RECENT FINDINGS Focal therapy reduces the rate of cancer progression and conversion to radical therapy in men on active surveillance for prostate cancer. As a strategy, success in focal therapy is heavily dependent on the use of imaging and targeted biopsies. Despite advances in these areas, there remains a small but significant risk of under-detecting clinically significant cancer. Similarly, under-estimation of tumor volume may contribute to infield recurrences and close attention must be paid to the ablation margin. Although long-term oncological outcomes remain lacking, focal therapy has a low complication rate, minimal impact on urinary continence and a moderate impact on erectile function. SUMMARY With the appropriate expertise in imaging, targeted biopsy and targeted ablation, focal therapy is a good option in men with low-intermediate risk cancer who are willing to maximize their urinary and sexual function. However, close posttreatment surveillance and the possibility of conversion to whole gland therapy must be accepted.
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Ma S, Xie H, Wang H, Han C, Yang J, Lin Z, Li Y, He Q, Wang R, Cui Y, Zhang X, Wang X. MRI-Based Radiomics Signature for the Preoperative Prediction of Extracapsular Extension of Prostate Cancer. J Magn Reson Imaging 2019; 50:1914-1925. [PMID: 31062459 DOI: 10.1002/jmri.26777] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Radiomics approaches based on multiparametric MRI (mp-MRI) have shown high accuracy in prostate cancer (PCa) management. However, there is a need to apply radiomics to the preoperative prediction of extracapsular extension (ECE). PURPOSE To develop and validate a radiomics signature to preoperatively predict the probability of ECE for patients with PCa, compared with the radiologists' interpretations. STUDY TYPE Retrospective. POPULATION In total, 210 patients with pathology-confirmed ECE status (101 positive, 109 negative) were enrolled. FIELD STRENGTH/SEQUENCE T2 -weighted imaging (T2 WI), diffusion-weighted imaging, and dynamic contrast-enhanced imaging were performed on two 3.0T MR scanners. ASSESSMENT A radiomics signature was constructed to predict the probability of ECE prior to radical prostatectomy (RP). In all, 17 stable radiomics features of 1619 extracted features based on T2 WI were selected. The same images were also evaluated by three radiologists. The predictive performance of the radiomics signature was validated and compared with radiologists' interpretations. STATISTICAL TESTS A radiomics signature was developed by a least absolute shrinkage and selection operator (LASSO) regression algorithm. Samples enrolled were randomly divided into two groups (143 for training and 67 for validation). Discrimination, calibration, and clinical usefulness were validated by analysis of the receiver operating characteristic (ROC) curve, calibration curve, and the decision curve, respectively. The predictive performance was then compared with visual assessments of three radiologists. RESULTS The radiomics signature yielded an AUC of 0.902 and 0.883 in the training and validation cohort, respectively, and outperformed the visual assessment (AUC: 0.600-0.697) in the validation cohort. Pairwise comparisons demonstrated that the radiomics signature was more sensitive than the radiologists (75.00% vs. 46.88%-50.00%, all P < 0.05), but obtained comparable specificities (91.43% vs. (88.57%-94.29%); P ranged from 0.64-1.00). DATA CONCLUSION A radiomics signature was developed and validated that outperformed the radiologists' visual assessments in predicting ECE status. LEVEL OF EVIDENCE 4 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:1914-1925.
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Affiliation(s)
- Shuai Ma
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Huihui Xie
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Huihui Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Chao Han
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Jiejin Yang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Zhiyong Lin
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Yifan Li
- Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, Beijing, China
| | - Qun He
- Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, Beijing, China
| | - Rui Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Yingpu Cui
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
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Duvnjak P, Schulman AA, Holtz JN, Huang J, Polascik TJ, Gupta RT. Multiparametric Prostate MR Imaging: Impact on Clinical Staging and Decision Making. Urol Clin North Am 2018; 45:455-466. [DOI: 10.1016/j.ucl.2018.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Dominguez C, Plata M, Cataño JG, Palau M, Aguirre D, Narvaez J, Trujillo S, Gómez F, Trujillo CG, Caicedo JI, Medina C. Diagnostic accuracy of multiparametric magnetic resonance imaging in detecting extracapsular extension in intermediate and high - risk prostate cancer. Int Braz J Urol 2018; 44:688-696. [PMID: 29570254 PMCID: PMC6092654 DOI: 10.1590/s1677-5538.ibju.2016.0485] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/15/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To evaluate the diagnostic performance of preoperative multiparametric magnetic resonance imaging (mp-MRI) as a predictor of extracapsular extension (ECE) and unfavorable Gleason score (GS) in patients with intermediate and high-risk prostate cancer (PCa). MATERIALS AND METHODS Patients with clinically localized PCa who underwent radical prostatectomy (RP) and had preoperative mp-MRI between May-2011 and December-2013. Mp-MRI was evaluated according to the European Society of Urogenital Radiology MRI prostate guidelines by two different readers. Histopathological RP results were the standard reference. RESULTS 79 patients were included; mean age was 61 and median preoperative prostate-specific antigen (PSA) 7.0. On MRI, 28% patients had ECE evidenced in the mp-MRI, 5% seminal vesicle invasion (SVI) and 4% lymph node involvement (LNI). At RP, 39.2% had ECE, 26.6% SVI and 12.8% LNI. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of mp-MRI for ECE were 54.9%, 90.9%, 76%, 81% and 74.1% respectively; for SVI values were 19.1%, 100%, 77.3%, 100% and 76.1% respectively and for LNI 20%, 98.4%, 86.7%, 66.7% and 88.7%. CONCLUSIONS Major surgical decisions are made with digital rectal exam (DRE) and ultrasound studies before the use of Mp-MRI. This imaging study contributes to rule out gross extraprostatic extension (ECE, SVI, LNI) without competing with pathological studies. The specificity and NPV are reasonable to decide surgical approach. A highly experienced radiology team is needed to provide accurate estimations of tumor extension and aggressiveness.
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Affiliation(s)
- Cristina Dominguez
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia, CO
| | - Mauricio Plata
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia, CO
| | - Juan Guillermo Cataño
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia, CO
| | - Mauricio Palau
- Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia, CO
| | - Diego Aguirre
- Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia, CO
| | - Jorge Narvaez
- Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia, CO
| | - Stephanie Trujillo
- Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia, CO
| | - Felipe Gómez
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia, CO
| | | | - Juan Ignacio Caicedo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia, CO
| | - Camilo Medina
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia, CO
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Multiparametric Prostate MR Imaging: Impact on Clinical Staging and Decision Making. Radiol Clin North Am 2018; 56:239-250. [DOI: 10.1016/j.rcl.2017.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Weaver JK, Kim EH, Vetter JM, Shetty A, Grubb RL, Strope SA, Andriole GL. Prostate Magnetic Resonance Imaging Provides Limited Incremental Value Over the Memorial Sloan Kettering Cancer Center Preradical Prostatectomy Nomogram. Urology 2017; 113:119-128. [PMID: 29217354 DOI: 10.1016/j.urology.2017.10.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/27/2017] [Accepted: 10/10/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the incremental value of prostate magnetic resonance imaging (MRI) when used in combination with the currently available preoperative risk stratification tool, the Memorial Sloan Kettering Cancer Center (MSKCC) preradical prostatectomy nomogram. MATERIALS AND METHODS We reviewed our institutional database of prostate MRI performed before radical prostatectomy between December 2014 and March 2016 (n = 236). We generated a logistic regression model based on observed final pathology results and the MSKCC nomogram predictions for organ-confined disease, extracapsular extension (ECE), seminal vesicle invasion, and lymph node involvement (LNI) ("MSKCC only"). We then generated a combined regression model incorporating both the MSKCC nomogram prediction with the degree of prostate MRI suspicion ("MSKCC + MRI"). Receiver operating characteristic curves were generated, and the area under the curves (AUCs) were compared. RESULTS When independently examining the MSKCC nomogram predicted risk and the degree of prostate MRI suspicion, MRI was a predictor for ECE (odds ratio 2.8, P <.01) and LNI (odds ratio 5.6, P = .01). When examining the "MSKCC + MRI" and "MSKCC only" models, the incremental benefit in risk discrimination from the combined model ("MSKCC + MRI") was not significant for organ-confined disease, ECE, seminal vesicle invasion, or LNI (ΔAUC +0.03, P = .10; ΔAUC +0.03, P = .08; ΔAUC 0.63, P = .63; ΔAUC +0.04, P = .42; respectively). CONCLUSION A combined model with prostate MRI and the MSKCC nomogram provides no additional risk discrimination over the MSKCC nomogram-based model alone. Evaluation of prostate MRI as a predictive tool should be performed in combination with, not independent of, these clinical risk stratification models.
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Affiliation(s)
- John K Weaver
- Division of Urology, Washington University School of Medicine, St. Louis, MO
| | - Eric H Kim
- Division of Urology, Washington University School of Medicine, St. Louis, MO
| | - Joel M Vetter
- Division of Urology, Washington University School of Medicine, St. Louis, MO
| | - Anup Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Robert L Grubb
- Division of Urology, Washington University School of Medicine, St. Louis, MO
| | - Seth A Strope
- Urologic Oncology, Baptist MD Anderson Cancer Center, Jacksonville, FL
| | - Gerald L Andriole
- Division of Urology, Washington University School of Medicine, St. Louis, MO.
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14
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Tavukçu HH, Aytaç Ö, Balcı NC, Kulaksızoğlu H, Atuğ F. The efficacy and utilisation of preoperative multiparametric magnetic resonance imaging in robot-assisted radical prostatectomy: does it change the surgical dissection plan? Turk J Urol 2017; 43:470-475. [PMID: 29201510 DOI: 10.5152/tud.2017.35589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/18/2017] [Indexed: 12/21/2022]
Abstract
Objective We investigated the effect of the use of multiparametric prostate magnetic resonance imaging (mp-MRI) on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robot-assisted radical prostatectomy. Material and methods We prospectively evaluated 60 consecutive patients, including 30 patients who had (Group 1), and 30 patients who had not (Group 2) mp-MRI before robot-assisted radical prostatectomy. Based on the findings of mp-MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial in the mp-MRI group. Two groups were compared in terms of age, prostate-specific antigen (PSA), Gleason sum scores and surgical margin positivity. Results There was no statistically significant difference between the two groups in terms of age, PSA, biopsy Gleason score, final pathological Gleason score and surgical margin positivity. mp-MRI changed the initial surgical plan in 18 of 30 patients (60%) in Group 1. In seventeen of these patients (56%) surgical plan was changed from non-nerve sparing to interfascial nerve sparing plan. In one patient dissection plan was changed to non-nerve sparing technique which had extraprostatic extension on final pathology. Surgical margin positivity was similar in Groups 1, and 2 (16% and 13%, respectively) although, Group 1 had higher number of high- risk patients. mp-MRI confirmed the primary tumour localisation in the final pathology in 27 of of 30 patients (90%). Conclusion Preoperative mp-MRI effected the decision to perform a nerve-sparing technique in 56% of the patients in our study; moreover, changing the dissection plan from non-nerve-sparing technique to a nerve sparing technique did not increase the rate of surgical margin positivity.
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Affiliation(s)
- Hasan Hüseyin Tavukçu
- Department of Urology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Ömer Aytaç
- Department of Urology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Numan Cem Balcı
- Department of Radiology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Haluk Kulaksızoğlu
- Department of Urology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Fatih Atuğ
- Department of Urology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
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15
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Patel VR, Sandri M, Grasso AAC, De Lorenzis E, Palmisano F, Albo G, Coelho RF, Mottrie A, Harvey T, Kameh D, Palayapalayam H, Wiklund P, Bosari S, Puliatti S, Zuccolotto P, Bianchi G, Rocco B. A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy. BJU Int 2017; 121:373-382. [PMID: 28941058 DOI: 10.1111/bju.14026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To create a statistical tool for the estimation of extracapsular extension (ECE) level of prostate cancer and determine the nerve-sparing (NS) approach that can be safely performed during radical prostatectomy (RP). PATIENTS AND METHODS A total of 11 794 lobes, from 6 360 patients who underwent robot-assisted RP between 2008 and 2016 were evaluated. Clinicopathological features were included in a statistical algorithm for the prediction of the maximum ECE width. Five multivariable logistic models were estimated for: presence of ECE and ECE width of >1, >2, >3, and >4 mm. A five-zone decision rule based on a lower and upper threshold is proposed. Using a graphical interface, surgeons can view patient's pre-treatment characteristics and a curve showing the estimated probabilities for ECE amount together with the areas identified by the decision rule. RESULTS Of the 6 360 patients, 1 803 (28.4%) were affected by non-organ-confined disease. ECE was present in 1 351 lobes (11.4%) and extended beyond the capsule for >1, >2, >3, and >4 mm in 498 (4.2%), 261 (2.2%), 148 (1.3%), 99 (0.8%) cases, respectively. ECE width was up to 15 mm (interquartile range 1.00-2.00). The five logistic models showed good predictive performance, the area under the receiver operating characteristic curve was: 0.81 for ECE, and 0.84, 0.85, 0.88, and 0.90 for ECE width of >1, >2, >3, and >4 mm, respectively. CONCLUSION This novel tool predicts with good accuracy the presence and amount of ECE. Furthermore, the graphical interface available at www.prece.it can support surgeons in patient counselling and preoperative planning.
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Affiliation(s)
- Vipul R Patel
- Global Robotics Institute, Florida Hospital-Celebration Health Celebration, University of Central Florida School of Medicine, Orlando, FL, USA
| | - Marco Sandri
- Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy
| | - Angelica A C Grasso
- Department of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Policlinico, University of Milan, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Policlinico, University of Milan, Milan, Italy
| | - Franco Palmisano
- Department of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Policlinico, University of Milan, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Policlinico, University of Milan, Milan, Italy
| | - Rafael F Coelho
- Department of Urology, Instituto do Cancer, Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas, Sao Paulo, SP, Brazil
| | - Alexander Mottrie
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.,OLV Vattikuti Robotic Surgery Institute, Melle, Belgium
| | - Tadzia Harvey
- Global Robotics Institute, Florida Hospital-Celebration Health Celebration, University of Central Florida School of Medicine, Orlando, FL, USA
| | - Darian Kameh
- Global Robotics Institute, Florida Hospital-Celebration Health Celebration, University of Central Florida School of Medicine, Orlando, FL, USA
| | - Hariharan Palayapalayam
- Global Robotics Institute, Florida Hospital-Celebration Health Celebration, University of Central Florida School of Medicine, Orlando, FL, USA
| | - Peter Wiklund
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Silvano Bosari
- Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Policlinico, University of Milan, Milan, Italy
| | - Stefano Puliatti
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Zuccolotto
- Big & Open Data Innovation Laboratory, University of Brescia, Brescia, Italy
| | - Giampaolo Bianchi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
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16
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Lee T, Hoogenes J, Wright I, Matsumoto ED, Shayegan B. Utility of preoperative 3 Tesla pelvic phased-array multiparametric magnetic resonance imaging in prediction of extracapsular extension and seminal vesicle invasion of prostate cancer and its impact on surgical margin status: Experience at a Canadian academic tertiary care centre. Can Urol Assoc J 2017; 11:E174-E178. [PMID: 28503230 DOI: 10.5489/cuaj.4211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION To evaluate the utility of 3 Tesla (3T) pelvic phased-array (PPA) multiparametric magnetic resonance imaging (mpMRI) to predict extracapsular extension (ECE) and seminal vesicle invasion (SVI) and its subsequent effect on radical prostatectomy (RP) surgical margin status. METHODS A retrospective evaluation was conducted of RP patients who underwent preoperative 3T PPA mpMRI (without endorectal coil) based on clinical probability of adverse pathological features. Frequencies, specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI in predicting the status of ECE and SVI were calculated. RESULTS Forty-eight consecutive patients were included. Sensitivity, specificity, PPV, and NPV for 3T PPA mpMRI using T2-weighted sequences with diffusion-weighted imaging (DWI) and dynamic contrast enhanced (DCE) imaging to predict ECE was 39%, 56%, 45%, and 50%, respectively, while SVI prediction was 33%, 95%, 50%, and 91%, respectively. Twelve of the 28 cases predicted as being negative for ECE had positive margins, while two of the 20 cases predicted to be positive for ECE had positive margins. Imaging predicted four cases would have SVI, yet two had positive margins, while of the 44 cases predicted as being negative for SVI, four had positive margins. CONCLUSIONS These findings at our centre suggest that the use of 3T PPA mpMRI using T2-weighted sequences with DWI and DCE in predicting pathological ECE and SVI is of questionable benefit. These mpMRI reports may result in closer dissection of neurovascular bundles and subsequent positive surgical margins. Caution should be exercised when basing intraoperative decisions on mpMRI findings.
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Affiliation(s)
- Taehyoung Lee
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Jen Hoogenes
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Ian Wright
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Edward D Matsumoto
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Bobby Shayegan
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
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17
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DCE-MRI, DW-MRI, and MRS in Cancer: Challenges and Advantages of Implementing Qualitative and Quantitative Multi-parametric Imaging in the Clinic. Top Magn Reson Imaging 2017; 25:245-254. [PMID: 27748710 PMCID: PMC5081190 DOI: 10.1097/rmr.0000000000000103] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Multi-parametric magnetic resonance imaging (mpMRI) offers a unique insight into tumor biology by combining functional MRI techniques that inform on cellularity (diffusion-weighted MRI), vascular properties (dynamic contrast-enhanced MRI), and metabolites (magnetic resonance spectroscopy) and has scope to provide valuable information for prognostication and response assessment. Challenges in the application of mpMRI in the clinic include the technical considerations in acquiring good quality functional MRI data, development of robust techniques for analysis, and clinical interpretation of the results. This article summarizes the technical challenges in acquisition and analysis of multi-parametric MRI data before reviewing the key applications of multi-parametric MRI in clinical research and practice.
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18
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Salerno J, Finelli A, Morash C, Morgan SC, Power N, Schieda N, Haider MA. Multiparametric magnetic resonance imaging for pre-treatment local staging of prostate cancer: A Cancer Care Ontario clinical practice guideline. Can Urol Assoc J 2016; 10:E332-E339. [PMID: 27800062 DOI: 10.5489/cuaj.3823] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The utility of T2-weighted magnetic resonance imaging (MRI) in the local staging of prostate cancer is controversial. Due to the success of multiparametric MRI in cancer localization, there is renewed interested in MRI (± functional sequences) for local staging. Guidance on pre-treatment local staging of prostate cancer by MRI was developed using systematic review methodology and expert consultation. METHODS MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and other databases were searched to identify studies comparing: (1) MRI staging vs. radical prostatectomy staging on diagnostic accuracy outcomes; and (2) MRI staging vs. routine clinical staging on clinical and patient outcomes. Studies meeting inclusion criteria were synthesized by outcome and sensitivity/specificity analysis by tumour location was performed. Evidence quality of included studies was assessed and considered in recommendation formulation. RESULTS The literature search identified 2510 citations; 62 studies were included. Analysis of MRI ≥1.5 T plus endorectal coil (ER) (± functional sequences) in the detection of extraprostatic extension or seminal vesicle invasion showed modest sensitivities (≥50%) and excellent specificities (>85%) among patients scheduled for radical prostatectomy. MRI upstaging was shown in 20/21 studies, with large variation in correctness (11-85%). Scarcity of clinical and patient outcomes among studies limited synthesis and evaluation. Quality assessment found non-trivial biases. CONCLUSIONS Modest imaging performance was shown for MRI (1.5 T + ER and 3 T ± ER) ± functional sequences in regards to sensitivity. Limitations in study design, reporting of clinical and patient outcomes, and the heterogeneous use of MRI tempered the strength of the recommendations.
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Affiliation(s)
- Jennifer Salerno
- McMaster University, Department of Oncology and Program in Evidence-Based Care, Cancer Care Ontario, Hamilton, ON, Canada
| | | | | | | | | | - Nichola Schieda
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Masoom A Haider
- Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
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19
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Czarniecki M, Jakuciński M, Królicki L. Prostate MRI - an update for the referring urologist. Cent European J Urol 2016; 69:162-9. [PMID: 27551553 PMCID: PMC4986294 DOI: 10.5173/ceju.2016.708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 10/04/2015] [Accepted: 11/22/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Prostate MRI is a new and important tool which has a role in prostate cancer guidelines worldwide. The amount of articles published and studies currently taking place on the subject requires urologists to understand how the examination is performed and its possible applications. This article explains prostate MRI and standardized reporting schemes, as well as its applications according to patients' staging and history. MATERIAL AND METHODS The use of prostate MRI prior to biopsy, MRI-guided biopsy and its use in active surveillance, surgery staging and planning, as well as in cases with biochemical recurrence are discussed. RESULTS The application of prostate MRI are not limited to initial diagnosis, but also has a developing role in biopsy and planning further treatment. Recently, its diagnostic applications have been included in EAU prostate cancer guidelines and new applications are in development. CONCLUSIONS Practicing urologists are seeing an emerging role of MRI in prostate cancer. Its current and future applications may have an impact on patient care, which mandates healthcare professionals to be vigilant about the method's new developments.
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Affiliation(s)
- Marcin Czarniecki
- Bródnowski Mazovian Hospital, Department of Diagnostic, Warsaw, Poland
| | - Maciej Jakuciński
- Bródnowski Mazovian Hospital, Department of Diagnostic, Warsaw, Poland
| | - Leszek Królicki
- Bródnowski Mazovian Hospital, Department of Diagnostic, Warsaw, Poland
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20
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de Rooij M, Hamoen EH, Witjes JA, Barentsz JO, Rovers MM. Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis. Eur Urol 2016. [DOI: 10.1016/j.eururo.2015.07.029] [Citation(s) in RCA: 366] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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21
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Gupta RT, Spilseth B, Patel N, Brown AF, Yu J. Multiparametric prostate MRI: focus on T2-weighted imaging and role in staging of prostate cancer. Abdom Radiol (NY) 2016; 41:831-43. [PMID: 27193786 DOI: 10.1007/s00261-015-0579-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Multiparametric MRI (mpMRI) represents a growing modality for the non-invasive evaluation of prostate cancer (PCa) and is increasingly being used for patients with persistently elevated PSA and prior negative biopsies, for monitoring patients in active surveillance protocols, for preoperative characterization of cancer for surgical planning, and in planning for MRI-targeted biopsy. The focus of this work is twofold. First, we review the key role of T2-weighted imaging (T2WI) in mpMRI, specifically outlining how it is used for anatomic evaluation of the prostate, detection of clinically significant PCa, assessment of extraprostatic extension (EPE), and mimics of PCa on this sequence. We will also discuss optimal technical acquisition parameters for this sequence and recent technical advancements in T2WI. Second, we will delineate the role that mpMRI plays in the staging of PCa and describe the implications of the information that mpMRI can provide in determining the most appropriate management plan for the patient with PCa.
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22
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Cerantola Y, Dragomir A, Tanguay S, Bladou F, Aprikian A, Kassouf W. Cost-effectiveness of multiparametric magnetic resonance imaging and targeted biopsy in diagnosing prostate cancer. Urol Oncol 2015; 34:119.e1-9. [PMID: 26602178 DOI: 10.1016/j.urolonc.2015.09.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 08/31/2015] [Accepted: 09/09/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Transrectal ultrasound-guided biopsy (TRUSGB) is the recommended approach to diagnose prostate cancer (PCa). Overdiagnosis and sampling errors represent major limitations. Magnetic resonance imaging (MRI)-targeted biopsy (MRTB) detects higher proportion of significant PCa and reduces diagnosis of insignificant PCa. Costs prevent MRTB from becoming the new standard in PCa diagnosis. The present study aimed at assessing whether added costs of MRI outweigh benefits of MRTB in a cost-utility model. MATERIALS AND METHODS A Markov model was developed to estimate quality-adjusted life-year gained (QALY) and costs for 2 strategies (the standard 12-core TRUSGB strategy and the MRTB strategy) over 5, 10, 15, and 20 years. MRI was used as triage test in biopsy-naive men with clinical suspicion of PCa. The model takes into account probability of men harboring PCa, diagnostic accuracy of both procedures, and probability of being assigned to various treatment options. Direct medical costs based on health care system perspective were included. RESULTS Following standard TRUSGB pathway, calculated cumulative effects at 5, 10, 15, and 20 years were 4.25, 7.17, 9.03, and 10.09 QALY, respectively. Cumulative effects in MRTB pathway were 4.29, 7.26, 9.17, and 10.26 QALY, correspondingly. Costs related to TRUSGB strategy were $8,027, $11,406, $14,883, and $17,587 at 5, 10, 15, and 20 years, respectively, as compared with $7,231, $10,450, $13,267, and $15,400 for the MRTB strategy. At 5, 10, 15, and 20 years, MRTB was the established dominant strategy. CONCLUSIONS Incorporation of MRI and MRTB in PCa diagnosis and management represents a cost-effective measure at 5, 10, 15, and 20 years after initial diagnosis.
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Affiliation(s)
- Yannick Cerantola
- Division of Urology, McGill University, Montreal, Canada; Division of Urology, University Hospital CHUV, Lausanne, Switzerland
| | - Alice Dragomir
- Division of Urology, McGill University, Montreal, Canada
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, Canada
| | - Franck Bladou
- Division of Urology, McGill University, Montreal, Canada
| | - Armen Aprikian
- Division of Urology, McGill University, Montreal, Canada
| | - Wassim Kassouf
- Division of Urology, McGill University, Montreal, Canada.
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23
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Feng TS, Sharif-Afshar AR, Wu J, Li Q, Luthringer D, Saouaf R, Kim HL. Multiparametric MRI Improves Accuracy of Clinical Nomograms for Predicting Extracapsular Extension of Prostate Cancer. Urology 2015; 86:332-7. [PMID: 26194289 DOI: 10.1016/j.urology.2015.06.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 05/12/2015] [Accepted: 06/02/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare the accuracy of multiparametric magnetic resonance imaging (MP-MRI) with the Partin tables and Memorial Sloan-Kettering (MSK) nomogram for predicting extracapsular extension (ECE) in prostate cancer and to create a tool for clinicians to estimate pathologic ECE risk. METHODS A retrospective review of 112 patients who underwent 3T MP-MRI of the prostate and radical prostatectomy was performed. Regression analyses were carried out to identify predictors of ECE. Predictive accuracy of models based on nomogram and MP-MRI were compared. RESULTS A total of 33 of patients (29%) had ECE on MP-MRI whereas 26 patients (23%) had ECE on final pathology. Mean age was 62.8 years and mean prostate-specific antigen was 8.2 ng/dL. MRI was a significant predictor of ECE that was independent of age, prostate-specific antigen, Gleason score, clinical stage, and percent positive cores on biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value of MP-MRI for ECE were 84.6%, 87.2%, 66.7%, and 94.9%, respectively. Areas under the curve for Partin and MSK nomograms for predicting ECE were 0.85 and 0.86, respectively. Area under the curve increased to 0.92 and 0.94, respectively, when MP-MRI was added to each nomogram. We provide an online tool that integrates Partin or MSK nomogram results with ECE status determined from MRI to predict pathologic ECE. Within the typical range of risks for ECE provided by the clinical nomograms (ie, 15%-40%), MRI was useful for predicting pathologic ECE. CONCLUSION MP-MRI may be a useful adjunct for clinically staging prostate cancer. MP-MRI improved accuracy of existing clinical nomograms for prediction of pathologic ECE.
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Affiliation(s)
- Tom S Feng
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Jonathan Wu
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Quanlin Li
- Department of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel Luthringer
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Rola Saouaf
- Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Hyung L Kim
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA.
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24
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Muralidhar V, Dinh KT, Mahal BA, Ziehr DR, Chen YW, Viswanathan VB, Nezolosky MD, Choueiri TK, Hoffman KE, Hu JC, Sweeney CJ, Trinh QD, Nguyen PL. Differential post-prostatectomy cancer-specific survival of occult T3 vs. clinical T3 prostate cancer: Implications for managing patients upstaged on prostate magnetic resonance imaging. Urol Oncol 2015; 33:330.e19-25. [PMID: 25990612 DOI: 10.1016/j.urolonc.2015.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/14/2015] [Accepted: 03/09/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE/OBJECTIVE Long-term androgen deprivation therapy (ADT) was proven in randomized trials to be superior to short-term ADT for radiation-managed patients who have clinical T3 (cT3) disease, but it is unknown whether patients with T3 disease seen only on magnetic resonance imaging require similarly aggressive treatment. We attempted to study this issue by analogy by comparing the long-term post-prostatectomy survival of patients with cT3 disease versus cT1/T2 disease upstaged to pathologic T3 disease. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 60,165 men diagnosed with prostate adenocarcinoma between 1995 and 2002 who underwent prostatectomy. Prostate cancer-specific mortality (PCSM) was evaluated by stage after adjusting for grade, marital status, race, sex, year of diagnosis, and age. RESULTS The median follow-up was 10.5 years. Patients with cT1/T2 but pathologic T3a disease had significantly better 10-year PCSM than men with cT3 disease had (3.0% vs. 9.9%, adjusted hazard ratio [AHR] = 0.420, P<0.001), but they had worse PCSM than men with pathologic T2 disease had (3.0% vs. 0.91%, AHR = 2.53, P<0.001). Of patients with occult T3a disease, those with low-grade/intermediate-grade disease (Gleason score 7 or less) had a slightly higher 10-year PCSM when compared with those with pathologic T2 disease (1.34% vs. 0.91%, AHR = 1.69, P<0.001). Patients with cT1/T2 and pathologic T3b disease had similar PCSM as men presenting with cT3 disease (11.0% vs. 9.86%, AHR = 1.14 [0.862, 1.52], P = 0.353). CONCLUSIONS Patients with occult T3a disease had less than half the risk of PCSM as those with cT3 disease, and a subset of those men had similar risk as patients with pathologic T2 disease. Therefore, it is possible that radiation-managed patients with low-grade/intermediate-grade T3a disease by magnetic resonance imaging only might not require long-term ADT. However, patients with occult T3b or high-grade occult T3a disease have similar PCSM as that of those presenting with cT3 disease, so they should be treated as aggressively, including long-course ADT when managed by radiation.
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Affiliation(s)
- Vinayak Muralidhar
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, MA
| | | | | | | | - Yu-Wei Chen
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Vidya B Viswanathan
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Michelle D Nezolosky
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Karen E Hoffman
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Jim C Hu
- Department of Urology, Brigham and Women's Hospital, Boston, MA
| | - Christopher J Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Quoc-Dien Trinh
- Department of Urology, Brigham and Women's Hospital, Boston, MA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA.
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Extracapsular Extension in Prostate Cancer: Added Value of Diffusion-Weighted MRI in Patients With Equivocal Findings on T2-Weighted Imaging. AJR Am J Roentgenol 2015; 204:W168-75. [DOI: 10.2214/ajr.14.12939] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Multiparametric magnetic resonance imaging localizes established extracapsular extension of prostate cancer. Urol Oncol 2014; 33:109.e15-22. [PMID: 25512160 DOI: 10.1016/j.urolonc.2014.11.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 11/10/2014] [Accepted: 11/11/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To define the accuracy of multiparametric magnetic resonance imaging (MP-MRI) for identifying focal and established extracapsular extension (ECE) in various zones of the prostate. METHODS Between 2010 and 2013, 342 patients underwent MP-MRI of the prostate (3T, no endorectal coil with axial perfusion and diffusion images). The findings of the images were reported as negative, suspicious, or positive for ECE by a single expert radiologist. Radical prostatectomy specimens were reviewed to confirm the size and the location of ECE and further defined as focal or established ECE. Established ECE included extension that was multifocal or involving more than 5 glands. The accuracy of MRI in localizing focal and established ECE to each zone of the prostate was determined. Regression analyses were performed to identify predictors of ECE. RESULTS We identified 112 patients who underwent prostate MP-MRI and radical prostatectomy. MRI findings considered suspicious or definite for ECE accurately predicted pathologic ECE (P<0.001). MP-MRI identified established ECE but not focal ECE. Sensitivity, specificity, positive predictive value, and negative predictive value of MP-MRI for established ECE were 70.7%, 90.6%, 57.1%, and 95.1%, respectively. MRI identified ECE to the left vs. right side as well as each zone of the prostate; however, sensitivity was lowest at the apex. On multivariate analysis, MRI was a significant predictor of ECE that was independent of prostate-specific antigen level, Gleason score, and clinical stage. CONCLUSION MP-MRI is useful for identifying established but not focal ECE in all zones of the prostate. MRI was a significant independent predictor of established ECE and may be a useful adjunct in staging prostate cancer.
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Multiparametric MRI for localized prostate cancer: lesion detection and staging. BIOMED RESEARCH INTERNATIONAL 2014; 2014:684127. [PMID: 25525600 PMCID: PMC4266765 DOI: 10.1155/2014/684127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 09/28/2014] [Accepted: 10/03/2014] [Indexed: 11/18/2022]
Abstract
Multiparametric MRI of the prostate combines high-resolution anatomic imaging with functional imaging of alterations in normal tissue caused by neoplastic transformation for the identification and characterization of in situ prostate cancer. Lesion detection relies on a systematic approach to the analysis of both anatomic and functional imaging using established criteria for the delineation of suspicious areas. Staging includes visual and functional analysis of the prostate "capsule" to determine if in situ disease is, in fact, organ-confined, as well as the evaluation of pelvic structures including lymph nodes and bones for the detection of metastasis. Although intertwined, the protocol can be optimized depending on whether lesion detection or staging is of the highest priority.
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Couñago F, Recio M, Del Cerro E, Cerezo L, Díaz Gavela A, Marcos FJ, Murillo R, Rodriguez Luna JM, Thuissard IJ, Martin JLR. Role of 3.0 T multiparametric MRI in local staging in prostate cancer and clinical implications for radiation oncology. Clin Transl Oncol 2014; 16:993-9. [PMID: 24865628 DOI: 10.1007/s12094-014-1186-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 04/23/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the accuracy of preoperative 3T multiparametric magnetic resonance imaging (3TmMRI) for local staging of prostate cancer and its influence on the decision to change the clinical target volume (CTV), total dose and hormonal therapy when treating prostate cancer patients with radiotherapy. METHODS From 2009 to 2013, 150 patients, who had confirmed prostate cancer and underwent a 3TmMRI before treatment with radical prostatectomy or radical radiation therapy, were included. Radiation therapy treatment (CTV, total dose and hormonal therapy) was initially determined on the basis of the clinical information, and radiation therapy plan was reevaluated after 3TmMRI review. The value of preoperative 3TmMRI in local staging and in the decision of radiotherapy treatment according to NCCN risk classification was analyzed. RESULTS 3TmMRI performed correct, over- and under staging in 78.7 % (37/47), 6.3 % (3/47), 14.8 % patients (7/47), respectively. 3TmMRI identified 6 cT2a, 7 cT2b, 28 cT2c, 3 cT3a, 3 cT3b tumors. At final pathology, 5 tumors were classified as pT2a, 5 as pT2b, 30 as pT2c, 4 as pT3a, 3 as pT3b. After reviewing the MRI reports, the initial radiotherapy and hormonal therapy plan was changed in 33.9 % patients (35/103). CONCLUSIONS In our group of patients, 3TmMRI has been a reliable technique providing an optimal staging for prostate cancer. Its routine use could induce important changes in radiation therapy treatments in a significant number of such patients. However, more additional studies are needed to clarify this issue.
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Affiliation(s)
- F Couñago
- Department of Radiation Oncology, Hospital Universitario Quirón Madrid, Calle Diego de Velázquez, 2, Pozuelo de Alarcón, 28223, Madrid, Spain,
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Borza T, Kibel AS. Local treatment of high risk prostate cancer: Role of surgery and radiation therapy. Cancer 2014; 120:1608-10. [PMID: 24647917 DOI: 10.1002/cncr.28645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 01/29/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Tudor Borza
- Division of Urologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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