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Giganti F, Dickinson L, Allen C, Moore CM. Reply to Jorge Abreu-Gomez, Masoom Haider, and Sangeet Ghai's Letter to the Editor re: Francesco Giganti, Louise Dickinson, Clement Orczyk, et al. Prostate Imaging after Focal Ablation (PI-FAB): A Proposal for a Scoring System for Multiparametric MRI of the Prostate After Focal Therapy. Eur Urol Oncol. 2023;6:629-634. Eur Urol Oncol 2024; 7:308. [PMID: 37722978 DOI: 10.1016/j.euo.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK.
| | - Louise Dickinson
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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Englman C, Maffei D, Allen C, Kirkham A, Albertsen P, Kasivisvanathan V, Baroni RH, Briganti A, De Visschere P, Dickinson L, Gómez Rivas J, Haider MA, Kesch C, Loeb S, Macura KJ, Margolis D, Mitra AM, Padhani AR, Panebianco V, Pinto PA, Ploussard G, Puech P, Purysko AS, Radtke JP, Rannikko A, Rastinehad A, Renard-Penna R, Sanguedolce F, Schimmöller L, Schoots IG, Shariat SF, Schieda N, Tempany CM, Turkbey B, Valerio M, Villers A, Walz J, Barrett T, Giganti F, Moore CM. PRECISE Version 2: Updated Recommendations for Reporting Prostate Magnetic Resonance Imaging in Patients on Active Surveillance for Prostate Cancer. Eur Urol 2024:S0302-2838(24)02232-2. [PMID: 38556436 DOI: 10.1016/j.eururo.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/21/2024] [Accepted: 03/05/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND OBJECTIVE The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations standardise the reporting of prostate magnetic resonance imaging (MRI) in patients on active surveillance (AS) for prostate cancer. An international consensus group recently updated these recommendations and identified the areas of uncertainty. METHODS A panel of 38 experts used the formal RAND/UCLA Appropriateness Method consensus methodology. Panellists scored 193 statements using a 1-9 agreement scale, where 9 means full agreement. A summary of agreement, uncertainty, or disagreement (derived from the group median score) and consensus (determined using the Interpercentile Range Adjusted for Symmetry method) was calculated for each statement and presented for discussion before individual rescoring. KEY FINDINGS AND LIMITATIONS Participants agreed that MRI scans must meet a minimum image quality standard (median 9) or be given a score of 'X' for insufficient quality. The current scan should be compared with both baseline and previous scans (median 9), with the PRECISE score being the maximum from any lesion (median 8). PRECISE 3 (stable MRI) was subdivided into 3-V (visible) and 3-NonV (nonvisible) disease (median 9). Prostate Imaging Reporting and Data System/Likert ≥3 lesions should be measured on T2-weighted imaging, using other sequences to aid in the identification (median 8), and whenever possible, reported pictorially (diagrams, screenshots, or contours; median 9). There was no consensus on how to measure tumour size. More research is needed to determine a significant size increase (median 9). PRECISE 5 was clarified as progression to stage ≥T3a (median 9). CONCLUSIONS AND CLINICAL IMPLICATIONS The updated PRECISE recommendations reflect expert consensus opinion on minimal standards and reporting criteria for prostate MRI in AS. PATIENT SUMMARY The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations are used in clinical practice and research to guide the interpretation and reporting of magnetic resonance imaging for patients on active surveillance for prostate cancer. An international panel has updated these recommendations, clarified the areas of uncertainty, and highlighted the areas for further research.
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Affiliation(s)
- Cameron Englman
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Davide Maffei
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Peter Albertsen
- Department of Surgery (Urology), UConn Health, Farmington, CT, USA
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Ronaldo Hueb Baroni
- Department of Radiology, Hospital Israelita Albert Einstein. Sao Paulo, Brazil
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Pieter De Visschere
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Louise Dickinson
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Juan Gómez Rivas
- Department of Urology, Clinico San Carlos University Hospital, Madrid, Spain
| | - Masoom A Haider
- Joint Department of Medical Imaging, Sinai Health System, University of Toronto, Toronto, Canada
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Stacy Loeb
- Department of Urology and Population Health, New York University Langone Health and Manhattan Veterans Affairs, New York, NY, USA
| | - Katarzyna J Macura
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Margolis
- Weill Cornell Medical College, Department of Radiology, New York, NY, USA
| | - Anita M Mitra
- Department of Cancer Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Rickmansworth Road, Middlesex, UK
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Philippe Puech
- Department of Radiology, University of Lille, Lille, France
| | - Andrei S Purysko
- Abdominal Imaging Section, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jan Philipp Radtke
- University Dusseldorf, Medical Faculty, Department of Urology, Dusseldorf, Germany
| | - Antti Rannikko
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Art Rastinehad
- Department of Urology, Lenox Hill Hospital, New York, NY, USA
| | - Raphaele Renard-Penna
- Department of Radiology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francesco Sanguedolce
- Department of Urology, Autonoma University of Barcelona, Barcelona, Spain; Department of Medicine, Surgery and Pharmacy, Universitá degli studi di Sassari - Italy
| | - Lars Schimmöller
- Dusseldorf University, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany; Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan
| | - Nicola Schieda
- Department of Radiology, University of Ottawa, Ottawa, ON, Canada
| | - Clare M Tempany
- Department of Radiology Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Massimo Valerio
- Department of Urology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Arnauld Villers
- Department of Urology, Hospital Claude Huriez, CHU Lille, Lille, France
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Center, Marseille, France
| | - Tristan Barrett
- Department of Radiology, University of Cambridge, Addenbrook''s Hospital, Cambridge, UK
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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Moore CM, Albertsen P. When Is It Too Early To Start Prostate Cancer Screening? Reflections on the PROBASE Study Using Magnetic Resonance Imaging for Men Aged 45 Yr with Elevated Prostate-specific Antigen. Eur Urol 2024; 85:112-113. [PMID: 37968189 DOI: 10.1016/j.eururo.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK.
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Jonkman AH, Warnaar RSP, Baccinelli W, Carbon NM, D'Cruz RF, Doorduin J, van Doorn JLM, Elshof J, Estrada-Petrocelli L, Graßhoff J, Heunks LMA, Koopman AA, Langer D, Moore CM, Nunez Silveira JM, Petersen E, Poddighe D, Ramsay M, Rodrigues A, Roesthuis LH, Rossel A, Torres A, Duiverman ML, Oppersma E. Analysis and applications of respiratory surface EMG: report of a round table meeting. Crit Care 2024; 28:2. [PMID: 38166968 PMCID: PMC10759550 DOI: 10.1186/s13054-023-04779-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
Surface electromyography (sEMG) can be used to measure the electrical activity of the respiratory muscles. The possible applications of sEMG span from patients suffering from acute respiratory failure to patients receiving chronic home mechanical ventilation, to evaluate muscle function, titrate ventilatory support and guide treatment. However, sEMG is mainly used as a monitoring tool for research and its use in clinical practice is still limited-in part due to a lack of standardization and transparent reporting. During this round table meeting, recommendations on data acquisition, processing, interpretation, and potential clinical applications of respiratory sEMG were discussed. This paper informs the clinical researcher interested in respiratory muscle monitoring about the current state of the art on sEMG, knowledge gaps and potential future applications for patients with respiratory failure.
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Affiliation(s)
- A H Jonkman
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R S P Warnaar
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - W Baccinelli
- Netherlands eScience Center, Amsterdam, The Netherlands
| | - N M Carbon
- Department of Anesthesiology, Friedrich Alexander-Universität Erlangen-Nürnberg, Uniklinikum Erlangen, Erlangen, Germany
| | - R F D'Cruz
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J L M van Doorn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Elshof
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - L Estrada-Petrocelli
- Facultad de Ingeniería and Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT) - Sistema Nacional de Investigación (SNI), Universidad Latina de Panamá (ULATINA), Panama, Panama
| | - J Graßhoff
- Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering, Lübeck, Germany
| | - L M A Heunks
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A A Koopman
- Division of Paediatric Critical Care Medicine, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - D Langer
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium
| | - C M Moore
- Netherlands eScience Center, Amsterdam, The Netherlands
| | - J M Nunez Silveira
- Hospital Italiano de Buenos Aires, Unidad de Terapia Intensiva, Ciudad de Buenos Aires, Argentina
| | - E Petersen
- Technical University of Denmark (DTU), DTU Compute, 2800, Kgs. Lyngby, Denmark
| | - D Poddighe
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium
| | - M Ramsay
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Rodrigues
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - L H Roesthuis
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Rossel
- Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - A Torres
- Institut de Bioenginyeria de Catalunya (IBEC), Barcelona Institute of Science and Technology (BIST) and Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Universitat Politècnica de Catalunya BarcelonaTech (UPC), Barcelona, Spain
| | - M L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - E Oppersma
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands.
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Englman C, Barrett T, Moore CM, Giganti F. Active Surveillance for Prostate Cancer: Expanding the Role of MR Imaging and the Use of PRECISE Criteria. Radiol Clin North Am 2024; 62:69-92. [PMID: 37973246 DOI: 10.1016/j.rcl.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Multiparametric magnetic resonance (MR) imaging has had an expanding role in active surveillance (AS) for prostate cancer. It can improve the accuracy of prostate biopsies, assist in patient selection, and help monitor cancer progression. The PRECISE recommendations standardize reporting of serial MR imaging scans during AS. We summarize the evidence on MR imaging-led AS and provide a clinical primer to help report using the PRECISE criteria. Some limitations to both serial imaging and the PRECISE recommendations must be considered as we move toward a more individualized risk-stratified approach to AS.
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Affiliation(s)
- Cameron Englman
- Department of Radiology, University College London Hospital NHS Foundation Trust, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK; Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK
| | - Tristan Barrett
- Department of Radiology, University of Cambridge, Box 218, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK; Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Box 218, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK; Department of Urology, University College London Hospital NHS Foundation Trust, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK; Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK.
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Light A, Kanthabalan A, Otieno M, Pavlou M, Omar R, Adeleke S, Giganti F, Brew-Graves C, Williams NR, Emara A, Haroon A, Latifoltojar A, Sidhu H, Freeman A, Orczyk C, Nikapota A, Dudderidge T, Hindley RG, Virdi J, Arya M, Payne H, Mitra AV, Bomanji J, Winkler M, Horan G, Moore CM, Emberton M, Punwani S, Ahmed HU, Shah TT. The Role of Multiparametric MRI and MRI-targeted Biopsy in the Diagnosis of Radiorecurrent Prostate Cancer: An Analysis from the FORECAST Trial. Eur Urol 2024; 85:35-46. [PMID: 37778954 DOI: 10.1016/j.eururo.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 08/01/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The role of multiparametric magnetic resonance imaging (MRI) for detecting recurrent prostate cancer after radiotherapy is unclear. OBJECTIVE To evaluate MRI and MRI-targeted biopsies for detecting intraprostatic cancer recurrence and planning for salvage focal ablation. DESIGN, SETTING, AND PARTICIPANTS FOcal RECurrent Assessment and Salvage Treatment (FORECAST; NCT01883128) was a prospective cohort diagnostic study that recruited 181 patients with suspected radiorecurrence at six UK centres (2014 to 2018); 144 were included here. INTERVENTION All patients underwent MRI with 5 mm transperineal template mapping biopsies; 84 had additional MRI-targeted biopsies. MRI scans with Likert scores of 3 to 5 were deemed suspicious. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS First, the diagnostic accuracy of MRI was calculated. Second, the pathological characteristics of MRI-detected and MRI-undetected tumours were compared using the Wilcoxon rank sum test and chi-square test for trend. Third, four biopsy strategies involving an MRI-targeted biopsy alone and with systematic biopsies of one to two other quadrants were studied. Fisher's exact test was used to compare MRI-targeted biopsy alone with the best other strategy for the number of patients with missed cancer and the number of patients with cancer harbouring additional tumours in unsampled quadrants. Analyses focused primarily on detecting cancer of any grade or length. Last, eligibility for focal therapy was evaluated for men with localised (≤T3bN0M0) radiorecurrent disease. RESULTS AND LIMITATIONS Of 144 patients, 111 (77%) had cancer detected on biopsy. MRI sensitivity and specificity at the patient level were 0.95 (95% confidence interval [CI] 0.92 to 0.99) and 0.21 (95% CI 0.07 to 0.35), respectively. At the prostate quadrant level, 258/576 (45%) quadrants had cancer detected on biopsy. Sensitivity and specificity were 0.66 (95% CI 0.59 to 0.73) and 0.54 (95% CI 0.46 to 0.62), respectively. At the quadrant level, compared with MRI-undetected tumours, MRI-detected tumours had longer maximum cancer core length (median difference 3 mm [7 vs 4 mm]; 95% CI 1 to 4 mm, p < 0.001) and a higher grade group (p = 0.002). Of the 84 men who also underwent an MRI-targeted biopsy, 73 (87%) had recurrent cancer diagnosed. Performing an MRI-targeted biopsy alone missed cancer in 5/73 patients (7%; 95% CI 3 to 15%); with additional systematic sampling of the other ipsilateral and contralateral posterior quadrants (strategy 4), 2/73 patients (3%; 95% CI 0 to 10%) would have had cancer missed (difference 4%; 95% CI -3 to 11%, p = 0.4). If an MRI-targeted biopsy alone was performed, 43/73 (59%; 95% CI 47 to 69%) patients with cancer would have harboured undetected additional tumours in unsampled quadrants. This reduced but only to 7/73 patients (10%; 95% CI 4 to 19%) with strategy 4 (difference 49%; 95% CI 36 to 62%, p < 0.0001). Of 73 patients, 43 (59%; 95% CI 47 to 69%) had localised radiorecurrent cancer suitable for a form of focal ablation. CONCLUSIONS For patients with recurrent prostate cancer after radiotherapy, MRI and MRI-targeted biopsy, with or without perilesional sampling, will diagnose cancer in the majority where present. MRI-undetected cancers, defined as Likert scores of 1 to 2, were found to be smaller and of lower grade. However, if salvage focal ablation is planned, an MRI-targeted biopsy alone is insufficient for prostate mapping; approximately three of five patients with recurrent cancer found on an MRI-targeted biopsy alone harboured further tumours in unsampled quadrants. Systematic sampling of the whole gland should be considered in addition to an MRI-targeted biopsy to capture both MRI-detected and MRI-undetected disease. PATIENT SUMMARY After radiotherapy, magnetic resonance imaging (MRI) is accurate for detecting recurrent prostate cancer, with missed cancer being smaller and of lower grade. Targeting a biopsy to suspicious areas on MRI results in a diagnosis of cancer in most patients. However, for every five men who have recurrent cancer, this targeted approach would miss cancers elsewhere in the prostate in three of these men. If further focal treatment of the prostate is planned, random biopsies covering the whole prostate in addition to targeted biopsies should be considered so that tumours are not missed.
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Affiliation(s)
- Alexander Light
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Abi Kanthabalan
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Marjorie Otieno
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Menelaos Pavlou
- Department of Statistical Science, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Sola Adeleke
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Chris Brew-Graves
- Division of Medicine, Faculty of Medicine, University College London, London, UK
| | - Norman R Williams
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Amr Emara
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Athar Haroon
- Department of Nuclear Medicine, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK; Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Arash Latifoltojar
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Radiology, Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Harbir Sidhu
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Medicine, Faculty of Medicine, University College London, London, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clement Orczyk
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Ashok Nikapota
- Sussex Cancer Centre, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Richard G Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Manit Arya
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Heather Payne
- Department of Histopathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Anita V Mitra
- Department of Oncology, University College London Hospital NHS Foundation Trust, London, UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mathias Winkler
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Gail Horan
- Department of Oncology, Queen Elizabeth Hospital, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Medicine, Faculty of Medicine, University College London, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | - Taimur T Shah
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK.
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Khan A, Moore CM, Minhaj Siddiqui M. Prostate MRI and image quality: The urologist's perspective. Eur J Radiol 2024; 170:111255. [PMID: 38101197 DOI: 10.1016/j.ejrad.2023.111255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
The development of different imaging modalities of the prostate has significantly improved tumor detection, patient risk stratification, and quality of care.Among these, multiparametric magnetic resonance imaging (mp-MRI) has emerged as the most sensitive tool.It is useful in the diagnosis, localization, risk stratification, and staging of clinically significant prostate cancer, PCa. As a result, mp-MRI of the prostate is recommended as the initial diagnostic test for men with suspected PCa. A multidisciplinary approach is crucial in the diagnosis and management of prostate cancer and mp-MRI plays a fundamental role in this scenario.While many aspects of image quality certainly fall within the purview of radiology, it is important to recognize that urologists must also be attentive to imaging quality when utilizing mp-MRI to facilitate PCa management. We present our viewpoint as urologists on how image quality impacts the management of men diagnosed with PCa andattempt to identify the factors that impact mp-MRI image quality, consequences of poor image quality, and finally suggestions for improvements.
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Affiliation(s)
- Amir Khan
- Division of Urology, Department of Surgery, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Caroline M Moore
- Division of Surgical and Interventional Sciences, University College London, London, UK.
| | - M Minhaj Siddiqui
- Division of Urology, Department of Surgery, University of Maryland, School of Medicine, Baltimore, MD, USA.
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Koelker M, Labban M, Frego N, Ye J, Lipsitz SR, Hubbell HT, Edelen M, Steele G, Salinas K, Meyer CP, Makanjuola J, Moore CM, Cole AP, Kibel AS, Trinh QD. Racial differences in patient-reported outcomes among men treated with radical prostatectomy for prostate cancer. Prostate 2024; 84:47-55. [PMID: 37710385 DOI: 10.1002/pros.24624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 08/08/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Real-world data on racial differences in the side effects of radical prostatectomy on quality of life (QoL) are lacking. We aimed to evaluate differences in patient-reported outcome measure (PROM) among non-Hispanic Black (NHB) and non-Hispanic White (NHW) men using the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) questionnaire to measure health-related QoL after radical prostatectomy. METHODS We retrospectively assessed prospectively collected PROMs using EPIC-CP scores at a tertiary care center between 2015 and 2021 for men with prostate cancer undergoing radical prostatectomy. The primary endpoint was the overall QoL score for NHB and NHW men, with a total score of 60 and higher scores indicating worse QoL. An imputed mixed linear regression model was used to examine the effect of covariates on the change in overall QoL score following surgery. A pairwise comparison was used to estimate the mean QoL scores before surgery as well as up to 24 months after surgery. RESULTS Our cohort consisted of 2229 men who answered at least one EPIC-CP questionnaire before or after surgery, of which 110 (4.94%) were NHB and 2119 (95.07%) were NHW men. The QoL scores differed for NHB and NHW at baseline (2.34, 95% confidence interval [CI] 0.36-4.31, p = 0.02), 3 months (4.36, 95% CI 2.29-6.42, p < 0.01), 6 months (3.26, 95% CI 1.10-5.43, p < 0.01), and 12 months after surgery (2.48, 95% CI 0.19-4.77, p = 0.03) with NHB having worse scores. There was no difference in QoL between NHB and NHW men 24 months after surgery. CONCLUSIONS A significant difference in QoL between NHB and NHW men was reported before surgery, 3, 6, and 12 months after surgery, with NHB having worse QoL scores. However, there was no long-term difference in reported QoL. Our findings inform strategies that can be implemented to mitigate racial differences in short-term outcomes.
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Affiliation(s)
- Mara Koelker
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Muhieddine Labban
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nicola Frego
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Urology, Humanitas Research Hospital-IRCCS, Milan, Italy
| | - Jamie Ye
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stuart R Lipsitz
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Maria Edelen
- Brigham and Women's Hospital, PROVE Center, Boston, Massachusetts, USA
| | - Grant Steele
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kevin Salinas
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Caroline M Moore
- Division of Surgical and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals Trust, London, UK
| | - Alexander P Cole
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Adam S Kibel
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
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9
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Bunda BA, Raniele RA, Lapayowker SA, Moore CM, Wood ME, McDermott VM, Naresh A. Self-Perception of HIV Risk and Interest in Pre-Exposure Prophylaxis in a General Obstetrics and Gynecology Clinic Population. J Womens Health (Larchmt) 2023; 32:1380-1387. [PMID: 37870743 DOI: 10.1089/jwh.2023.0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
Background: Pre-exposure prophylaxis (PrEP) for HIV is underutilized, particularly among attendees of obstetrics and gynecology (Ob/Gyn) clinics. Lack of self-perception of HIV risk is a barrier to PrEP utilization, and a lack of understanding of community risk factors for HIV may contribute to that lack of self-perception of risk. Methods: Attendees of general Ob/Gyn clinics in New Orleans completed a survey assessing HIV knowledge, self-perception of HIV risk, and interest in PrEP. They reviewed a brief written educational intervention on demographic and behavioral risk factors for HIV and availability of PrEP. HIV knowledge, self-perception of HIV risk, and interest in PrEP were reassessed after the intervention. Results: One-hundred seventy individuals completed the survey. Eighty-five participants (50%) expressed initial interest in PrEP. Self-perception of risk of HIV acquisition was associated with interest in PrEP. Ten of 11 (90.9%) respondents who had high self-perceived risk of HIV were interested in PrEP, compared with 75 of 159 (47.2%) of those who had low self-perceived risk (p = 0.01). The association remained significant in a multivariate analysis. After the intervention, the number of those who perceived themselves to be at risk of HIV increased from 11 to 25 individuals (p < 0.01) and 20 of these (80%) were interested in PrEP. Knowledge of HIV risk factors increased (p < 0.01). The intervention did not significantly alter interest in PrEP. Conclusions: Self-perception of HIV risk was associated with interest in PrEP. A brief written educational intervention increased knowledge of HIV risk factors and increased self-perception of risk of HIV. The intervention did not translate to increased interest in PrEP.
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Affiliation(s)
- Bridget A Bunda
- Tulane University School of Medicine, New Orleans, Louisiana, USA
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Rachel A Raniele
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | - Caroline M Moore
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Moira E Wood
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Victoria M McDermott
- Tulane University School of Medicine, New Orleans, Louisiana, USA
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Amber Naresh
- Department of Obstetrics and Gynecology, Tulane University School of Medicine, New Orleans, Louisiana, USA
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10
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Giganti F, Dickinson L, Orczyk C, Haider A, Freeman A, Emberton M, Allen C, Moore CM. Prostate Imaging after Focal Ablation (PI-FAB): A Proposal for a Scoring System for Multiparametric MRI of the Prostate After Focal Therapy. Eur Urol Oncol 2023; 6:629-634. [PMID: 37210343 DOI: 10.1016/j.euo.2023.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/30/2023] [Accepted: 04/20/2023] [Indexed: 05/22/2023]
Abstract
At present there is no standardised system for scoring the appearance of the prostate on multiparametric magnetic resonance imaging (MRI) after focal ablation for localised prostate cancer. We propose a novel scoring system, the Prostate Imaging after Focal Ablation (PI-FAB) score, to fill this gap. PI-FAB involves a 3-point scale for rating MRI sequences in sequential order: (1) dynamic contrast-enhanced sequences; (2) diffusion-weighted imaging, split into assessment of the high-b-value sequence first and then the apparent diffusion coefficient map; and (3) T2-weighted imaging. It is essential that the pretreatment scan is also available to help with this assessment. We designed PI-FAB using our experience of reading postablation scans over the past 15 years and include details for four representative patients initially treated with high-intensity focus ultrasound at our institution to demonstrate the scoring system. We propose PI-FAB as a standardised method for evaluating prostate MRI scans after treatment with focal ablation. The next step is to evaluate its performance across multiple experienced readers of MRI after focal therapy in a clinical data set. PATIENT SUMMARY: We propose a scoring system called PI-FAB for assessing the appearance of magnetic resonance imaging scans of the prostate after focal treatment for localised prostate cancer. This will help clinicians in deciding on further follow-up.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK.
| | - Louise Dickinson
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clément Orczyk
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Aiman Haider
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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11
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Robinson ML, Hahn PG, Inouye BD, Underwood N, Whitehead SR, Abbott KC, Bruna EM, Cacho NI, Dyer LA, Abdala-Roberts L, Allen WJ, Andrade JF, Angulo DF, Anjos D, Anstett DN, Bagchi R, Bagchi S, Barbosa M, Barrett S, Baskett CA, Ben-Simchon E, Bloodworth KJ, Bronstein JL, Buckley YM, Burghardt KT, Bustos-Segura C, Calixto ES, Carvalho RL, Castagneyrol B, Chiuffo MC, Cinoğlu D, Cinto Mejía E, Cock MC, Cogni R, Cope OL, Cornelissen T, Cortez DR, Crowder DW, Dallstream C, Dáttilo W, Davis JK, Dimarco RD, Dole HE, Egbon IN, Eisenring M, Ejomah A, Elderd BD, Endara MJ, Eubanks MD, Everingham SE, Farah KN, Farias RP, Fernandes AP, Fernandes GW, Ferrante M, Finn A, Florjancic GA, Forister ML, Fox QN, Frago E, França FM, Getman-Pickering AS, Getman-Pickering Z, Gianoli E, Gooden B, Gossner MM, Greig KA, Gripenberg S, Groenteman R, Grof-Tisza P, Haack N, Hahn L, Haq SM, Helms AM, Hennecke J, Hermann SL, Holeski LM, Holm S, Hutchinson MC, Jackson EE, Kagiya S, Kalske A, Kalwajtys M, Karban R, Kariyat R, Keasar T, Kersch-Becker MF, Kharouba HM, Kim TN, Kimuyu DM, Kluse J, Koerner SE, Komatsu KJ, Krishnan S, Laihonen M, Lamelas-López L, LaScaleia MC, Lecomte N, Lehn CR, Li X, Lindroth RL, LoPresti EF, Losada M, Louthan AM, Luizzi VJ, Lynch SC, Lynn JS, Lyon NJ, Maia LF, Maia RA, Mannall TL, Martin BS, Massad TJ, McCall AC, McGurrin K, Merwin AC, Mijango-Ramos Z, Mills CH, Moles AT, Moore CM, Moreira X, Morrison CR, Moshobane MC, Muola A, Nakadai R, Nakajima K, Novais S, Ogbebor CO, Ohsaki H, Pan VS, Pardikes NA, Pareja M, Parthasarathy N, Pawar RR, Paynter Q, Pearse IS, Penczykowski RM, Pepi AA, Pereira CC, Phartyal SS, Piper FI, Poveda K, Pringle EG, Puy J, Quijano T, Quintero C, Rasmann S, Rosche C, Rosenheim LY, Rosenheim JA, Runyon JB, Sadeh A, Sakata Y, Salcido DM, Salgado-Luarte C, Santos BA, Sapir Y, Sasal Y, Sato Y, Sawant M, Schroeder H, Schumann I, Segoli M, Segre H, Shelef O, Shinohara N, Singh RP, Smith DS, Sobral M, Stotz GC, Tack AJM, Tayal M, Tooker JF, Torrico-Bazoberry D, Tougeron K, Trowbridge AM, Utsumi S, Uyi O, Vaca-Uribe JL, Valtonen A, van Dijk LJA, Vandvik V, Villellas J, Waller LP, Weber MG, Yamawo A, Yim S, Zarnetske PL, Zehr LN, Zhong Z, Wetzel WC. Plant size, latitude, and phylogeny explain within-population variability in herbivory. Science 2023; 382:679-683. [PMID: 37943897 DOI: 10.1126/science.adh8830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/27/2023] [Indexed: 11/12/2023]
Abstract
Interactions between plants and herbivores are central in most ecosystems, but their strength is highly variable. The amount of variability within a system is thought to influence most aspects of plant-herbivore biology, from ecological stability to plant defense evolution. Our understanding of what influences variability, however, is limited by sparse data. We collected standardized surveys of herbivory for 503 plant species at 790 sites across 116° of latitude. With these data, we show that within-population variability in herbivory increases with latitude, decreases with plant size, and is phylogenetically structured. Differences in the magnitude of variability are thus central to how plant-herbivore biology varies across macroscale gradients. We argue that increased focus on interaction variability will advance understanding of patterns of life on Earth.
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Affiliation(s)
- M L Robinson
- Department of Entomology, Michigan State University, East Lansing, MI, USA
- Department of Biology, Utah State University, Logan, UT, USA
| | - P G Hahn
- Entomology and Nematology Department, University of Florida, Gainesville, FL, USA
| | - B D Inouye
- Department of Biological Science, Florida State University, Tallahassee, FL, USA
| | - N Underwood
- Department of Biological Science, Florida State University, Tallahassee, FL, USA
| | - S R Whitehead
- Department of Biological Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - K C Abbott
- Department of Biology, Case Western Reserve University, Cleveland, OH, USA
| | - E M Bruna
- Center for Latin American Studies, University of Florida, Gainesville, FL, USA
- Department of Wildlife Ecology and Conservation, University of Florida, Gainesville, FL, USA
| | - N I Cacho
- Instituto de Biología, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - L A Dyer
- Biology Department, University of Nevada, Reno, Reno, NV, USA
| | - L Abdala-Roberts
- Departamento de Ecología Tropical, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - W J Allen
- Bio-Protection Research Centre, University of Canterbury, Christchurch, New Zealand
| | - J F Andrade
- Departamento de Sistemática e Ecologia Universidade Federal da Paraíba, João Pessoa, Brazil
| | - D F Angulo
- Centro de Investigación Científica de Yucatán, Departamento de Recursos Naturales, Mérida, Yucatán, México
| | - D Anjos
- Instituto de Biologia, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - D N Anstett
- Department of Entomology, Michigan State University, East Lansing, MI, USA
- Plant Resilience Institute, Michigan State University, East Lansing, MI, USA
- Department of Plant Biology, Michigan State University, East Lansing, MI, USA
| | - R Bagchi
- Department of Ecology and Evolutionary Biology, University of Connecticut, Storrs, CT, USA
| | - S Bagchi
- Centre for Ecological Sciences, Indian Institute of Science, Bangalore, Karnataka, India
| | - M Barbosa
- Department of Genetics, Ecology and Evolution, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - S Barrett
- Department of Biodiversity Conservation & Attractions Western Australia, Albany, Western Australia, Australia
| | - C A Baskett
- Institute of Science and Technology Austria, Klosterneuburg, Austria
| | - E Ben-Simchon
- Department of Natural Resources, Institute of Plant Sciences, Agricultural Research Organization - Volcani Institute, Rishon Le Tzion, Israel
- Robert H. Smith Faculty of Agriculture, Food, and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - K J Bloodworth
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC, USA
| | - J L Bronstein
- Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ, USA
| | - Y M Buckley
- School of Natural Sciences, Zoology, Trinity College Dublin, Dublin, Ireland
| | - K T Burghardt
- Department of Entomology, University of Maryland, College Park, MD, USA
| | - C Bustos-Segura
- Institute of Biology, University of Neuchatel, Neuchatel, Switzerland
| | - E S Calixto
- Entomology and Nematology Department, University of Florida, Gainesville, FL, USA
| | - R L Carvalho
- Institute of Advanced Studies, University of São Paulo, São Paulo, Brazil
| | | | - M C Chiuffo
- Grupo de Ecología de Invasiones, INIBIOMA, Universidad Nacional del Comahue, CONICET, San Carlos de Bariloche, Río Negro, Argentina
| | - D Cinoğlu
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA
| | - E Cinto Mejía
- Department of Entomology, Michigan State University, East Lansing, MI, USA
| | - M C Cock
- Facultad de Ciencias Exactas y Naturales, Instituto de Ciencias de la Tierra y Ambientales de La Pampa, Santa Rosa, La Pampa, Argentina
| | - R Cogni
- Department of Ecology, University of São Paulo, São Paulo, Brazil
| | - O L Cope
- Department of Entomology, Michigan State University, East Lansing, MI, USA
- Department of Biology, Whitworth University, Spokane, WA, USA
| | - T Cornelissen
- Department of Genetics, Ecology and Evolution, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - D R Cortez
- Department of Biology, California State University San Bernardino, San Bernardino, CA, USA
| | - D W Crowder
- Department of Entomology, Washington State University, Pullman, WA, USA
| | - C Dallstream
- Department of Biology, McGill University, Montreal, Quebec, Canada
| | - W Dáttilo
- Red de Ecoetología, Instituto de Ecología AC, Xalapa, Veracruz, Mexico
| | - J K Davis
- Department of Entomology, Cornell University, Ithaca, NY, USA
| | - R D Dimarco
- Department of Biology and Biochemistry, University of Houston, Houston, TX, USA
- Grupo de Ecología de Poblaciones de Insectos, IFAB, San Carlos de Bariloche, Río Negro, Argentina
| | - H E Dole
- Department of Entomology, Michigan State University, East Lansing, MI, USA
| | - I N Egbon
- Department of Animal and Environmental Biology, University of Benin, Benin City, Nigeria
| | - M Eisenring
- Forest Entomology, Swiss Federal Research Institute WSL, Birmensdorf, Switzerland
| | - A Ejomah
- Department of Animal and Environmental Biology, University of Benin, Benin City, Nigeria
| | - B D Elderd
- Department of Biological Sciences, Louisiana State University, Baton Rouge, LA, USA
| | - M-J Endara
- Grupo de Investigación en Ecología y Evolución en los Trópicos-EETROP, Universidad de las Américas, Quito, Ecuador
| | - M D Eubanks
- Department of Entomology, Texas A&M University, College Station, TX, USA
| | - S E Everingham
- Institute of Plant Sciences, University of Bern, Bern, Switzerland
- Evolution & Ecology Research Centre, University of New South Wales Sydney, Sydney, Australia
| | - K N Farah
- Department of Biology, Washington University in St. Louis, St. Louis, MO, USA
| | - R P Farias
- Instituto de Biologia, Universidade Federal da Bahia, Salvador, Bahia, Brasil
| | - A P Fernandes
- Department of Botany, Ganpat Parsekar College of Education Harmal, Pernem, Goa, India
| | - G W Fernandes
- Department of Genetics, Ecology and Evolution, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Knowledge Center for Biodiversity, Brazil
| | - M Ferrante
- Faculty of Agricultural Sciences and Environment, University of the Azores, Ponta Delgada, Portugal
- Department of Crop Sciences, University of Göttingen, Göttingen, Germany
| | - A Finn
- School of Natural Sciences, Zoology, Trinity College Dublin, Dublin, Ireland
| | - G A Florjancic
- Department of Biological Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - M L Forister
- Biology Department, University of Nevada, Reno, Reno, NV, USA
| | - Q N Fox
- Department of Biology, Washington University in St. Louis, St. Louis, MO, USA
| | - E Frago
- CIRAD, UMR CBGP, INRAE, Institut Agro, IRD, Université Montpellier, Montpellier, France
| | - F M França
- School of Biological Sciences, University of Bristol, Bristol, UK
- Programa de Pós-Graduação em Ecologia, Universidade Federal do Pará, Belém, Pará, Brasil
| | | | - Z Getman-Pickering
- Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, MA, USA
| | - E Gianoli
- Departamento de Biología, Universidad de La Serena, La Serena, Chile
| | - B Gooden
- CSIRO Black Mountain Laboratories, CSIRO Health and Biosecurity, Canberra, Australia
| | - M M Gossner
- Forest Entomology, Swiss Federal Research Institute WSL, Birmensdorf, Switzerland
- Institute of Terrestrial Ecosystems, Department of Environmental Systems Science, ETH Zurich, Zurich, Switzerland
| | - K A Greig
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA
| | - S Gripenberg
- School of Biological Sciences, University of Reading, Reading, UK
| | - R Groenteman
- Manaaki Whenua - Landcare Research, Lincoln, New Zealand
| | - P Grof-Tisza
- Institute of Biology, University of Neuchatel, Neuchatel, Switzerland
| | - N Haack
- Independent Institute for Environmental Issues, Halle, Germany
| | - L Hahn
- Molecular Evolution and Systematics of Animals, University of Leipzig, Leipzig, Germany
| | - S M Haq
- Wildlife Crime Control Division, Wildlife Trust of India, Noida, Uttar Pradesh, India
| | - A M Helms
- Department of Entomology, Texas A&M University, College Station, TX, USA
| | - J Hennecke
- Systematic Botany and Functional Biodiversity, Leipzig University, Leipzig, Germany
- German Centre for Integrative Biodiversity Research (iDiv), Leipzig, Germany
| | - S L Hermann
- Department of Entomology, The Pennsylvania State University, University Park, PA, USA
| | - L M Holeski
- Department of Biological Sciences and Center for Adaptive Western Landscapes, Northern Arizona University, Flagstaff, AZ, USA
| | - S Holm
- Department of Environmental and Biological Sciences, University of Eastern Finland, Joensuu, Finland
- Department of Zoology, University of Tartu, Tartu, Estonia
| | - M C Hutchinson
- Department of Life and Environmental Sciences, University of California, Merced, Merced, CA, USA
| | - E E Jackson
- School of Biological Sciences, University of Reading, Reading, UK
| | - S Kagiya
- Field Science Center for Northern Biosphere, Hokkaido University, Sapporo, Hokkaido, Japan
| | - A Kalske
- Department of Biology, University of Turku, Turku, Finland
| | - M Kalwajtys
- Department of Entomology, Michigan State University, East Lansing, MI, USA
| | - R Karban
- Department of Entomology and Nematology, University of California Davis, Davis, CA, USA
| | - R Kariyat
- Department of Entomology and Plant Pathology, University of Arkansas, Fayetteville, AR, USA
| | - T Keasar
- Department of Biology and the Environment, University of Haifa - Oranim, Oranim, Tivon, Israel
| | - M F Kersch-Becker
- Department of Entomology, The Pennsylvania State University, University Park, PA, USA
| | - H M Kharouba
- Department of Biology, University of Ottawa, Ottawa, Ontario, Canada
| | - T N Kim
- Department of Entomology, Kansas State University, Manhattan, KS, USA
| | - D M Kimuyu
- Department of Natural Resources, Karatina University, Karatina, Kenya
| | - J Kluse
- Department of Biological Sciences, Louisiana State University, Baton Rouge, LA, USA
| | - S E Koerner
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC, USA
| | - K J Komatsu
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC, USA
- Smithsonian Environmental Research Center, Edgewater, MD, USA
| | - S Krishnan
- Center for Sustainable Future, Amrita University and EIACP RP, Amrita Viswa Vidyapeetham, Coimbatore, India
| | - M Laihonen
- Biodiversity Unit, University of Turku, Turku, Finland
| | - L Lamelas-López
- Faculty of Agricultural Sciences and Environment, University of the Azores, Ponta Delgada, Portugal
| | - M C LaScaleia
- Department of Ecology and Evolutionary Biology, University of Connecticut, Storrs, CT, USA
| | - N Lecomte
- Canada Research Chair in Polar and Boreal Ecology, Department of Biology and Centre d'Études Nordiques, Université de Moncton, Moncton, Canada
| | - C R Lehn
- Biological Sciences Course, Instituto Federal Farroupilha, Panambi, RS, Brazil
| | - X Li
- College of Resources and Environmental sciences, Jilin Agricultural University, Changchun, China
| | - R L Lindroth
- Department of Entomology, University of Wisconsin-Madison, Madison, WI, USA
| | - E F LoPresti
- Department of Biological Sciences, University of South Carolina, Columbia, SC, USA
| | - M Losada
- Department of Soil Science and Agricultural Chemistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - A M Louthan
- Division of Biology, Kansas State University, Manhattan, KS, USA
| | - V J Luizzi
- Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ, USA
| | - S C Lynch
- Division of Biology, Kansas State University, Manhattan, KS, USA
| | - J S Lynn
- Department of Biological Sciences, University of Bergen, Bergen, Norway
- Department of Earth and Environmental Sciences, University of Manchester, Manchester, UK
| | - N J Lyon
- Department of Entomology, Michigan State University, East Lansing, MI, USA
| | - L F Maia
- Bio-Protection Research Centre, University of Canterbury, Christchurch, New Zealand
- School of Biological Sciences, University of Bristol, Bristol, UK
| | - R A Maia
- Department of Genetics, Ecology and Evolution, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - T L Mannall
- Institute of Plant Sciences, University of Bern, Bern, Switzerland
| | - B S Martin
- Department of Plant Biology, Michigan State University, East Lansing, MI, USA
- Ecology, Evolution, and Behavior Program, Michigan State University, East Lansing, MI, USA
| | - T J Massad
- Department of Scientific Services, Gorongosa National Park, Sofala, Mozambique
| | - A C McCall
- Biology Department, Denison University, Granville, OH, USA
| | - K McGurrin
- Department of Entomology, University of Maryland, College Park, MD, USA
| | - A C Merwin
- Department of Biology and Geology, Baldwin Wallace University, Berea, OH, USA
| | - Z Mijango-Ramos
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA
| | - C H Mills
- Evolution & Ecology Research Centre, University of New South Wales Sydney, Sydney, Australia
| | - A T Moles
- Evolution & Ecology Research Centre, University of New South Wales Sydney, Sydney, Australia
| | - C M Moore
- Department of Biology, Colby College, Waterville, ME, USA
| | - X Moreira
- Misión Biológica de Galicia, Consejo Superior de Investigaciones Científicas, Pontevedra, Galicia, Spain
| | - C R Morrison
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA
| | - M C Moshobane
- South African National Biodiversity Institute, Pretoria National Botanical Garden, Brummeria, Silverton, South Africa
- Centre for Functional Biodiversity, University of KwaZulu-Natal, Scottsville, Pietermaritzburg, South Africa
| | - A Muola
- Division of Biotechnology and Plant Health, Norwegian Institute of Bioeconomy Research, Tromsø, Norway
| | - R Nakadai
- Faculty of Environment and Information Sciences, Yokohama National University, Yokohama, Kanagawa, Japan
| | - K Nakajima
- Insitute of Science and Engineering, Chuo University, Tokyo, Japan
- Institute of Cave Research, Shimohei-guun, Iwate Prefecture, Japan
| | - S Novais
- Red de Interacciones Multitróficas, Instituto de Ecología A.C., Xalapa, Veracruz, Mexico
| | - C O Ogbebor
- Nigerian Institute for Oil Palm Research, Benin City, Edo State, Nigeria
| | - H Ohsaki
- Department of Biological Sciences, Hirosaki University, Hirosaki, Aomori, Japan
| | - V S Pan
- Ecology, Evolution, and Behavior Program, Michigan State University, East Lansing, MI, USA
- Department of Integrative Biology, Michigan State University, East Lansing, MI, USA
| | - N A Pardikes
- Department of Biology, Utah State University, Logan, UT, USA
| | - M Pareja
- Departamento de Biologia Animal, Universidade Estadual de Campinas, Campinas, Brazil
| | - N Parthasarathy
- Department of Ecology and Evironmental Sciences, Pondicherry University, Puducherry, India
| | | | - Q Paynter
- Manaaki Whenua - Landcare Research, Auckland, New Zealand
| | - I S Pearse
- U.S. Geological Survey, Fort Collins Science Center, Fort Collins, CO, USA
| | - R M Penczykowski
- Department of Biology, Washington University in St. Louis, St. Louis, MO, USA
| | - A A Pepi
- Department of Biology, Tufts University, Medford, MA, USA
| | - C C Pereira
- Department of Genetics, Ecology and Evolution, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - S S Phartyal
- School of Ecology & Environment Studies, Nalanda University, Rajgir, India
| | - F I Piper
- Millennium Nucleus of Patagonian Limit of Life and Instituto de Ciencias Biológicas, Universidad de Talca, Talca, Chile
- Institute of Ecology and Biodiversity, Ñuñoa, Santiago
| | - K Poveda
- Department of Entomology, Cornell University, Ithaca, NY, USA
| | - E G Pringle
- Biology Department, University of Nevada, Reno, Reno, NV, USA
| | - J Puy
- School of Natural Sciences, Zoology, Trinity College Dublin, Dublin, Ireland
- Estación Biológica de Doñana, Consejo Superior de Investigaciones Científicas, Sevilla, Spain
| | - T Quijano
- Departamento de Ecología Tropical, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - C Quintero
- INIBIOMA, CONICET - Universidad Nacional del Comahue, San Carlos de Bariloche, Río Negro, Argentina
| | - S Rasmann
- Institute of Biology, University of Neuchatel, Neuchatel, Switzerland
| | - C Rosche
- German Centre for Integrative Biodiversity Research (iDiv), Leipzig, Germany
- Institute of Geobotany and Botanical Garden, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - L Y Rosenheim
- Department of Entomology and Nematology, University of California Davis, Davis, CA, USA
| | - J A Rosenheim
- Department of Entomology and Nematology, University of California Davis, Davis, CA, USA
| | - J B Runyon
- Rocky Mountain Research Station, USDA Forest Service, Bozeman, MT, USA
| | - A Sadeh
- Department of Natural Resources, Newe Ya'ar Research Center, Volcani Institute, Ramat Yishay, Israel
| | - Y Sakata
- Department of Biological Environment, Akita Prefectural University, Shimoshinjyo-Nakano, Akita, Japan
| | - D M Salcido
- Biology Department, University of Nevada, Reno, Reno, NV, USA
| | - C Salgado-Luarte
- Instituto de Investigación Multidisciplinario en Ciencia y Tecnología, Universidad de La Serena, La Serena, Chile
| | - B A Santos
- Departamento de Sistemática e Ecologia Universidade Federal da Paraíba, João Pessoa, Brazil
| | - Y Sapir
- The Botanic Garden, School of Plant Sciences and Food Security, Faculty of Life Science, Tel Aviv University, Tel Aviv, Israel
| | - Y Sasal
- INIBIOMA, CONICET - Universidad Nacional del Comahue, San Carlos de Bariloche, Río Negro, Argentina
| | - Y Sato
- Department of Evolutionary Biology and Environmental Studies, University of Zurich, Zurich, Switzerland
| | - M Sawant
- Department of Ecology, University of Pune, Maharashtra, India
| | - H Schroeder
- Department of Entomology, Cornell University, Ithaca, NY, USA
| | - I Schumann
- Department of Human Genetics, University of Leipzig, Leipzig, Germany
| | - M Segoli
- Mitrani Department of Desert Ecology, Blaustein Institutes for Desert Research, Ben-Gurion University of the Negev, Midreshet Ben-Gurion, Israel
| | - H Segre
- Department of Natural Resources, Institute of Plant Sciences, Agricultural Research Organization - Volcani Institute, Rishon Le Tzion, Israel
- Robert H. Smith Faculty of Agriculture, Food, and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
- Department of Natural Resources, Newe Ya'ar Research Center, Volcani Institute, Ramat Yishay, Israel
| | - O Shelef
- Department of Natural Resources, Institute of Plant Sciences, Agricultural Research Organization - Volcani Institute, Rishon Le Tzion, Israel
| | - N Shinohara
- Graduate School of Life Sciences, Tohoku University, Sendai, Japan
| | - R P Singh
- McGuire Center for Lepidoptera and Biodiversity, Florida Museum of Natural History, University of Florida, Gainesville, FL, USA
| | - D S Smith
- Department of Biology, California State University San Bernardino, San Bernardino, CA, USA
| | - M Sobral
- Department of Soil Science and Agricultural Chemistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - G C Stotz
- Department of Plant and Environmental Sciences, Clemson University, Clemson, SC, USA
| | - A J M Tack
- Department of Ecology, Environment and Plant Sciences, Stockholm University, Stockholm, Sweden
| | - M Tayal
- Department of Plant and Environmental Sciences, Clemson University, Clemson, SC, USA
| | - J F Tooker
- Department of Entomology, The Pennsylvania State University, University Park, PA, USA
| | - D Torrico-Bazoberry
- Laboratorio de Comportamiento Animal y Humano, Centro de Investigación en Complejidad Social, Universidad del Desarrollo, Las Condes, Chile
| | - K Tougeron
- Écologie et Dynamique des Systèmes Anthropisés, Université de Picardie Jules Verne, UMR 7058 CNRS, Amiens, France
- Ecology of Interactions and Global Change, Institut de Recherche en Biosciences, Université de Mons, Mons, Belgium
| | - A M Trowbridge
- Department of Forest and Wildlife Ecology, University of Wisconsin, Madison, WI, USA
| | - S Utsumi
- Field Science Center for Northern Biosphere, Hokkaido University, Sapporo, Hokkaido, Japan
| | - O Uyi
- Department of Animal and Environmental Biology, University of Benin, Benin City, Nigeria
- Department of Entomology, University of Georgia, Tifton, GA, USA
| | - J L Vaca-Uribe
- Programa de ingeniría agroecológica, Corporación Universitaria Minuto de Dios, Bogotá, Colombia
| | - A Valtonen
- Department of Environmental and Biological Sciences, University of Eastern Finland, Joensuu, Finland
| | - L J A van Dijk
- Department of Ecology, Environment and Plant Sciences, Stockholm University, Stockholm, Sweden
- Department of Bioinformatics and Genetics, Swedish Museum of Natural History, Stockholm, Sweden
| | - V Vandvik
- Department of Biological Sciences, University of Bergen, Bergen, Norway
| | - J Villellas
- Department of Life Sciences, University of Alcalá, Madrid, Spain
| | - L P Waller
- Bioprotection Aotearoa, Lincoln University, Lincoln, New Zealand
| | - M G Weber
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI, USA
| | - A Yamawo
- Department of Biological Sciences, Hirosaki University, Hirosaki, Aomori, Japan
- Center for Ecological Research, Kyoto University, Otsu, Japan
| | - S Yim
- Biology Department, University of Nevada, Reno, Reno, NV, USA
| | - P L Zarnetske
- Ecology, Evolution, and Behavior Program, Michigan State University, East Lansing, MI, USA
- Department of Integrative Biology, Michigan State University, East Lansing, MI, USA
| | - L N Zehr
- Department of Entomology, Michigan State University, East Lansing, MI, USA
| | - Z Zhong
- Institute of Grassland Science, Key Laboratory of Vegetation Ecology, Ministry of Education/Jilin Songnen Grassland Ecosystem National Observation and Research Station, Northeast Normal University, Changchun, Jilin Province, China
- Institute of Plant Protection, Chinese Academy of Agricultural Sciences, State Key Laboratory for Biology of Plant Diseases and Insect Pests, Beijing, China
| | - W C Wetzel
- Department of Entomology, Michigan State University, East Lansing, MI, USA
- Plant Resilience Institute, Michigan State University, East Lansing, MI, USA
- Ecology, Evolution, and Behavior Program, Michigan State University, East Lansing, MI, USA
- Department of Integrative Biology, Michigan State University, East Lansing, MI, USA
- W.K. Kellogg Biological Station, Michigan State University, Hickory Corners, MI, USA
- Land Resources and Environmental Sciences, Montana State University, Bozeman, MT, USA
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12
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Sanmugalingam N, Sushentsev N, Lee KL, Caglic I, Englman C, Moore CM, Giganti F, Barrett T. The PRECISE Recommendations for Prostate MRI in Patients on Active Surveillance for Prostate Cancer: A Critical Review. AJR Am J Roentgenol 2023; 221:649-660. [PMID: 37341180 DOI: 10.2214/ajr.23.29518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations were published in 2016 to standardize the reporting of MRI examinations performed to assess for disease progression in patients on active surveillance for prostate cancer. Although a limited number of studies have reported outcomes from use of PRECISE in clinical practice, the available studies have demonstrated PRECISE to have high pooled NPV but low pooled PPV for predicting progression. Our experience in using PRECISE in clinical practice at two teaching hospitals has highlighted issues with its application and areas requiring clarification. This Clinical Perspective critically appraises PRECISE on the basis of this experience, focusing on the system's key advantages and disadvantages and exploring potential changes to improve the system's utility. These changes include consideration of image quality when applying PRECISE scoring, incorporation of quantitative thresholds for disease progression, adoption of a PRECISE 3F sub-category for progression not qualifying as substantial, and comparisons with both the baseline and most recent prior examinations. Items requiring clarification include derivation of a patient-level score in patients with multiple lesions, intended application of PRECISE score 5 (i.e., if requiring development of disease that is no longer organ-confined), and categorization of new lesions in patients with prior MRI-invisible disease.
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Affiliation(s)
- Nimalan Sanmugalingam
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
| | - Kang-Lung Lee
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Iztok Caglic
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
| | - Cameron Englman
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
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Singh S, Giganti F, Dickinson L, Rogers H, Kanber B, Clemente J, Pye H, Heavey S, Stopka-Farooqui U, Johnston EW, Moore CM, Freeman A, Whitaker HC, Alexander DC, Panagiotaki E, Punwani S. Prostate MR image quality of apparent diffusion coefficient maps versus fractional intracellular volume maps from VERDICT MRI using the PI-QUAL score and a dedicated Likert scale for artefacts. Eur J Radiol 2023; 168:111109. [PMID: 37769532 DOI: 10.1016/j.ejrad.2023.111109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/30/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE This study aimed to assess the image quality of apparent diffusion coefficient (ADC) maps derived from conventional diffusion-weighted MRI and fractional intracellular volume maps (FIC) from VERDICT MRI (Vascular, Extracellular, Restricted Diffusion for Cytometry in Tumours) in patients from the INNOVATE trial. The inter-reader agreement was also assessed. METHODS Two readers analysed both ADC and FIC maps from 57 patients enrolled in the INNOVATE prospective trial. Image quality was assessed using the Prostate Imaging Quality (PI-QUAL) score and a subjective image quality Likert score (Likert-IQ). The image quality of FIC and ADC were compared using a Wilcoxon Signed Ranks test. The inter-reader agreement was assessed with Cohen's kappa. RESULTS There was no statistically significant difference between the PI-QUAL score for FIC datasets compared to ADC datasets for either reader (p = 0.240 and p = 0.614). Using the Likert-IQ score, FIC image quality was higher compared to ADC (p = 0.021) as assessed by reader-1 but not for reader-2 (p = 0.663). The inter-reader agreement was 'fair' for PI-QUAL scoring of datasets with FIC maps at 0.27 (95% confidence interval; 0.08-0.46) and ADC datasets at 0.39 (95% confidence interval 0.22-0.57). For Likert scoring, the inter-reader agreement was also 'fair' for FIC maps at 0.38 (95% confidence interval; 0.10-0.65) and substantial for ADC maps at 0.62 (95% confidence interval; 0.39-0.86). CONCLUSION Image quality was comparable for FIC and ADC. The inter-reader agreement was similar when using PIQUAL for both FIC and ADC datasets but higher for ADC maps compared to FIC maps using the image quality Likert score.
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Affiliation(s)
- Saurabh Singh
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Francesco Giganti
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | - Louise Dickinson
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Harriet Rogers
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Baris Kanber
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, UK
| | - Joey Clemente
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Hayley Pye
- Division of Surgery & Interventional Science, University College London, London, UK; Molecular Diagnostics and Therapeutics Group, University College London, UK
| | - Susan Heavey
- Division of Surgery & Interventional Science, University College London, London, UK; Molecular Diagnostics and Therapeutics Group, University College London, UK
| | - Urszula Stopka-Farooqui
- Division of Surgery & Interventional Science, University College London, London, UK; Molecular Diagnostics and Therapeutics Group, University College London, UK
| | - Edward W Johnston
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK; Department of Interventional Radiology, Royal Marsden Hospital, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hayley C Whitaker
- Molecular Diagnostics and Therapeutics Group, University College London, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, UK
| | - Eleftheria Panagiotaki
- Centre for Medical Image Computing, Department of Computer Science, University College London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
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14
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Woernle A, Englman C, Dickinson L, Kirkham A, Punwani S, Haider A, Freeman A, Kasivisivanathan V, Emberton M, Hines J, Moore CM, Allen C, Giganti F. Picture Perfect: The Status of Image Quality in Prostate MRI. J Magn Reson Imaging 2023. [PMID: 37804007 DOI: 10.1002/jmri.29025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/08/2023] Open
Abstract
Magnetic resonance imaging is the gold standard imaging modality for the diagnosis of prostate cancer (PCa). Image quality is a fundamental prerequisite for the ability to detect clinically significant disease. In this critical review, we separate the issue of image quality into quality improvement and quality assessment. Beginning with the evolution of technical recommendations for scan acquisition, we investigate the role of patient preparation, scanner factors, and more advanced sequences, including those featuring Artificial Intelligence (AI), in determining image quality. As means of quality appraisal, the published literature on scoring systems (including the Prostate Imaging Quality score), is evaluated. Finally, the application of AI and teaching courses as ways to facilitate quality assessment are discussed, encouraging the implementation of future image quality initiatives along the PCa diagnostic and monitoring pathway. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Alexandre Woernle
- Faculty of Medical Sciences, University College London, London, UK
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Cameron Englman
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Louise Dickinson
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Centre for Medical Imaging, University College London, 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
| | - Veeru Kasivisivanathan
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - John Hines
- Faculty of Medical Sciences, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
- North East London Cancer Alliance & North Central London Cancer Alliance Urology, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
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Giganti F, Ng A, Asif A, Chan VWS, Rossiter M, Nathan A, Khetrapal P, Dickinson L, Punwani S, Brew-Graves C, Freeman A, Emberton M, Moore CM, Allen C, Kasivisvanathan V. Global Variation in Magnetic Resonance Imaging Quality of the Prostate. Radiology 2023; 309:e231130. [PMID: 37815448 DOI: 10.1148/radiol.231130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Background High variability in prostate MRI quality might reduce accuracy in prostate cancer detection. Purpose To prospectively evaluate the quality of MRI scanners taking part in the quality control phase of the global PRIME (Prostate Imaging Using MRI ± Contrast Enhancement) trial using the Prostate Imaging Quality (PI-QUAL) standardized scoring system, give recommendations on how to improve the MRI protocols, and establish whether MRI quality could be improved by these recommendations. Materials and Methods In the prospective clinical trial (PRIME), for each scanner, centers performing prostate MRI submitted five consecutive studies and the MRI protocols (phase I). Submitted data were evaluated in consensus by two expert genitourinary radiologists using the PI-QUAL scoring system that evaluates MRI diagnostic quality using five points (1 and 2 = nondiagnostic; 3 = sufficient; 4 = adequate, 5 = optimal) between September 2021 and August 2022. Feedback was provided for scanners not achieving a PI-QUAL 5 score, and centers were invited to resubmit new imaging data using the modified protocol (phase II). Descriptive comparison of outcomes was made between the MRI scanners, feedback provided, and overall PI-QUAL scores. Results In phase I, 41 centers from 18 countries submitted a total of 355 multiparametric MRI studies from 71 scanners, with nine (13%) scanners achieving a PI-QUAL score of 3, 39 (55%) achieving a score of 4, and 23 (32%) achieving a score of 5. Of the 48 (n = 71 [68%]) scanners that received feedback to improve, the dynamic contrast-enhanced sequences were those that least adhered to the Prostate Imaging Reporting and Data System, version 2.1, criteria (44 of 48 [92%]), followed by diffusion-weighted imaging (20 of 48 [42%]) and T2-weighted imaging (19 of 48 [40%]). In phase II, 36 centers from 17 countries resubmitted revised studies, resulting in a total of 62 (n = 64 [97%]) scanners with a final PI-QUAL score of 5. Conclusion Substantial variation in global prostate MRI acquisition parameters as a measure of quality was observed, particularly with DCE sequences. Basic evaluation and modifications to MRI protocols using PI-QUAL can lead to substantial improvements in quality. Clinical trial registration no. NCT04571840 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Almansour and Chernyak in this issue.
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Affiliation(s)
- Francesco Giganti
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Alexander Ng
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Aqua Asif
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Vinson Wai-Shun Chan
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Marimo Rossiter
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Arjun Nathan
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Pramit Khetrapal
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Louise Dickinson
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Shonit Punwani
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Chris Brew-Graves
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Alex Freeman
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Mark Emberton
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Caroline M Moore
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Clare Allen
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
| | - Veeru Kasivisvanathan
- From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.)
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16
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Stavrinides V, Eksi E, Finn R, Texeira-Mendes L, Rana S, Trahearn N, Grey A, Giganti F, Huet E, Fiard G, Freeman A, Haider A, Allen C, Kirkham A, Cole AP, Collins T, Pendse D, Dickinson L, Punwani S, Pashayan N, Emberton M, Moore CM, Orczyk C. Magnetic Resonance Imaging Follow-up of Targeted Biopsy-negative Prostate Lesions. Eur Urol Focus 2023; 9:781-787. [PMID: 37031096 DOI: 10.1016/j.euf.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/03/2023] [Accepted: 03/23/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The optimal radiological follow-up of prostate lesions negative on magnetic resonance imaging (MRI)-targeted biopsy (MRI-TB) is yet to be optimised. OBJECTIVE To present medium-term radiological and clinical follow-up of biopsy-negative lesions. DESIGN, SETTING, AND PARTICIPANTS The records for men who underwent multiparametric MRI at the UCLH one-stop clinic for suspected prostate cancer between September 2017 and March 2020 were reviewed (n = 1199). Patients with Likert 4 or 5 lesions were considered (n = 495), and those with a subsequent negative MRI-TB comprised the final study population (n = 91). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Baseline and follow-up MRI and biopsy data (including prostate-specific antigen [PSA], prostate volume, radiological scores, and presence of any noncancerous pathology) were extracted from reports. The last follow-up date was the date of the last test or review in clinic. RESULTS AND LIMITATIONS Median follow-up was 1.8 yr (656 d, interquartile range [IQR] 359-1008). At baseline, the median age was 65.4 yr (IQR 60.7-70.0), median PSA was 7.1 ng/ml (IQR 4.7-10.0), median prostate volume was 54 ml (IQR 39.5-75.0), and median PSA density (PSAD) was 0.13 ng/ml2 (IQR 0.09-0.18). Eighty-six men (95%) had Likert 4 lesions, while the remaining five (5%) had Likert 5 lesions. Only 21 men (23%) had a single lesion; most had at least two. Atrophy was the most prevalent pathology on MRI-TB, present in 64 men (74%), and followed by acute inflammation in 42 (46%), prostatic intraepithelial neoplasia in 33 (36%), chronic inflammation in 18 (20%), atypia in 13 (14%), and granulomatous inflammation in three (3%). Fifty-eight men had a second MRI study (median 376 d, IQR 361-412). At the second MRI, median PSAD decreased to 0.11 ng/ml2 (IQR 0.08-0.18). A Likert 4 or 5 score persisted only in five men (9%); 40 men (69%) were scored Likert 3, while the remaining 13 (22%) were scored Likert 2 (no lesion). Of 45 men with a Likert ≥3 score, most only had one lesion at the second MRI (28 men; 62%). Of six men with repeat MRI-TB during the study period, two were subsequently diagnosed with prostate cancer and both had persistent Likert 4 scores (at baseline and at least one follow-up MRI). CONCLUSIONS Most biopsy-negative MRI lesions in the prostate resolve over time, but any persistent lesions should be closely monitored. PATIENT SUMMARY Lesions in the prostate detected via magnetic resonance imaging (MRI) scans that are negative for cancer on biopsy usually resolve. Repeat MRI can indicate persistent lesions that might need a second biopsy.
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Affiliation(s)
- Vasilis Stavrinides
- Division of Surgery & Interventional Science, University College London, London, UK; The Alan Turing Institute, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Ece Eksi
- CEDAR, Knight Cancer Institute, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Ron Finn
- Division of Surgery & Interventional Science, University College London, London, UK
| | | | - Sarina Rana
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Alistair Grey
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Eric Huet
- TRePCa, Université Paris Est-Créteil, Créteil, France
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble, France
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aiman Haider
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alexander P Cole
- Division of Urological Surgery, Harvard Medical School, Boston, MA, USA
| | - Tom Collins
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Douglas Pendse
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Louise Dickinson
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nora Pashayan
- Department of Applied Health Research, Institute of Epidemiology & Health, University College London, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Clement Orczyk
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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17
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Habashy D, Reddy D, Peters M, Shah TT, van Son M, van Rossum PSN, Tanaka MB, Cullen E, Engle R, McCracken S, Greene D, Hindley RG, Emara A, Nigam R, Orczyk C, Shergill I, Persad R, Virdi J, Moore CM, Arya M, Winkler M, Emberton M, Ahmed HU, Dudderidge T. Evaluation of Outcomes Following Focal Ablative Therapy for Treatment of Localized Clinically Significant Prostate Cancer in Patients >70 Years: A Multi-institute, Multi-energy 15-Year Experience. J Urol 2023; 210:108-116. [PMID: 37014172 DOI: 10.1097/ju.0000000000003443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/22/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE In older patients who do not wish to undergo watchful waiting, focal therapy could be an alternative to the more morbid radical treatment. We evaluated the role of focal therapy in patients 70 years and older as an alternative management modality. MATERIALS AND METHODS A total of 649 patients across 11 UK sites receiving focal high-intensity focused ultrasound or cryotherapy between June 2006 and July 2020 reported within the UK-based HEAT (HIFU Evaluation and Assessment of Treatment) and ICE (International Cryotherapy Evaluation) registries were evaluated. Primary outcome was failure-free survival, defined by need for more than 1 focal reablation, progression to radical treatment, development of metastases, need for systemic treatment, or prostate cancer-specific death. This was compared to the failure-free survival in patients undergoing radical treatment via a propensity score weighted analysis. RESULTS Median age was 74 years (IQR: 72, 77) and median follow-up 24 months (IQR: 12, 41). Sixty percent had intermediate-risk disease and 35% high-risk disease. A total of 113 patients (17%) required further treatment. Sixteen had radical treatment and 44 required systemic treatment. Failure-free survival was 82% (95% CI: 76%-87%) at 5 years. Comparing patients who had radical therapy to those who had focal therapy, 5-year failure-free survival was 96% (95% CI: 93%-100%) and 82% (95% CI: 75%-91%) respectively (P < .001). Ninety-three percent of those in the radical treatment arm had received radiotherapy as their primary treatment with its associated use of androgen deprivation therapy, thereby leading to potential overestimation of treatment success in the radical treatment arm, especially given the similar metastases-free and overall survival rates seen. CONCLUSIONS We propose focal therapy to be an effective management option for the older or comorbid patient who is unsuitable for or not willing to undergo radical treatment.
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Affiliation(s)
- David Habashy
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Deepika Reddy
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Max Peters
- Department of Radiation Oncology, University Medical Centre, Utrecht, The Netherlands
| | - Taimur T Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Marieke van Son
- Department of Radiation Oncology, University Medical Centre, Utrecht, The Netherlands
| | - Peter S N van Rossum
- Department of Radiation Oncology, University Medical Centre, Utrecht, The Netherlands
| | | | - Emma Cullen
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Ryan Engle
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Stuart McCracken
- Department of Urology, Sunderland Royal Hospital, City Hospital Foundation Trust, Sunderland, United Kingdom
| | - Damian Greene
- Department of Urology, Spire Hospital, Washington, United Kingdom
| | - Richard G Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, United Kingdom
- BMI The Hampshire Clinic, Basingstoke, United Kingdom
| | - Amr Emara
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, United Kingdom
- Ain Shams University Hospitals, Cairo, Egypt
| | - Raj Nigam
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
- BMI Mount Alvernia Hospital, Guildford, United Kingdom
| | - Clement Orczyk
- Department of Surgery and Interventional Sciences, University College London, and University College Hospital London, London, United Kingdom
| | - Iqbal Shergill
- Department of Urology, Wrexham Maelor Hospital, Wrexham, United Kingdom
| | - Raj Persad
- North Bristol NHS Trust, Westbury on Trym, Bristol, United Kingdom
| | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom
| | - Caroline M Moore
- Department of Surgery and Interventional Sciences, University College London, and University College Hospital London, London, United Kingdom
- Princess Grace Hospital, London, United Kingdom
- King Edward VII Hospital, London, United Kingdom
| | - Manit Arya
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Surgery and Interventional Sciences, University College London, and University College Hospital London, London, United Kingdom
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mark Emberton
- Department of Surgery and Interventional Sciences, University College London, and University College Hospital London, London, United Kingdom
- Princess Grace Hospital, London, United Kingdom
- King Edward VII Hospital, London, United Kingdom
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- King Edward VII Hospital, London, United Kingdom
- Cromwell Hospital, London, United Kingdom
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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18
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Koelker M, Labban M, Frego N, Meyer CP, Salomon G, Lipsitz SR, Withington J, Moore CM, Tempany CM, Tuncali K, George A, Kibel AS, Trinh QD, Cole AP. Contemporary patterns of local ablative therapies for prostate cancer at United States cancer centers: results from a national registry. World J Urol 2023; 41:1309-1315. [PMID: 36930254 PMCID: PMC10506077 DOI: 10.1007/s00345-023-04354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/26/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE To describe the national-level patterns of care for local ablative therapy among men with PCa and identify patient- and hospital-level factors associated with the receipt of these techniques. METHODS We retrospectively interrogated the National Cancer Database (NCDB) for men with clinically localized PCa between 2010 and 2017. The main outcome was receipt of local tumor ablation with either cryo- or laser-ablation, and "other method of local tumor destruction including high-intensity focused ultrasound (HIFU)". Patient level, hospital level, and demographic variables were collected. Mixed effect logistic regression models were fitted to identify separately patient- and hospital-level predictors of receipt of local ablative therapy. RESULTS Overall, 11,278 patients received ablative therapy, of whom 78.8% had cryotherapy, 15.6% had laser, and 5.7% had another method including HIFU. At the patient level, men with intermediate-risk PCa were more likely to be treated with local ablative therapy (OR 1.05; 95% CI 1.00-1.11; p = 0.05), as were men with Charlson Comorbidity Index > 1 (OR 1.36; 95% CI 1.29-1.43; p < 0.01), men between 71 and 80 years (OR 3.70; 95% CI 3.43-3.99; p < 0.01), men with Medicare insurance (OR 1.38; 95% 1.31-1.46; p < 0.01), and an income < $47,999 (OR 1.16; 95% CI 1.06-1.21; p < 0.01). At the hospital-level, local ablative therapy was less likely to be performed in academic/research facilities (OR 0.45; 95% CI 0.32-0.64; p < 0.01). CONCLUSIONS Local ablative therapy for PCa treatment is more commonly offered among older and comorbid patients. Future studies should investigate the uptake of these technologies in non-hospital-based settings and in light of recent changes in insurance coverage.
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Affiliation(s)
- Mara Koelker
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Muhieddine Labban
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
| | - Nicola Frego
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
- Department of Urology, Humanitas Research Hospital-IRCCS, Rozzano, Milan, Italy
| | - Christian P Meyer
- Department of Urology, Ruhr University Bochum, Klinikum Herford, Herford, Germany
| | - Georg Salomon
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stuart R Lipsitz
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
| | - John Withington
- Division of Surgical and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals Trust, London, UK
| | - Caroline M Moore
- Division of Surgical and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals Trust, London, UK
| | - Clare M Tempany
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Arvin George
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Adam S Kibel
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
| | - Alexander P Cole
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA.
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19
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Asif A, Nathan A, Ng A, Khetrapal P, Chan VWS, Giganti F, Allen C, Freeman A, Punwani S, Lorgelly P, Clarke CS, Brew-Graves C, Muirhead N, Emberton M, Agarwal R, Takwoingi Y, Deeks JJ, Moore CM, Kasivisvanathan V. Comparing biparametric to multiparametric MRI in the diagnosis of clinically significant prostate cancer in biopsy-naive men (PRIME): a prospective, international, multicentre, non-inferiority within-patient, diagnostic yield trial protocol. BMJ Open 2023; 13:e070280. [PMID: 37019486 PMCID: PMC10083803 DOI: 10.1136/bmjopen-2022-070280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
INTRODUCTION Prostate MRI is a well-established tool for the diagnostic work-up for men with suspected prostate cancer (PCa). Current recommendations advocate the use of multiparametric MRI (mpMRI), which is composed of three sequences: T2-weighted sequence (T2W), diffusion-weighted sequence (DWI) and dynamic contrast-enhanced sequence (DCE). Prior studies suggest that a biparametric MRI (bpMRI) approach, omitting the DCE sequences, may not compromise clinically significant cancer detection, though there are limitations to these studies, and it is not known how this may affect treatment eligibility. A bpMRI approach will reduce scanning time, may be more cost-effective and, at a population level, will allow more men to gain access to an MRI than an mpMRI approach. METHODS Prostate Imaging Using MRI±Contrast Enhancement (PRIME) is a prospective, international, multicentre, within-patient diagnostic yield trial assessing whether bpMRI is non-inferior to mpMRI in the diagnosis of clinically significant PCa. Patients will undergo the full mpMRI scan. Radiologists will be blinded to the DCE and will initially report the MRI using only the bpMRI (T2W and DWI) sequences. They will then be unblinded to the DCE sequence and will then re-report the MRI using the mpMRI sequences (T2W, DWI and DCE). Men with suspicious lesions on either bpMRI or mpMRI will undergo prostate biopsy. The main inclusion criteria are men with suspected PCa, with a serum PSA of ≤20 ng/mL and without prior prostate biopsy. The primary outcome is the proportion of men with clinically significant PCa detected (Gleason score ≥3+4 or Gleason grade group ≥2). A sample size of at least 500 patients is required. Key secondary outcomes include the proportion of clinically insignificant PCa detected and treatment decision. ETHICS AND DISSEMINATION Ethical approval was obtained from the National Research Ethics Committee West Midlands, Nottingham (21/WM/0091). Results of this trial will be disseminated through peer-reviewed publications. Participants and relevant patient support groups will be informed about the results of the trial. TRIAL REGISTRATION NUMBER NCT04571840.
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Affiliation(s)
- Aqua Asif
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Arjun Nathan
- Division of Surgery and Interventional Science, University College London, London, UK
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Alexander Ng
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Pramit Khetrapal
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, Whipps Cross University Hospital, London, UK
| | - Vinson Wai-Shun Chan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Francesco Giganti
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Clare Allen
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
- Centre for Medical Imaging, University College London, London, UK
| | - Paula Lorgelly
- Institute of Epidemiology and Health Care, University College London, London, UK
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Caroline S Clarke
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Chris Brew-Graves
- National Cancer Imaging Translational Accelerator, University College London, London, UK
| | - Nicola Muirhead
- National Cancer Imaging Translational Accelerator, University College London, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ridhi Agarwal
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan J Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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20
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Shah TT, Kanthabalan A, Otieno M, Pavlou M, Omar R, Adeleke S, Giganti F, Brew-Graves C, Williams NR, Grierson J, Miah H, Emara A, Haroon A, Latifoltojar A, Sidhu H, Clemente J, Freeman A, Orczyk C, Nikapota A, Dudderidge T, Hindley RG, Virdi J, Arya M, Payne H, Mitra A, Bomanji J, Winkler M, Horan G, Moore CM, Emberton M, Punwani S, Ahmed HU. Corrigendum to "Magnetic Resonance Imaging and targeted biopsies compared to transperineal mapping biopsies prior to salvage focal therapy/ablation in localised and metastatic recurrent prostate cancer after radiotherapy. Primary Outcomes from the FORECAST Trial" [Eur Urol 2022;81(6):598-605]. Eur Urol 2023; 83:e117-e118. [PMID: 36681537 DOI: 10.1016/j.eururo.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Taimur T Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Sciences, University College London, London, UK.
| | - Abi Kanthabalan
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Marjorie Otieno
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Menelaos Pavlou
- Department of Statistical Science, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Sola Adeleke
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Oncology, King's College London, London, UK; Department of Oncology, Maidstone and Tunbridge Wells Hospital, Maidstone, UK; School of Cancer & Pharmaceutical Sciences, King's College London, Queen Square, London WC1N 3BG, UK; High Dimensional Neurology, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Francesco Giganti
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Chris Brew-Graves
- Division of Medicine, Faculty of Medicine, University College London, London, UK
| | - Norman R Williams
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Jack Grierson
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Haroon Miah
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Amr Emara
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK; Urology Department, Ain Shams University Hospitals, Cairo, Egypt
| | - Athar Haroon
- Department of Nuclear Medicine, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK; Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Arash Latifoltojar
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK
| | - Harbir Sidhu
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Joey Clemente
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clement Orczyk
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Ashok Nikapota
- Sussex Cancer Centre. Royal Sussex County Hospital, Brighton, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Richard G Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Manit Arya
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Heather Payne
- Department of Oncology, University College London and University College London Hospital NHS Foundation Trust, London, UK
| | - Anita Mitra
- Department of Oncology, University College London and University College London Hospital NHS Foundation Trust, London, UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Gail Horan
- Department of Oncology, Queen Elizabeth Hospital, Kings Lynn, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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21
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Woernle A, Dickinson L, Lelie S, Pendse D, Heffernan Ho D, Ramachandran N, Kirkham A, Von Stempel C, Punwani S, Wah So C, Withington J, Grey A, Collins T, Maffei D, Haider A, Freeman A, Emberton M, Piper JW, Moore CM, Hines J, Orczyk C, Allen C, Giganti F. A semi-automated software program to assess the impact of second reads in prostate MRI for equivocal lesions: results from a UK tertiary referral centre. Eur J Radiol 2023; 162:110796. [PMID: 37003197 DOI: 10.1016/j.ejrad.2023.110796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023]
Abstract
PURPOSE To investigate the utility of a prostate magnetic resonance imaging (MRI) second read using a semi-automated software program in the one-stop clinic, where patients undergo multiparametric MRI, review and biopsy planning in one visit. We looked at concordance between readers for patients with equivocal scans and the possibility for biopsy deferral in this group. METHODS We present data from 664 consecutive patients. Scans were reported by seven different expert genitourinary radiologists using dedicated software (MIM®) and a Likert scale. All scans were rescored by another expert genitourinary radiologist using a customised workflow for second reads that includes annotated biopsy contours for accurate visual targeting. The number of scans in which a biopsy could have been deferred using biopsy results and prostate specific antigen density was assessed. Gleason score ≥ 3 + 4 was considered clinically significant disease. Concordance between first and second reads for equivocal scans (Likert 3) was evaluated. RESULTS A total of 209/664 (31%) patients scored Likert 3 on first read, 128 of which (61%) were concordant after second read. 103/209 (49%) of patients with Likert 3 scans were biopsied, with clinically significant disease in 31 (30%) cases. Considering Likert 3 scans that were both downgraded and biopsied using the workflow-generated biopsy contours, 25/103 (24%) biopsies could have been deferred. CONCLUSIONS Implementing a semi-automated workflow for accurate lesion contouring and targeting biopsies is helpful during the one-stop clinic. We observed a reduction of indeterminate scans after second reading and almost a quarter of biopsies could have been deferred, reducing the potential biopsy-related side effects.
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Affiliation(s)
- Alexandre Woernle
- Faculty of Medical Sciences, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Louise Dickinson
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | | | - Doug Pendse
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Daniel Heffernan Ho
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Navin Ramachandran
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Conrad Von Stempel
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Centre for Medical Imaging, University College London, London, UK
| | - Chun Wah So
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - John Withington
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | - Alistair Grey
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | - Thomas Collins
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | - Davide Maffei
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Aiman Haider
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | | | - Caroline M Moore
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | - John Hines
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; North East London Cancer Alliance & North Central London Cancer Alliance Urology, London, UK
| | - Clément Orczyk
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK.
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22
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Cole AP, Koelker M, Makanjuola J, Moore CM. Can PROMs improve racial equity in outcomes after prostatectomy? Nat Rev Urol 2023; 20:125-126. [PMID: 36414799 DOI: 10.1038/s41585-022-00682-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Alexander P Cole
- Division of Urological Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Mara Koelker
- Division of Urological Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonathan Makanjuola
- Department of Urology, King Edward VII Memorial Hospital, Bermuda Hospitals Board, Hamilton, Bermuda
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK
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23
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Cole AP, Koelker M, Makanjuola J, Moore CM. Author Correction: Can PROMs improve racial equity in outcomes after prostatectomy? Nat Rev Urol 2023; 20:194. [PMID: 36550314 DOI: 10.1038/s41585-022-00712-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Alexander P Cole
- Division of Urological Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Mara Koelker
- Division of Urological Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonathan Makanjuola
- Department of Urology, King Edward VII Memorial Hospital, Bermuda Hospitals Board, Hamilton, Bermuda
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK
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24
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Maffei D, Giganti F, Moore CM. Seminar: Revisiting the value of PSA-based prostate cancer screening Essay No 5: Should men undergo MRI before prostate biopsy? (Pro). Urol Oncol 2023; 41:88-91. [PMID: 35871993 DOI: 10.1016/j.urolonc.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Abstract
Prostate cancer is the commonest cancer in men in Europe and many countries worldwide, and the second commonest cause of cancer-related death. A screening programme to detect clinically relevant prostate cancer at a time when it can be cured, without burdensome overdiagnosis and subsequent overtreatment, is a laudable goal. We will set out the advances in MRI imaging, and the progress in MRI for men prior to biopsy, discussing whether MRI has a place before biopsy, or as a primary screening tool, in a modern approach to prostate cancer screening.
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Affiliation(s)
- Davide Maffei
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK.
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25
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Moore CM, King LE, Withington J, Amin MB, Andrews M, Briers E, Chen RC, Chinegwundoh FI, Cooperberg MR, Crowe J, Finelli A, Fitch MI, Frydenberg M, Giganti F, Haider MA, Freeman J, Gallo J, Gibbs S, Henry A, James N, Kinsella N, Lam TBL, Lichty M, Loeb S, Mahal BA, Mastris K, Mitra AV, Merriel SWD, van der Kwast T, Van Hemelrijck M, Palmer NR, Paterson CC, Roobol MJ, Segal P, Schraidt JA, Short CE, Siddiqui MM, Tempany CMC, Villers A, Wolinsky H, MacLennan S. Best Current Practice and Research Priorities in Active Surveillance for Prostate Cancer-A Report of a Movember International Consensus Meeting. Eur Urol Oncol 2023; 6:160-182. [PMID: 36710133 DOI: 10.1016/j.euo.2023.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/06/2022] [Accepted: 01/04/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Active surveillance (AS) is recommended for low-risk and some intermediate-risk prostate cancer. Uptake and practice of AS vary significantly across different settings, as does the experience of surveillance-from which tests are offered, and to the levels of psychological support. OBJECTIVE To explore the current best practice and determine the most important research priorities in AS for prostate cancer. DESIGN, SETTING, AND PARTICIPANTS A formal consensus process was followed, with an international expert panel of purposively sampled participants across a range of health care professionals and researchers, and those with lived experience of prostate cancer. Statements regarding the practice of AS and potential research priorities spanning the patient journey from surveillance to initiating treatment were developed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Panel members scored each statement on a Likert scale. The group median score and measure of consensus were presented to participants prior to discussion and rescoring at panel meetings. Current best practice and future research priorities were identified, agreed upon, and finally ranked by panel members. RESULTS AND LIMITATIONS There was consensus agreement that best practice includes the use of high-quality magnetic resonance imaging (MRI), which allows digital rectal examination (DRE) to be omitted, that repeat standard biopsy can be omitted when MRI and prostate-specific antigen (PSA) kinetics are stable, and that changes in PSA or DRE should prompt MRI ± biopsy rather than immediate active treatment. The highest ranked research priority was a dynamic, risk-adjusted AS approach, reducing testing for those at the least risk of progression. Improving the tests used in surveillance, ensuring equity of access and experience across different patients and settings, and improving information and communication between and within clinicians and patients were also high priorities. Limitations include the use of a limited number of panel members for practical reasons. CONCLUSIONS The current best practice in AS includes the use of high-quality MRI to avoid DRE and as the first assessment for changes in PSA, with omission of repeat standard biopsy when PSA and MRI are stable. Development of a robust, dynamic, risk-adapted approach to surveillance is the highest research priority in AS for prostate cancer. PATIENT SUMMARY A diverse group of experts in active surveillance, including a broad range of health care professionals and researchers and those with lived experience of prostate cancer, agreed that best practice includes the use of high-quality magnetic resonance imaging, which can allow digital rectal examination and some biopsies to be omitted. The highest research priority in active surveillance research was identified as the development of a dynamic, risk-adjusted approach.
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Affiliation(s)
- Caroline M Moore
- Division of Surgical and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK.
| | | | - John Withington
- Division of Surgical and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK
| | - Mahul B Amin
- Department of Pathology and Lab Medicine, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Urology, USC Keck School of Medicine, Los Angeles, CA, USA
| | | | | | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Francis I Chinegwundoh
- Department of Urology, Barts Health NHS Trust, London, UK; City University of London, London, UK
| | - Matthew R Cooperberg
- Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Department of Urology, University of California at San Francisco, San Francisco, CA, USA
| | - Jane Crowe
- Australian Prostate Centre, North Melbourne, Victoria, Australia
| | - Antonio Finelli
- Department of Surgery (Urology), Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, Toronto, ON, Canada
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Mark Frydenberg
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Department of Urology, Cabrini Institute, Cabrini Health, Melbourne, Victoria, Australia
| | - Francesco Giganti
- Division of Surgical and Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Masoom A Haider
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | | | - Joseph Gallo
- Active Surveillance Patients International, East Stroudsburg, PA, USA
| | | | | | - Nicholas James
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Netty Kinsella
- Translational Oncology and Urology Research, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Urology, Royal Marsden Hospital, London, UK
| | - Thomas B L Lam
- Academic Urology Unit, Aberdeen University, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Mark Lichty
- Active Surveillance Patients International, East Stroudsburg, PA, USA
| | - Stacy Loeb
- Department of Urology, New York University, New York, NY, USA; Department of Population Health, New York University, New York, NY, USA; Manhattan Veterans Affairs Medical Center, New York, NY, USA
| | - Brandon A Mahal
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | | | - Anita V Mitra
- Cancer Services, University College London Hospitals, NHS, London, UK
| | - Samuel W D Merriel
- Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter, UK; Centre for Primary Care & Health Services Research, University of Manchester, Manchester, UK
| | - Theodorus van der Kwast
- Department of Pathology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nynikka R Palmer
- Department of Medicine, Zuckerberg San Francisco General Hospital. University of California San Francisco School of Medicine; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco; Department of Urology, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Catherine C Paterson
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia; Canberra Health Services and ACT Health, Synergy Nursing and Midwifery Research Centre, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Phillip Segal
- Prostate Cancer Support Toronto, Toronto, ON, Canada
| | | | - Camille E Short
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia; Melbourne Centre for Behaviour Change, University of Melbourne, Melbourne, Victoria, Australia
| | - M Minhaj Siddiqui
- Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Clare M C Tempany
- Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Arnaud Villers
- Department of Urology Univ. Lille, CHU Lille, Department of Urology F-59000 Lille, France
| | - Howard Wolinsky
- Answer Cancer Foundation, Tumacacori, Arizona, USA; TheActiveSurveillor.com, Flossmoor, Illinois, USA
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Warren H, Wagner T, Gorin MA, Rowe S, Holman BF, Pencharz D, El-Sheikh S, Barod R, Patki P, Mumtaz F, Bex A, Kasivisvanathan V, Moore CM, Campain N, Cartledge J, Scarsbrook A, Hassan F, O'Brien TS, Stewart GD, Mendichovszky I, Dizdarevic S, Alanbuki A, Wildgoose WH, Wah T, Vindrola-Padros C, Pizzo E, Dehbi HM, Lorgelly P, Gurusamy K, Emberton M, Tran MGB. Protocol for a MULTI-centre feasibility study to assess the use of 99mTc-sestaMIBI SPECT/CT in the diagnosis of kidney tumours (MULTI-MIBI study). BMJ Open 2023; 13:e067496. [PMID: 36693694 PMCID: PMC9884914 DOI: 10.1136/bmjopen-2022-067496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The incidence of renal tumours is increasing and anatomic imaging cannot reliably distinguish benign tumours from renal cell carcinoma. Up to 30% of renal tumours are benign, with oncocytomas the most common type. Biopsy has not been routinely adopted in many centres due to concerns surrounding non-diagnostic rate, bleeding and tumour seeding. As a result, benign masses are often unnecessarily surgically resected. 99mTc-sestamibi SPECT/CT has shown high diagnostic accuracy for benign renal oncocytomas and other oncocytic renal neoplasms of low malignant potential in single-centre studies. The primary aim of MULTI-MIBI is to assess feasibility of a multicentre study of 99mTc-sestamibi SPECT/CT against a reference standard of histopathology from surgical resection or biopsy. Secondary aims of the study include obtaining estimates of 99mTc-sestamibi SPECT/CT sensitivity and specificity and to inform the design and conduct of a future definitive trial. METHODS AND ANALYSIS A feasibility prospective multicentre study of participants with indeterminate, clinical T1 renal tumours to undergo 99mTc-sestamibi SPECT/CT (index test) compared with histopathology from biopsy or surgical resection (reference test). Interpretation of the index and reference tests will be blinded to the results of the other. Recruitment rate as well as estimates of sensitivity, specificity, positive and negative predictive value will be reported. Semistructured interviews with patients and clinicians will provide qualitative data to inform onward trial design and delivery. Training materials for 99mTc-sestamibi SPECT/CT interpretation will be developed, assessed and optimised. Early health economic modelling using a decision analytic approach for different diagnostic strategies will be performed to understand the potential cost-effectiveness of 99mTc-sestamibi SPECT/CT. ETHICS AND DISSEMINATION Ethical approval has been granted (UK HRA REC 20/YH/0279) protocol V.5.0 dated 21/6/2022. Study outputs will be presented and published nationally and internationally. TRIAL REGISTRATION NUMBER ISRCTN12572202.
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Affiliation(s)
- Hannah Warren
- Division of Surgery and Interventional Science, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Thomas Wagner
- Department of Nuclear Medicine, Royal Free Hospital, London, UK
| | - Michael A Gorin
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Steven Rowe
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Soha El-Sheikh
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
- Department of Pathology, Royal Free Hospital, London, UK
| | - Ravi Barod
- Division of Surgery and Interventional Science, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Prasad Patki
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Faiz Mumtaz
- Division of Surgery and Interventional Science, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Axel Bex
- Division of Surgery and Interventional Science, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College Hospital, London, UK
| | - Nicholas Campain
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Jon Cartledge
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew Scarsbrook
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Fahim Hassan
- Department of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tim S O'Brien
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Iosif Mendichovszky
- Department of Radiology, University of Cambridge, Cambridge, UK
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sabina Dizdarevic
- Department of Nuclear Medicine, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Ammar Alanbuki
- Department of Urology, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | | | - Tze Wah
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Cecilia Vindrola-Padros
- Rapid Research, Evaluation and Appraisal Lab (RREAL), Department of Targeted Intervention, University College London, London, UK
| | - Elena Pizzo
- Department of Applied Health Research, University College London, London, UK
| | - Hakim-Moulay Dehbi
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Paula Lorgelly
- Department of Applied Health Research, University College London, London, UK
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College Hospital, London, UK
| | - Maxine G B Tran
- Division of Surgery and Interventional Science, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
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27
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Reddy D, van Son M, Peters M, Bertoncelli Tanaka M, Dudderidge T, Cullen E, Ho CLT, Hindley RG, Emara A, McCracken S, Orczyk C, Shergill I, Mangar S, Nigam R, Virdi J, Moore CM, Arya M, Shah TT, Winkler M, Emberton M, Falconer A, Belsey J, Ahmed HU. Focal therapy versus radical prostatectomy and external beam radiotherapy as primary treatment options for non-metastatic prostate cancer: results of a cost-effectiveness analysis. J Med Econ 2023; 26:1099-1107. [PMID: 37656223 DOI: 10.1080/13696998.2023.2251849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
AIMS Focal therapy treats individual areas of tumour in non-metastatic prostate cancer in patients unsuitable for active surveillance. The aim of this work was to evaluate the cost-effectiveness of focal therapy versus prostatectomy and external beam radiotherapy (EBRT). MATERIALS AND METHODS A Markov cohort health state transition model with four health states (stable disease, local recurrence, metastatic disease and death) was created, evaluating costs and utilities over a 10-year time horizon for patients diagnosed with non-metastatic prostate cancer. National Health Service (NHS) for England perspective was used, based on direct healthcare costs. Clinical transition probabilities were derived from prostate cancer registries in patients undergoing radical prostatectomy, EBRT and focal therapy using cryotherapy (Boston Scientific) or high-intensity focused ultrasound (HIFU) (Sonablate). Propensity score matching was used to ensure that at-risk populations were comparable. Variables included age, prostate-specific antigen (PSA), International Society of Urological Pathology (ISUP) grade group, maximum cancer core length (mm), T-stage and year of treatment. RESULTS Focal therapy was associated with a lower overall cost and higher quality-adjusted life year (QALY) gains than either prostatectomy or EBRT, dominating both treatment strategies. Positive incremental net monetary benefit (NMB) values confirm focal therapy as cost-effective versus the alternatives at a willingness to pay (WTP) threshold of £30,000/QALY. One-way deterministic sensitivity analyses revealed consistent results. LIMITATIONS Data used to calculate the transition probabilities were derived from a limited number of hospitals meaning that other potential treatment options were excluded. Limited data were available on later outcomes and none on quality of life data, therefore, literature-based estimates were used. CONCLUSIONS Cost-effectiveness modelling demonstrates use of focal therapy (cryotherapy or HIFU) is associated with greater QALY gains at a lower overall cost than either radical prostatectomy or EBRT, representing good value for money in the NHS.
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Affiliation(s)
| | | | - Max Peters
- Amsterdam University Medical Centers, The Netherlands
| | | | - Tim Dudderidge
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | | | - Richard G Hindley
- Hampshire Hospitals NHS Foundation Trust, UK
- BMI The Hampshire Clinic, Basingstoke, UK
| | - Amr Emara
- Hampshire Hospitals NHS Foundation Trust, UK
| | | | - Clement Orczyk
- University College London NHS Foundation Trust, London, UK
| | | | | | - Raj Nigam
- Royal Surrey NHS Foundation Trust, Guildford, UK
- BMI Mount Alvernia Hospital, Guildford, UK
| | - Jaspal Virdi
- Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Caroline M Moore
- University College London NHS Foundation Trust, London, UK
- Princess Grace Hospital, London, UK
- King Edward VII Hospital, London, UK
| | - Manit Arya
- Imperial College NHS Healthcare Trust, London, UK
- University College London NHS Foundation Trust, London, UK
| | - Taimur T Shah
- Imperial College, London, UK
- Imperial College NHS Healthcare Trust, London, UK
| | - Mathias Winkler
- Imperial College, London, UK
- Imperial College NHS Healthcare Trust, London, UK
| | - Mark Emberton
- University College London NHS Foundation Trust, London, UK
- Princess Grace Hospital, London, UK
- King Edward VII Hospital, London, UK
| | | | | | - Hashim U Ahmed
- Imperial College, London, UK
- Imperial College NHS Healthcare Trust, London, UK
- King Edward VII Hospital, London, UK
- Department of Urology, Cromwell Hospital, London, UK
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28
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Giganti F, Cole AP, Fennessy FM, Clinton T, Moreira PLDF, Bernardes MC, Westin CF, Krishnaswamy D, Fedorov A, Wollin DA, Langbein B, Frego N, Labban M, Badaoui JS, Chang SL, Briggs LG, Tokuda J, Ambrosi A, Kirkham A, Emberton M, Kasivisvanathan V, Moore CM, Allen C, Tempany CM. Promoting the use of the PI-QUAL score for prostate MRI quality: results from the ESOR Nicholas Gourtsoyiannis teaching fellowship. Eur Radiol 2023; 33:461-471. [PMID: 35771247 PMCID: PMC9244244 DOI: 10.1007/s00330-022-08947-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The Prostate Imaging Quality (PI-QUAL) score is a new metric to evaluate the diagnostic quality of multiparametric magnetic resonance imaging (MRI) of the prostate. This study assesses the impact of an intervention, namely a prostate MRI quality training lecture, on the participant's ability to apply PI-QUAL. METHODS Sixteen participants (radiologists, urologists, physicists, and computer scientists) of varying experience in reviewing diagnostic prostate MRI all assessed the image quality of ten examinations from different vendors and machines. Then, they attended a dedicated lecture followed by a hands-on workshop on MRI quality assessment using the PI-QUAL score. Five scans assessed by the participants were evaluated in the workshop using the PI-QUAL score for teaching purposes. After the course, the same participants evaluated the image quality of a new set of ten scans applying the PI-QUAL score. Results were assessed using receiver operating characteristic analysis. The reference standard was the PI-QUAL score assessed by one of the developers of PI-QUAL. RESULTS There was a significant improvement in average area under the curve for the evaluation of image quality from baseline (0.59 [95 % confidence intervals: 0.50-0.66]) to post-teaching (0.96 [0.92-0.98]), an improvement of 0.37 [0.21-0.41] (p < 0.001). CONCLUSIONS A teaching course (dedicated lecture + hands-on workshop) on PI-QUAL significantly improved the application of this scoring system to assess the quality of prostate MRI examinations. KEY POINTS • A significant improvement in the application of PI-QUAL for the assessment of prostate MR image quality was observed after an educational intervention. • Appropriate training on image quality can be delivered to those involved in the acquisition and interpretation of prostate MRI. • Further investigation will be needed to understand the impact on improving the acquisition of high-quality diagnostic prostate MR examinations.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., W1W 7TS, London, UK.
| | - Alexander P Cole
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fiona M Fennessy
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy Clinton
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Mariana Costa Bernardes
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carl-Fredrik Westin
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Deepa Krishnaswamy
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andriy Fedorov
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel A Wollin
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bjoern Langbein
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicola Frego
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Muhieddine Labban
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joy S Badaoui
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven L Chang
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Logan G Briggs
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Junichi Tokuda
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., W1W 7TS, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., W1W 7TS, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., W1W 7TS, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare M Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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29
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Singh S, Rogers H, Kanber B, Clemente J, Pye H, Johnston EW, Parry T, Grey A, Dinneen E, Shaw G, Heavey S, Stopka-Farooqui U, Haider A, Freeman A, Giganti F, Atkinson D, Moore CM, Whitaker HC, Alexander DC, Panagiotaki E, Punwani S. Avoiding Unnecessary Biopsy after Multiparametric Prostate MRI with VERDICT Analysis: The INNOVATE Study. Radiology 2022; 305:623-630. [PMID: 35916679 DOI: 10.1148/radiol.212536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background In men suspected of having prostate cancer (PCa), up to 50% of men with positive multiparametric MRI (mpMRI) findings (Prostate Imaging Reporting and Data System [PI-RADS] or Likert score of 3 or higher) have no clinically significant (Gleason score ≤3+3, benign) biopsy findings. Vascular, Extracellular, and Restricted Diffusion for Cytometry in Tumor (VERDICT) MRI analysis could improve the stratification of positive mpMRI findings. Purpose To evaluate VERDICT MRI, mpMRI-derived apparent diffusion coefficient (ADC), and prostate-specific antigen density (PSAD) as determinants of clinically significant PCa (csPCa). Materials and Methods Between April 2016 and December 2019, men suspected of having PCa were prospectively recruited from two centers and underwent VERDICT MRI and mpMRI at one center before undergoing targeted biopsy. Biopsied lesion ADC, lesion-derived fractional intracellular volume (FIC), and PSAD were compared between men with csPCa and those without csPCa, using nonparametric tests subdivided by Likert scores. Area under the receiver operating characteristic curve (AUC) was calculated to test diagnostic performance. Results Among 303 biopsy-naive men, 165 study participants (mean age, 65 years ± 7 [SD]) underwent targeted biopsy; of these, 73 had csPCa. Median lesion FIC was higher in men with csPCa (FIC, 0.53) than in those without csPCa (FIC, 0.18) for Likert 3 (P = .002) and Likert 4 (0.60 vs 0.28, P < .001) lesions. Median lesion ADC was lower for Likert 4 lesions with csPCa (0.86 × 10-3 mm2/sec) compared with lesions without csPCa (1.12 × 10-3 mm2/sec, P = .03), but there was no evidence of a difference for Likert 3 lesions (0.97 × 10-3 mm2/sec vs 1.20 × 10-3 mm2/sec, P = .09). PSAD also showed no difference for Likert 3 (0.17 ng/mL2 vs 0.12 ng/mL2, P = .07) or Likert 4 (0.14 ng/mL2 vs 0.12 ng/mL2, P = .47) lesions. The diagnostic performance of FIC (AUC, 0.96; 95% CI: 0.93, 1.00) was higher (P = .02) than that of ADC (AUC, 0.85; 95% CI: 0.79, 0.91) and PSAD (AUC, 0.74; 95% CI: 0.66, 0.82) for the presence of csPCa in biopsied lesions. Conclusion Lesion fractional intracellular volume enabled better classification of clinically significant prostate cancer than did apparent diffusion coefficient and prostate-specific antigen density. Clinical trial registration no. NCT02689271 © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Saurabh Singh
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Harriet Rogers
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Baris Kanber
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Joey Clemente
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Hayley Pye
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Edward W Johnston
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Tom Parry
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Alistair Grey
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Eoin Dinneen
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Greg Shaw
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Susan Heavey
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Urszula Stopka-Farooqui
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Aiman Haider
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Alex Freeman
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Francesco Giganti
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - David Atkinson
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Caroline M Moore
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Hayley C Whitaker
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Daniel C Alexander
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Eleftheria Panagiotaki
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
| | - Shonit Punwani
- From the Centre for Medical Imaging, Division of Medicine (S.S., H.R., J.C., E.W.J., T.P., D.A., S.P.), Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (B.K.), Molecular Diagnostics and Therapeutics Group (H.P., S.H., U.S.F., H.C.W.), Division of Surgery and Interventional Sciences (F.G., C.M.M.), and Centre for Medical Image Computing, Department of Computer Science (D.C.A., E.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, England; Department of Diagnostic Radiology, Royal Marsden Hospital, London, England (E.W.J.); Departments of Urology (A.G., E.D., G.S., C.M.M.), Pathology (A.H., A.F.), and Radiology (F.G.), University College London Hospitals NHS Foundation Trust, London, England; and Department of Urology, Barts Health, NHS Foundation Trust, London, England (A.G., G.S.)
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Dinneen E, Shaw GL, Kealy R, Alexandris P, Finnegan K, Chu K, Haidar N, Santos‐Vidal S, Kudahetti S, Moore CM, Grey ADR, Berney DM, Sahdev A, Cathcart PJ, Oliver RTD, Rajan P, Cuzick J. Feasibility of aspirin and/or vitamin D3 for men with prostate cancer on active surveillance with Prolaris® testing. BJUI Compass 2022; 3:458-465. [PMID: 36267207 PMCID: PMC9579886 DOI: 10.1002/bco2.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives To test the feasibility of a randomised controlled trial (RCT) of aspirin and/or vitamin D3 in active surveillance (AS) low/favourable intermediate risk prostate cancer (PCa) patients with Prolaris® testing. Patients and Methods Newly-diagnosed low/favourable intermediate risk PCa patients (PSA ≤ 15 ng/ml, International Society of Urological Pathology (ISUP) Grade Group ≤2, maximum biopsy core length <10 mm, clinical stage ≤cT2c) were recruited into a multi-centre randomised, double-blind, placebo-controlled study (ISRCTN91422391, NCT03103152). Participants were randomised to oral low dose (100 mg), standard dose (300 mg) aspirin or placebo and/or vitamin D3 (4000 IU) versus placebo in a 3 × 2 factorial RCT design with biopsy tissue Prolaris® testing. The primary endpoint was trial acceptance/entry rates. Secondary endpoints included feasibility of Prolaris® testing, 12-month disease re-assessment (imaging/biochemical/histological), and 12-month treatment adherence/safety. Disease progression was defined as any of the following (i) 50% increase in baseline PSA, (ii) new Prostate Imaging-Reporting and Data System (PI-RADS) 4/5 lesion(s) on multi-parametric MRI where no previous lesion, (iii) 33% volume increase in lesion size, or radiological upstaging to ≥T3, (iv) ISUP Grade Group upgrade or (v) 50% increase in maximum cancer core length. Results Of 130 eligible patients, 104 (80%) accepted recruitment from seven sites over 12 months, of which 94 patients represented the per protocol population receiving treatment. Prolaris® testing was performed on 76/94 (81%) diagnostic biopsies. Twelve-month disease progression rate was 43.3%. Assessable 12-month treatment adherence in non-progressing patients to aspirin and vitamin D across all treatment arms was 91%. Two drug-attributable serious adverse events in 1 patient allocated to aspirin were identified. The study was not designed to determine differences between treatment arms. Conclusion Recruitment of AS PCa patients into a multi-centre multi-arm placebo-controlled RCT of minimally-toxic adjunctive oral drug treatments with molecular biomarker profiling is acceptable and safe. A larger phase III study is needed to determine optimal agents, intervention efficacy, and outcome-associated biomarkers.
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Affiliation(s)
- Eoin Dinneen
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of Urology, University College Hospital at Westmoreland StreetUniversity College Hospital London NHS Foundation TrustLondonUK
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Gregory L. Shaw
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of Urology, University College Hospital at Westmoreland StreetUniversity College Hospital London NHS Foundation TrustLondonUK
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
- Department of Urology, The Royal London HospitalBarts Health NHS TrustLondonUK
| | - Roseann Kealy
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
- Present address:
Cancer Prevention Trial Unit, School of Cancer & Pharmaceutical SciencesKing's College LondonLondonUK.
| | - Panos Alexandris
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Kier Finnegan
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Kimberley Chu
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Nadia Haidar
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Sara Santos‐Vidal
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Sakunthala Kudahetti
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Caroline M. Moore
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of Urology, University College Hospital at Westmoreland StreetUniversity College Hospital London NHS Foundation TrustLondonUK
| | - Alistair D. R. Grey
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of Urology, University College Hospital at Westmoreland StreetUniversity College Hospital London NHS Foundation TrustLondonUK
- Department of Urology, The Royal London HospitalBarts Health NHS TrustLondonUK
| | - Daniel M. Berney
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
- Department of Cellular Pathology, The Royal London HospitalBarts Health NHS TrustLondonUK
| | - Anju Sahdev
- Department of Radiology, St Bartholomew's HospitalBarts Health NHS TrustLondonUK
| | - Paul J. Cathcart
- Department of Urology, Guy's HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - R. Timothy D. Oliver
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Prabhakar Rajan
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of Urology, University College Hospital at Westmoreland StreetUniversity College Hospital London NHS Foundation TrustLondonUK
- Department of Urology, The Royal London HospitalBarts Health NHS TrustLondonUK
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Jack Cuzick
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
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Giganti F, Aupin L, Thoumin C, Faouzi I, Monnier H, Fontaine M, Navidi A, Ritvo PG, Ong V, Chung C, Bibi I, Lehrer R, Hermieu N, Barret E, Ambrosi A, Kasivisvanathan V, Emberton M, Allen C, Kirkham A, Moore CM, Renard-Penna R. Promoting the use of the PRECISE score for prostate MRI during active surveillance: results from the ESOR Nicholas Gourtsoyiannis teaching fellowship. Insights Imaging 2022; 13:111. [PMID: 35794256 PMCID: PMC9259779 DOI: 10.1186/s13244-022-01252-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/11/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives The PRECISE criteria for serial multiparametric magnetic resonance imaging (MRI) of the prostate during active surveillance recommend the use of a dedicated scoring system (PRECISE score) to assess the likelihood of clinically significant radiological change. This pilot study assesses the effect of an interactive teaching course on prostate MRI during active surveillance in assessing radiological change in serial imaging. Methods Eleven radiology fellows and registrars with different experience in prostate MRI reading participated in a dedicated teaching course where they initially evaluated radiological change (based on their previous training in prostate MRI reading) independently in fifteen patients on active surveillance (baseline and follow-up scan), and then attended a lecture on the PRECISE score. The initial scans were reviewed for teaching purposes and afterwards the participants re-assessed the degree of radiological change in a new set of images (from fifteen different patients) applying the PRECISE score. Receiver operating characteristic analysis was performed. Confirmatory biopsies and PRECISE scores given in consensus by two radiologists (involved in the original draft of the PRECISE score) were the reference standard.
Results There was a significant improvement in the average area under the curve (AUC) for the assessment of radiological change from baseline (AUC: 0.60 [Confidence Intervals: 0.51–0.69] to post-teaching (AUC: 0.77 [0.70–0.84]). This was an improvement of 0.17 [0.016–0.28] (p = 0.004).
Conclusions A dedicated teaching course on the use of the PRECISE score improves the accuracy in the assessment of radiological change in serial MRI of the prostate.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK. .,Division of Surgery and Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., London, W1W 7TS, UK.
| | - Laurene Aupin
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Camille Thoumin
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Ingrid Faouzi
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Hippolyte Monnier
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Matthieu Fontaine
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Alexandre Navidi
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Paul-Gydéon Ritvo
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Valentin Ong
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Cecile Chung
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Imen Bibi
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Raphaële Lehrer
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Nicolas Hermieu
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., London, W1W 7TS, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., London, W1W 7TS, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- AP-HP, Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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Remmers S, Helleman J, Nieboer D, Trock B, Hyndman ME, Moore CM, Gnanapragasam V, Shiong Lee L, Elhage O, Klotz L, Carroll P, Pickles T, Bjartell A, Robert G, Frydenberg M, Sugimoto M, Ehdaie B, Morgan TM, Rubio-Briones J, Semjonow A, Bangma CH, Roobol MJ. Active Surveillance for Men Younger than 60 Years or with Intermediate-risk Localized Prostate Cancer. Descriptive Analyses of Clinical Practice in the Movember GAP3 Initiative. EUR UROL SUPPL 2022; 41:126-133. [PMID: 35813247 PMCID: PMC9257656 DOI: 10.1016/j.euros.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Active surveillance (AS) is a management option for men diagnosed with low-risk prostate cancer. Opinions differ on whether it is safe to include young men (≤60 yr) or men with intermediate-risk disease. Objective To assess whether reasons for discontinuation, treatment choice after AS, and adverse pathology at radical prostatectomy (RP; N1, or ≥GG3, or ≥pT3) differ for men ≤60 yr or those with European Association of Urology (EAU) intermediate-risk disease from those for men >60 yr or those with EAU low-risk disease. Design setting and participants We analyzed data from 5411 men ≤60 yr and 14 959 men >60 yr, 14 064 men with low-risk cancer, and 2441 men with intermediate-risk cancer, originating from the GAP3 database (21 169 patients/27 cohorts worldwide). Outcome measurements and statistical analysis Cumulative incidence curves were used to estimate the rates of AS discontinuation and treatment choice. Results and limitations The probability of discontinuation of AS due to disease progression at 5 yr was similar for men aged ≤60 yr (22%) and those >60 yr (25%), as well as those of any age with low-risk disease (24%) versus those with intermediate-risk disease (24%). Men with intermediate-risk disease are more prone to discontinue AS without evidence of progression than men with low-risk disease (at 1/5 yr: 5.9%/14.2% vs 2.0%/8.8%). Adverse pathology at RP was observed in 32% of men ≤60 yr compared with 36% of men >60 yr (p = 0.029), and in 34% with low-risk disease compared with 40% with intermediate-risk disease (p = 0.048). Conclusions Our descriptive analysis of AS practices worldwide showed that the risk of progression during AS is similar across the age and risk groups studied. The proportion of adverse pathology was higher among men >60 yr than among men ≤60 yr. These results suggest that men ≤60 yr and those with EAU intermediate-risk disease should not be excluded from opting for AS as initial management. Patient summary Data from 27 international centers reflecting daily clinical practice suggest that younger men or men with intermediate-risk prostate cancer do not hold greater risk for disease progression during active surveillance.
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Affiliation(s)
- Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
- Corresponding author. Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. Tel. +31 10 703 2239; Fax: +31 10 703 5315.
| | - Jozien Helleman
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bruce Trock
- The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew E. Hyndman
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada
| | - Caroline M. Moore
- University College London, London, UK
- University College London Hospitals Trust, London, UK
| | | | | | - Oussama Elhage
- King's College London, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Laurence Klotz
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Peter Carroll
- University of California San Francisco, San Francisco, CA, USA
| | - Tom Pickles
- University of British Columbia, BC Cancer Agency, Vancouver, BC, Canada
| | | | - Grégoire Robert
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Mark Frydenberg
- Monash University and Epworth HealthCare, Melbourne, Australia
| | | | - Behfar Ehdaie
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Todd M. Morgan
- University of Michigan, Ann Arbor, MI, USA
- Michigan Urological Surgery Improvement Collaborative (MUSIC), Ann Arbor, MI, USA
| | | | | | - Chris H. Bangma
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Monique J. Roobol
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
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Shah TT, Kanthabalan A, Otieno M, Pavlou M, Omar R, Adeleke S, Giganti F, Brew-Graves C, Williams NR, Grierson J, Miah H, Emara A, Haroon A, Latifoltojar A, Sidhu H, Clemente J, Freeman A, Orczyk C, Nikapota A, Dudderidge T, Hindley RG, Virdi J, Arya M, Payne H, Mitra A, Bomanji J, Winkler M, Horan G, Moore CM, Emberton M, Punwani S, Ahmed HU. Magnetic Resonance Imaging and Targeted Biopsies Compared to Transperineal Mapping Biopsies Before Focal Ablation in Localised and Metastatic Recurrent Prostate Cancer After Radiotherapy. Eur Urol 2022; 81:598-605. [PMID: 35370021 PMCID: PMC9156577 DOI: 10.1016/j.eururo.2022.02.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/30/2022] [Accepted: 02/23/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Recurrent prostate cancer after radiotherapy occurs in one in five patients. The efficacy of prostate magnetic resonance imaging (MRI) in recurrent cancer has not been established. Furthermore, high-quality data on new minimally invasive salvage focal ablative treatments are needed. OBJECTIVE To evaluate the role of prostate MRI in detection of prostate cancer recurring after radiotherapy and the role of salvage focal ablation in treating recurrent disease. DESIGN, SETTING, AND PARTICIPANTS The FORECAST trial was both a paired-cohort diagnostic study evaluating prostate multiparametric MRI (mpMRI) and MRI-targeted biopsies in the detection of recurrent cancer and a cohort study evaluating focal ablation at six UK centres. A total of 181 patients were recruited, with 155 included in the MRI analysis and 93 in the focal ablation analysis. INTERVENTION Patients underwent choline positron emission tomography/computed tomography and a bone scan, followed by prostate mpMRI and MRI-targeted and transperineal template-mapping (TTPM) biopsies. MRI was reported blind to other tests. Those eligible underwent subsequent focal ablation. An amendment in December 2014 permitted focal ablation in patients with metastases. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcomes were the sensitivity of MRI and MRI-targeted biopsies for cancer detection, and urinary incontinence after focal ablation. A key secondary outcome was progression-free survival (PFS). RESULTS AND LIMITATIONS Staging whole-body imaging revealed localised cancer in 128 patients (71%), with involvement of pelvic nodes only in 13 (7%) and metastases in 38 (21%). The sensitivity of MRI-targeted biopsy was 92% (95% confidence interval [CI] 83-97%). The specificity and positive and negative predictive values were 75% (95% CI 45-92%), 94% (95% CI 86-98%), and 65% (95% CI 38-86%), respectively. Four cancer (6%) were missed by TTPM biopsy and six (8%) were missed by MRI-targeted biopsy. The overall MRI sensitivity for detection of any cancer was 94% (95% CI 88-98%). The specificity and positive and negative predictive values were 18% (95% CI 7-35%), 80% (95% CI 73-87%), and 46% (95% CI 19-75%), respectively. Among 93 patients undergoing focal ablation, urinary incontinence occurred in 15 (16%) and five (5%) had a grade ≥3 adverse event, with no rectal injuries. Median follow-up was 27 mo (interquartile range 18-36); overall PFS was 66% (interquartile range 54-75%) at 24 mo. CONCLUSIONS Patients should undergo prostate MRI with both systematic and targeted biopsies to optimise cancer detection. Focal ablation for areas of intraprostatic recurrence preserves continence in the majority, with good early cancer control. PATIENT SUMMARY We investigated the role of magnetic resonance imaging (MRI) scans of the prostate and MRI-targeted biopsies in outcomes after cancer-targeted high-intensity ultrasound or cryotherapy in patients with recurrent cancer after radiotherapy. Our findings show that these patients should undergo prostate MRI with both systematic and targeted biopsies and then ablative treatment focused on areas of recurrent cancer to preserve their quality of life. This trial is registered at ClinicalTrials.gov as NCT01883128.
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Affiliation(s)
- Taimur T Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Sciences, University College London, London, UK.
| | - Abi Kanthabalan
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Marjorie Otieno
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Menelaos Pavlou
- Department of Statistical Science, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Sola Adeleke
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Oncology, King's College London, London, UK; Department of Oncology, Maidstone and Tunbridge Wells Hospital, Maidstone, UK; School of Cancer & Pharmaceutical Sciences, King's College London, Queen Square, London WC1N 3BG, UK; High Dimensional Neurology, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Francesco Giganti
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Chris Brew-Graves
- Division of Medicine, Faculty of Medicine, University College London, London, UK
| | - Norman R Williams
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Jack Grierson
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Haroon Miah
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Amr Emara
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK; Urology Department, Ain Shams University Hospitals, Cairo, Egypt
| | - Athar Haroon
- Department of Nuclear Medicine, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK; Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Arash Latifoltojar
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK
| | - Harbir Sidhu
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Joey Clemente
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clement Orczyk
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Ashok Nikapota
- Sussex Cancer Centre. Royal Sussex County Hospital, Brighton, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Richard G Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Manit Arya
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Heather Payne
- Department of Oncology, University College London and University College London Hospital NHS Foundation Trust, London, UK
| | - Anita Mitra
- Department of Oncology, University College London and University College London Hospital NHS Foundation Trust, London, UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Gail Horan
- Department of Oncology, Queen Elizabeth Hospital, Kings Lynn, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Singh S, Mathew M, Mertzanidou T, Suman S, Clemente J, Retter A, Papoutsaki MV, Smith L, Grussu F, Kasivisvanathan V, Grey A, Dinneen E, Shaw G, Carter M, Patel D, Moore CM, Atkinson D, Panagiotaki E, Haider A, Freeman A, Alexander D, Punwani S. Histo-MRI map study protocol: a prospective cohort study mapping MRI to histology for biomarker validation and prediction of prostate cancer. BMJ Open 2022; 12:e059847. [PMID: 35396316 PMCID: PMC8995953 DOI: 10.1136/bmjopen-2021-059847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Multiparametric MRI (mpMRI) is now widely used to risk stratify men with a suspicion of prostate cancer and identify suspicious regions for biopsy. However, the technique has modest specificity and a high false-positive rate, especially in men with mpMRI scored as indeterminate (3/5) or likely (4/5) to have clinically significant cancer (csPCa) (Gleason ≥3+4). Advanced MRI techniques have emerged which seek to improve this characterisation and could predict biopsy results non-invasively. Before these techniques are translated clinically, robust histological and clinical validation is required. METHODS AND ANALYSIS This study aims to clinically validate two advanced MRI techniques in a prospectively recruited cohort of men suspected of prostate cancer. Histological analysis of men undergoing biopsy or prostatectomy will be used for biological validation of biomarkers derived from Vascular and Extracellular Restricted Diffusion for Cytometry in Tumours and Luminal Water imaging. In particular, prostatectomy specimens will be processed using three-dimension printed patient-specific moulds to allow for accurate MRI and histology mapping. The index tests will be compared with the histological reference standard to derive false positive rate and true positive rate for men with mpMRI scores which are indeterminate (3/5) or likely (4/5) to have clinically significant prostate cancer (csPCa). Histopathological validation from both biopsy and prostatectomy samples will provide the best ground truth in validating promising MRI techniques which could predict biopsy results and help avoid unnecessary biopsies in men suspected of prostate cancer. ETHICS AND DISSEMINATION Ethical approval was granted by the London-Queen Square Research Ethics Committee (19/LO/1803) on 23 January 2020. Results from the study will be presented at conferences and submitted to peer-reviewed journals for publication. Results will also be available on ClinicalTrials.gov. TRIAL REGISTRATION NUMBER NCT04792138.
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Affiliation(s)
- Saurabh Singh
- Centre for Medical Imaging, University College London, London, UK
| | - Manju Mathew
- Centre for Medical Imaging, University College London, London, UK
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Thomy Mertzanidou
- Centre for Medical Imaging Computing, Department of Computer Science, University College London, London, UK
| | - Shipra Suman
- Centre for Medical Imaging, University College London, London, UK
- Centre for Medical Imaging Computing, Department of Computer Science, University College London, London, UK
| | - Joey Clemente
- Centre for Medical Imaging, University College London, London, UK
| | - Adam Retter
- Centre for Medical Imaging, University College London, London, UK
| | | | - Lorna Smith
- Centre for Medical Imaging, University College London, London, UK
| | - Francesco Grussu
- Centre for Medical Imaging Computing, Department of Computer Science, University College London, London, UK
- Radiomics Group, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Veeru Kasivisvanathan
- Division Of Surgery and Interventional Sciences, University College London, London, UK
| | - Alistair Grey
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Urology, Barts Health NHS Trust, London, UK
| | - Eoin Dinneen
- Division Of Surgery and Interventional Sciences, University College London, London, UK
| | - Greg Shaw
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Urology, Barts Health NHS Trust, London, UK
| | - Martyn Carter
- Faculty of the Built Environment, University College London, London, UK
| | - Dominic Patel
- Department of Pathology, University College London Cancer Institute, London, UK
| | - Caroline M Moore
- Division Of Surgery and Interventional Sciences, University College London, London, UK
| | - David Atkinson
- Centre for Medical Imaging, University College London, London, UK
| | - Eleftheria Panagiotaki
- Centre for Medical Imaging Computing, Department of Computer Science, University College London, London, UK
| | - Aiman Haider
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Daniel Alexander
- Centre for Medical Imaging Computing, Department of Computer Science, University College London, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, UK
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Giganti F, Stavrinides V, Moore CM. Magnetic Resonance Imaging–guided Active Surveillance of Prostate Cancer: Time to Say Goodbye to Protocol-based Biopsies. EUR UROL SUPPL 2022; 38:40-43. [PMID: 35243397 PMCID: PMC8885616 DOI: 10.1016/j.euros.2021.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/30/2022] Open
Abstract
Traditional protocols for active surveillance (AS) are commonly based on digital rectal examination, prostate-specific antigen (PSA), and standard transrectal biopsy, meaning that initial classification errors and inaccurate lesion monitoring can occur. Protocol-based biopsies are performed to assess changes in cancer grade and extent at prespecified intervals, but this approach represents a barrier to AS adherence and tolerability. There is evidence to support the use of magnetic resonance imaging (MRI) during AS, as this technique (associated with favourable PSA kinetics) offers an opportunity to follow patients on AS without the need for routine, protocol-based biopsies in the absence of signs of radiological progression provided that image quality, interpretation, and reporting of serial imaging are of the highest standards. Patient summary In this report we looked at the role of magnetic resonance imaging (MRI) scans in avoiding unnecessary prostate biopsies for patients being monitored for low- or intermediate-risk prostate cancer. We conclude that patients on active surveillance can be monitored with MRI scans over time and that biopsies could be used only when there are changes on MRI or a rising prostate-specific antigen (PSA) not explained by an increase in prostate size.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
- Corresponding author at: Division of Surgery & Interventional Science, University College London, London, UK.
| | - Vasilis Stavrinides
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M. Moore
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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Cerdan-Garcia E, Baylay A, Polyviou D, Woodward EMS, Wrightson L, Mahaffey C, Lohan MC, Moore CM, Bibby TS, Robidart JC. Transcriptional responses of Trichodesmium to natural inverse gradients of Fe and P availability. ISME J 2022; 16:1055-1064. [PMID: 34819612 PMCID: PMC8941076 DOI: 10.1038/s41396-021-01151-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/28/2022]
Abstract
The filamentous diazotrophic cyanobacterium Trichodesmium is responsible for a significant fraction of marine di-nitrogen (N2) fixation. Growth and distribution of Trichodesmium and other diazotrophs in the vast oligotrophic subtropical gyres is influenced by iron (Fe) and phosphorus (P) availability, while reciprocally influencing the biogeochemistry of these nutrients. Here we use observations across natural inverse gradients in Fe and P in the North Atlantic subtropical gyre (NASG) to demonstrate how Trichodesmium acclimates in situ to resource availability. Transcriptomic analysis identified progressive upregulation of known iron-stress biomarker genes with decreasing Fe availability, and progressive upregulation of genes involved in the acquisition of diverse P sources with decreasing P availability, while genes involved in N2 fixation were upregulated at the intersection under moderate Fe and P availability. Enhanced N2 fixation within the Fe and P co-stressed transition region was also associated with a distinct, consistent metabolic profile, including the expression of alternative photosynthetic pathways that potentially facilitate ATP generation required for N2 fixation with reduced net oxygen production. The observed response of Trichodesmium to availability of both Fe and P supports suggestions that these biogeochemically significant organisms employ unique molecular, and thus physiological responses as adaptations to specifically exploit the Fe and P co-limited niche they construct.
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Affiliation(s)
- E Cerdan-Garcia
- Ocean and Earth Science, University of Southampton, Southampton, SO14 3ZH, UK.
| | - A Baylay
- Ocean and Earth Science, University of Southampton, Southampton, SO14 3ZH, UK
| | - D Polyviou
- National Oceanography Centre, Southampton, SO14 3ZH, UK
| | | | - L Wrightson
- Earth, Ocean and Ecological Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - C Mahaffey
- Earth, Ocean and Ecological Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - M C Lohan
- Ocean and Earth Science, University of Southampton, Southampton, SO14 3ZH, UK
| | - C M Moore
- Ocean and Earth Science, University of Southampton, Southampton, SO14 3ZH, UK
| | - T S Bibby
- Ocean and Earth Science, University of Southampton, Southampton, SO14 3ZH, UK
| | - J C Robidart
- National Oceanography Centre, Southampton, SO14 3ZH, UK.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Marsden T, McCartan N, Brown L, Rodriguez-Justo M, Syer T, Brembilla G, Van Hemelrijck M, Coolen T, Attard G, Punwani S, Moore CM, Ahmed HU, Emberton M. The ReIMAGINE prostate cancer risk study protocol: A prospective cohort study in men with a suspicion of prostate cancer who are referred onto an MRI-based diagnostic pathway with donation of tissue, blood and urine for biomarker analyses. PLoS One 2022; 17:e0259672. [PMID: 35202397 PMCID: PMC8870538 DOI: 10.1371/journal.pone.0259672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/24/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The ReIMAGINE Consortium was conceived to develop risk-stratification models that might incorporate the full range of novel prostate cancer (PCa) diagnostics (both commercial and academic). METHODS ReIMAGINE Risk is an ethics approved (19/LO/1128) multicentre, prospective, observational cohort study which will recruit 1000 treatment-naive men undergoing a multi-parametric MRI (mpMRI) due to an elevated PSA (≤20ng/ml) or abnormal prostate examination who subsequently had a suspicious mpMRI (score≥3, stage ≤T3bN0M0). Primary outcomes include the detection of ≥Gleason 7 PCa at baseline and time to clinical progression, metastasis and death. Baseline blood, urine, and biopsy cores for fresh prostate tissue samples (2 targeted and 1 non-targeted) will be biobanked for future analysis. High-resolution scanning of pathology whole-slide imaging and MRI-DICOM images will be collected. Consortium partners will be granted access to data and biobanks to develop and validate biomarkers using correlation to mpMRI, biopsy-based disease status and long-term clinical outcomes. RESULTS Recruitment began in September 2019(n = 533). A first site opened in September 2019 (n = 296), a second in November 2019 (n = 210) and a third in December 2020 (n = 27). Acceptance to the study has been 65% and a mean of 36.5ml(SD+/-10.0), 12.9ml(SD+/-3.7) and 2.8ml(SD+/-0.7) urine, plasma and serum donated for research, respectively. There are currently 4 academic and 15 commercial partners spanning imaging (~9 radiomics, artificial intelligence/machine learning), fluidic (~3 blood-based and ~2urine-based) and tissue-based (~1) biomarkers. CONCLUSION The consortium will develop, or adjust, risk models for PCa, and provide a platform for evaluating the role of novel diagnostics in the era of pre-biopsy MRI and targeted biopsy.
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Affiliation(s)
- Teresa Marsden
- UCL Division of Surgical & Interventional Sciences, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- * E-mail:
| | - Neil McCartan
- UCL Division of Surgical & Interventional Sciences, University College London, London, United Kingdom
| | - Louise Brown
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Manuel Rodriguez-Justo
- Research Department of Pathology, University College London, London, United Kingdom
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Tom Syer
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Giorgio Brembilla
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Sciences, Kings College London, London, United Kingdom
| | - Ton Coolen
- London Institute for Mathematical Sciences, London, United Kingdom
| | - Gerhardt Attard
- Cancer Institute, University College London, London, United Kingdom
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Caroline M. Moore
- UCL Division of Surgical & Interventional Sciences, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Hashim U. Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Imperial Urology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mark Emberton
- UCL Division of Surgical & Interventional Sciences, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Kasivisvanathan V, Chan VWS, Clement KD, Levis B, Haider M, Agarwal R, Emberton M, Pond GR, Takwoingi Y, Klotz L, Moore CM. A protocol for the VISION study: An indiVidual patient data meta-analysis of randomised trials comparing MRI-targeted biopsy to standard transrectal ultraSound guided bIopsy in the detection of prOstate cancer. PLoS One 2022; 17:e0263345. [PMID: 35113918 PMCID: PMC8812968 DOI: 10.1371/journal.pone.0263345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/17/2022] [Indexed: 01/10/2023] Open
Abstract
Background Transrectal ultrasound (TRUS) guided biopsy for prostate cancer is prone to random and systemic error and has been shown to have a negative predictive value of 70%. PRECISION and PRECISE are among the first randomised studies to evaluate the new MRI-targeted biopsy (MRI-TB) pathway with a non-paired design to detect clinically significant prostate cancer and avoid unnecessary treatment. The trials’ results individually demonstrated non-inferiority of MRI-TB compared to TRUS biopsy. An individual patient data (IPD) meta-analysis was planned from the outset of the two trials in parallel and this IPD meta-analysis aims to further elucidate the utility of MRI-TB as the optimal diagnostic pathway for prostate cancer. Methods and materials This study is registered on PROSPERO (CRD42021249263). A search of Medline, Embase, Cochrane Central Register of Registered Trials (CENTRAL), Web of Science, and ClinicalTrials.gov was performed up until 4th February 2021. Only randomised controlled trials (PRECISE, PRECISION and other eligible trials) comparing the MRI-targeted biopsy pathway and traditional TRUS biopsy pathway will be included. The primary outcome of the review is the proportion of men diagnosed with clinically significant prostate cancer in each arm (Gleason ≥ 3+4 = 7). IPD and study-level data and characteristics will be sought from eligible studies. Analyses will be done primarily using an intention-to-treat approach, and a one-step IPD meta-analysis will be performed using generalised linear mixed models. A non-inferiority margin of 5 percentage points will be used. Heterogeneity will be quantified using the variance parameters from the mixed model. If there is sufficient data, we will investigate heterogeneity by exploring the effect of the different conducts of MRIs, learning curves of MRI reporting and MRI targeted biopsies. Trial registration This systematic review is registered on PROSPERO (CRD42021249263)
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Affiliation(s)
- Veeru Kasivisvanathan
- Division of Surgery and Interventional Sciences, University College London, United Kingdom
- Department of Urology, University College London Hospitals Trust, London, United Kingdom
- * E-mail:
| | - Vinson Wai-Shun Chan
- Division of Surgery and Interventional Sciences, University College London, United Kingdom
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Keiran D. Clement
- Department of Urology, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
| | - Brooke Levis
- Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Masoom Haider
- Toronto General Hospital, Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Ridhi Agarwal
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, and NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, United Kingdom
- Department of Urology, University College London Hospitals Trust, London, United Kingdom
- NIHR UCLH/UCL Comprehensive Biomedical Research Centre, London, United Kingdom
| | - Gregory R. Pond
- Department of Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, and NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Laurence Klotz
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Caroline M. Moore
- Division of Surgery and Interventional Sciences, University College London, United Kingdom
- Department of Urology, University College London Hospitals Trust, London, United Kingdom
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Remmers S, Kasivisvanathan V, Verbeek JF, Moore CM, Roobol MJ. Reducing Biopsies and Magnetic Resonance Imaging Scans During the Diagnostic Pathway of Prostate Cancer: Applying the Rotterdam Prostate Cancer Risk Calculator to the PRECISION Trial Data. EUR UROL SUPPL 2022; 36:1-8. [PMID: 35098168 PMCID: PMC8783039 DOI: 10.1016/j.euros.2021.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 12/23/2022] Open
Abstract
Background Risk stratification in the diagnostic pathway of prostate cancer (PCa) can be used to reduce biopsies and magnetic resonance imaging (MRI) scans, while maintaining the detection of clinically significant PCa (csPCa). The use of highly discriminating and well-calibrated models will generate better clinical outcomes if context-dependent thresholds are used. Objective To retrospectively assess the effect of the upfront use of the Rotterdam Prostate Cancer Risk Calculator (RPCRC) developed in a screening cohort and the RPCRC-MRI developed in a clinical cohort while exploring the need to adapt thresholds in biopsy-naïve men in the PRECISION (Prostate Evaluation for Clinically Important Disease: Sampling Using Image Guidance or Not?) trial. Design, setting, and participants In the transrectal ultrasonography arm, we evaluated 188 men; in the MRI arm, we evaluated 206 (for the reduction of MRI scans) and 137 (for the reduction of targeted biopsies) men. Outcome measurements and statistical analysis Performance was assessed by discrimination, calibration, and clinical utility. Results and limitations The performance of the RPCRC was good. However, intercept adjustment was warranted. Net benefit was observed from a recalibrated probability of 32% for any PCa and 10% for csPCa. After recalibration and applying a threshold of 20% for any PCa or 10% for csPCa, 28% of all biopsies could have been reduced, missing five cases of csPCa. The uncalibrated RPCRC could reduce 35% of all MRI scans, with a threshold of 20% for any PCa or 4% for csPCa. In the MRI arm, performance was good without stressing recalibration. Net benefit was observed from a probability of 22% for any PCa and 7% for csPCa. With a threshold of 20% for any PCa or 4% for csPCa, 9% of all targeted biopsies could be reduced, missing one grade group 2 PCa. Conclusions The performance of the RPCRC and RPCRC-MRI in men included in the PRECISION trial was good, but recalibration and adaptation of the risk threshold of the RPCRC are indicated to reach optimal performance. Patient summary In this report, we show that risk stratification with the Rotterdam Prostate Cancer Risk Calculator has added value in reducing harm, but adjustment to reflect the characteristics of the patient cohort is indicated.
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Withington J, Moore CM. Active Surveillance for Prostate Cancer: Will Magnetic Resonance Imaging Help Us Address the Current Controversies in Traditional Surveillance Approaches? Eur Urol 2022; 81:347-348. [PMID: 35101301 DOI: 10.1016/j.eururo.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Affiliation(s)
- John Withington
- Division of Surgical and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK
| | - Caroline M Moore
- Division of Surgical and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK.
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Sampurno F, Kowalski C, Connor SE, Nguyen AV, Acuña ÀP, Ng CF, Foster C, Feick G, Boronat OG, Dieng S, Brglevska S, Ferrante S, Leung S, Villanti P, Moore CM, Graham ID, Millar JL, Litwin MS, Papa N. Knowledge and insights from a maturing international clinical quality registry. J Am Med Inform Assoc 2022; 29:964-969. [PMID: 35048976 PMCID: PMC9006702 DOI: 10.1093/jamia/ocab281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/17/2021] [Accepted: 12/06/2021] [Indexed: 01/22/2023] Open
Abstract
Since 2017, the TrueNTH Global Registry (TNGR) has aimed to drive improvement in patient outcomes for individuals with localized prostate cancer by collating data from healthcare institutions across 13 countries. As TNGR matures, a systematic evaluation of existing processes and documents is necessary to evaluate whether the registry is operating as intended. The main supporting documents: protocol and data dictionary, were comprehensively reviewed in a series of meetings over a 10-month period by an international working group. In parallel, individual consultations with local institutions regarding a benchmarking quality-of-care report were conducted. Four consensus areas for improvement emerged: updating operational definitions, appraisal of the recruitment process, refinement of data elements, and improvement of data quality and reporting. Recommendations presented were drawn from our collective experience and accumulated knowledge in operating an international registry. These can be readily generalized to other health-related reporting programs beyond clinical registries.
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Affiliation(s)
- Fanny Sampurno
- Corresponding Author: Fanny Sampurno, BA, BSc (Hons), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia;
| | | | - Sarah E Connor
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Anissa V Nguyen
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Àngels Pont Acuña
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Chi-Fai Ng
- SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Claire Foster
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Günter Feick
- Patient Support Association Bundesverband Prostatakrebs Selbsthilfe, Bonn, Germany
| | - Olatz Garin Boronat
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | | | - Stephanie Ferrante
- Department of Urology, University of Michigan (on behalf of MUSIC), Ann Arbor, Michigan, USA
| | - Steven Leung
- SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Caroline M Moore
- Department of Urology, Division of Surgical and Interventional Science, University College London, London, UK
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeremy L Millar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Olivier J, Li W, Nieboer D, Helleman J, Roobol M, Gnanapragasam V, Frydenberg M, Sugimoto M, Carroll P, Morgan TM, Valdagni R, Rubio-Briones J, Robert G, Stricker P, Hayen A, Schoots I, Haider M, Moore CM, Denton B, Villers A. Prostate Cancer Patients Under Active Surveillance with a Suspicious Magnetic Resonance Imaging Finding Are at Increased Risk of Needing Treatment: Results of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium. EUR UROL SUPPL 2022; 35:59-67. [PMID: 35024633 PMCID: PMC8738894 DOI: 10.1016/j.euros.2021.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The inclusion criterion for active surveillance (AS) is low- or intermediate-risk prostate cancer. The predictive value of the presence of a suspicious lesion at magnetic resonance imaging (MRI) at the time of inclusion is insufficiently known. OBJECTIVE To evaluate the percentage of patients needing active treatment stratified by the presence or absence of a suspicious lesion at baseline MRI. DESIGN SETTING AND PARTICIPANTS A retrospective analysis of the data from the multicentric AS GAP3 Consortium database was conducted. The inclusion criteria were men with grade group (GG) 1 or GG 2 prostate cancer combined with prostate-specific antigen <20 ng/ml. We selected a subgroup of patients who had MRI at baseline and for whom MRI results and targeted biopsies were used for AS eligibility. Suspicious MRI was defined as an MRI lesion with Prostate Imaging Reporting and Data System (PI-RADS)/Likert ≥3 and for which targeted biopsies did not exclude the patient for AS. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was treatment free survival (FS). The secondary outcomes were histological GG progression FS and continuation of AS (discontinuation FS). RESULTS AND LIMITATIONS The study cohort included 2119 patients (1035 men with nonsuspicious MRI and 1084 with suspicious MRI) with a median follow-up of 23 (12-43) mo. For the whole cohort, 3-yr treatment FS was 71% (95% confidence interval [CI]: 69-74). For nonsuspicious MRI and suspicious MRI groups, 3-yr treatment FS rates were, respectively, 80% (95% CI: 77-83) and 63% (95% CI: 59-66). Active treatment (hazard ratio [HR] = 2.0, p < 0.001), grade progression (HR = 1.9, p < 0.001), and discontinuation of AS (HR = 1.7, p < 0.001) were significantly higher in the suspicious MRI group than in the nonsuspicious MRI group. CONCLUSIONS The risks of switching to treatment, histological progression, and AS discontinuation are higher in cases of suspicious MRI at inclusion. PATIENT SUMMARY Among men with low- or intermediate-risk prostate cancer who choose active surveillance, those with suspicious magnetic resonance imaging (MRI) at the time of inclusion in active surveillance are more likely to show switch to treatment than men with nonsuspicious MRI.
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Affiliation(s)
| | - Weiyu Li
- University of Michigan, Ann Arbor, MI, USA
| | - Daan Nieboer
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jozien Helleman
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Monique Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Mark Frydenberg
- Cabrini Health, Cabrini Institute, Monash University, Clayton, VIC, Australia
| | | | - Peter Carroll
- University California San Francisco, San Francisco, CA, USA
| | - Todd M. Morgan
- University of Michigan, Ann Arbor, MI, USA
- Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI, USA
| | - Riccardo Valdagni
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy
- Radiation Oncology Department and Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Grégoire Robert
- Centre Hospitalier Universitaire de Bordeaux (CHU), Bordeaux, France
| | | | - Andrew Hayen
- University of Technology Sydney, Sydney, Australia
| | - Ivo Schoots
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Masoom Haider
- Sinai Health System, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Caroline M. Moore
- University College London & University College London Hospitals Trust, London, UK
| | | | - Arnauld Villers
- Lille University Medical Center, Lille, France
- Corresponding author. Lille University Medical Center, Lille, France
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Green S, Tuck S, Long J, Green T, Green A, Ellis P, Haire A, Moss C, Cahill F, McCartan N, Brown L, Santaolalla A, Marsden T, Justo MR, Hadley J, Punwani S, Attard G, Ahmed H, Moore CM, Emberton M, Van Hemelrijck M. ReIMAGINE: a prostate cancer research consortium with added value through its patient and public involvement and engagement. Res Involv Engagem 2021; 7:81. [PMID: 34789334 PMCID: PMC8596340 DOI: 10.1186/s40900-021-00322-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND ReIMAGINE aims to improve the current prostate specific antigen (PSA)/biopsy risk stratification for prostate cancer (PCa) and develop a new image-based method (with biomarkers) for diagnosing high/low risk PCa in men. ReIMAGINE's varied patient and public involvement (PPI) and engagement (PE) strategy maximises the impact of its scientific output by informing and shaping the different stages of research. AIMS Through including the voice of patients and the public, the ReIMAGINE Consortium aims to translate these different perspectives into the design and implementation process. This will improve the overall quality of the research by: reflecting the needs and priorities of patients and the public, ensuring methods and procedures are feasible and appropriate ensuring information is relevant and accessible to those being recruited to the study identifying dissemination channels relevant to patients/the public and developing outputs that are accessible to a lay audience With support from our patient/user groups, the ReIMAGINE Consortium aims to improve our ability to derive prognostic information and allocate men to the most appropriate and effective therapies, using a novel image-based risk stratification with investigation of non-imaging biomarkers. FINDINGS We have been working with patients and the public from initiation of the project to ensure that the research is relevant to men and their families. Our PPI Sub-Committee, led by a PCa patient, has been involved in our dissemination strategy, outreach activities, and study design recommendations. For example, the sub-committee have developed a variety of informative videos relevant and accessible to those being recruited, and organised multiple online research engagement events that are accessible to a lay audience. As quoted by one of the study participants, "the more we present the benefits and opportunities to patients and the public, the more research commitment we obtain, and the sooner critical clinical questions such as PCa diagnostics will be addressed".
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Affiliation(s)
- S Green
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - S Tuck
- ReIMAGINE Consortium Patient Representative, London, UK
| | - J Long
- ReIMAGINE Consortium Patient Representative, London, UK
| | - T Green
- ReIMAGINE Consortium Patient Representative, London, UK
| | - A Green
- ReIMAGINE Consortium Patient Representative, London, UK
| | - P Ellis
- ReIMAGINE Consortium Patient Representative, London, UK
| | - A Haire
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - C Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - F Cahill
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - N McCartan
- UCL Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - L Brown
- MRC Clinical Trials Unit, University College London, London, UK
| | - A Santaolalla
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - T Marsden
- UCL Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Rodriquez Justo
- UCL Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Hadley
- UCL Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Punwani
- Centre for Medical Imaging, University College London, London, UK
| | - G Attard
- UCL Division of Surgical and Interventional Sciences, University College London, London, UK
| | - H Ahmed
- Imperial College, London, UK
| | - C M Moore
- UCL Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Emberton
- UCL Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
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Santaolalla A, Hulsen T, Davis J, Ahmed HU, Moore CM, Punwani S, Attard G, McCartan N, Emberton M, Coolen A, Van Hemelrijck M. The ReIMAGINE Multimodal Warehouse: Using Artificial Intelligence for Accurate Risk Stratification of Prostate Cancer. Front Artif Intell 2021; 4:769582. [PMID: 34870187 PMCID: PMC8637844 DOI: 10.3389/frai.2021.769582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/12/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction. Prostate cancer (PCa) is the most frequent cancer diagnosis in men worldwide. Our ability to identify those men whose cancer will decrease their lifespan and/or quality of life remains poor. The ReIMAGINE Consortium has been established to improve PCa diagnosis. Materials and methods. MRI will likely become the future cornerstone of the risk-stratification process for men at risk of early prostate cancer. We will, for the first time, be able to combine the underlying molecular changes in PCa with the state-of-the-art imaging. ReIMAGINE Screening invites men for MRI and PSA evaluation. ReIMAGINE Risk includes men at risk of prostate cancer based on MRI, and includes biomarker testing. Results. Baseline clinical information, genomics, blood, urine, fresh prostate tissue samples, digital pathology and radiomics data will be analysed. Data will be de-identified, stored with correlated mpMRI disease endotypes and linked with long term follow-up outcomes in an instance of the Philips Clinical Data Lake, consisting of cloud-based software. The ReIMAGINE platform includes application programming interfaces and a user interface that allows users to browse data, select cohorts, manage users and access rights, query data, and more. Connection to analytics tools such as Python allows statistical and stratification method pipelines to run profiling regression analyses. Discussion. The ReIMAGINE Multimodal Warehouse comprises a unique data source for PCa research, to improve risk stratification for PCa and inform clinical practice. The de-identified dataset characterized by clinical, imaging, genomics and digital pathology PCa patient phenotypes will be a valuable resource for the scientific and medical community.
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Affiliation(s)
- Aida Santaolalla
- King’s College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), London, United Kingdom
| | - Tim Hulsen
- Philips Research, Department of Hospital Services and Informatics, Eindhoven, Netherlands
| | - Jenson Davis
- Philips, Data Science Services, Best, Netherlands
| | - Hashim U. Ahmed
- Imperial College London, Faculty of Medicine, Imperial Prostate, Department of Surgery and Cancer, London, United Kingdom
| | - Caroline M. Moore
- Division of Surgical and Interventional Science, University College London, London, United Kingdom
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Gert Attard
- Cancer Institute, University College London, London, United Kingdom
| | - Neil McCartan
- Division of Surgical and Interventional Science, University College London, London, United Kingdom
| | - Mark Emberton
- Division of Surgical and Interventional Science, University College London, London, United Kingdom
| | - Anthony Coolen
- King’s College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), London, United Kingdom
- Department of Biophysics, Donders Institute, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Mieke Van Hemelrijck
- King’s College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), London, United Kingdom
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Giganti F, Lindner S, Piper JW, Kasivisvanathan V, Emberton M, Moore CM, Allen C. Multiparametric prostate MRI quality assessment using a semi-automated PI-QUAL software program. Eur Radiol Exp 2021; 5:48. [PMID: 34738219 PMCID: PMC8568748 DOI: 10.1186/s41747-021-00245-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/08/2021] [Indexed: 11/10/2022] Open
Abstract
The technical requirements for the acquisition of multiparametric magnetic resonance imaging (mpMRI) of the prostate have been clearly outlined in the Prostate Imaging Reporting and Data System (PI-RADS) guidelines, but there is still huge variability in image quality among centres across the world. It has been difficult to quantify what constitutes a good-quality image, and a first attempt to address this matter has been the publication of the Prostate Imaging Quality (PI-QUAL) score and its dedicated scoring sheet. This score includes the assessment of technical parameters that can be obtained from the DICOM files along with a visual evaluation of certain features on prostate MRI (e.g., anatomical structures). We retrospectively analysed the image quality of 10 scans from different vendors and magnets using a semiautomated dedicated PI-QUAL software program and compared the time needed for assessing image quality using two methods (semiautomated assessment versus manual filling of the scoring sheet). This semiautomated software is able to assess the technical parameters automatically, but the visual assessment is still performed by the radiologist. There was a significant reduction in the reporting time of prostate mpMRI quality according to PI-QUAL using the dedicated software program compared to manual filling (5'54″ versus 7'59″; p = 0.005). A semiautomated PI-QUAL software program allows the radiologist to assess the technical details related to the image quality of prostate mpMRI in a quick and reliable manner, allowing clinicians to have more confidence that the quality of mpMRI of the prostate is sufficient to determine patient care.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., W1W 7TS, London, UK.
| | | | | | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., W1W 7TS, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., W1W 7TS, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
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Shanahan JP, Moore CM, Kampf JW, Szymczak NK. Modulation of H +/H - exchange in iridium-hydride 2-hydroxypyridine complexes by remote Lewis acids. Chem Commun (Camb) 2021; 57:11705-11708. [PMID: 34693408 DOI: 10.1039/d1cc04778g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A series of iridium hydride complexes featuring dihydrogen bonding are presented and shown to undergo rapid H+/H- exchange (1240 s-1 at 25 °C). We demonstrate that the H+/H- exchange rate can be modified by post-synthetic modification at a remote site using BH3, Zn(C6F5)2, and [Me3O][BF4]. This route provides a complementary strategy to traditional methods that rely on pre-metalation modifications to a metal's primary sphere.
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Affiliation(s)
- J P Shanahan
- Department of Chemistry, Columbia University, New York, New York 10027, USA
| | - C M Moore
- Chemistry Division, Los Alamos National Laboratory, MS K558, Los Alamos, NM 87545, USA
| | - Jeff W Kampf
- Department of Chemistry, University of Michigan, 930 N. University Ave., Ann Arbor, MI 48109-1055, USA.
| | - N K Szymczak
- Department of Chemistry, University of Michigan, 930 N. University Ave., Ann Arbor, MI 48109-1055, USA.
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Marsden T, Lomas DJ, McCartan N, Hadley J, Tuck S, Brown L, Haire A, Moss CL, Green S, Van Hemelrijck M, Coolen T, Santaolalla A, Isaac E, Brembilla G, Kopcke D, Giganti F, Sidhu H, Punwani S, Emberton M, Moore CM. ReIMAGINE Prostate Cancer Screening Study: protocol for a single-centre feasibility study inviting men for prostate cancer screening using MRI. BMJ Open 2021; 11:e048144. [PMID: 34593491 PMCID: PMC8487192 DOI: 10.1136/bmjopen-2020-048144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The primary objective of the ReIMAGINE Prostate Cancer Screening Study is to explore the uptake of an invitation to prostate cancer screening using MRI. METHODS AND ANALYSIS The ReIMAGINE Prostate Cancer Screening Study is a prospective single-centre feasibility study. Eligible men aged 50-75 years with no prior prostate cancer diagnosis or treatment will be identified through general practitioner practices and randomly selected for invitation. Those invited will be offered an MRI scan and a prostate-specific antigen (PSA) blood test. The screening MRI scan consists of T2-weighted, diffusion-weighted and research-specific sequences, without the use of intravenous contrast agents. Men who screen positive on either MRI or PSA density will be recommended to have standard of care (National Health Service) tests for prostate cancer assessment, which includes multiparametric MRI. The study will assess the acceptability of an MRI-based prostate screening assessment and the prevalence of cancer detected in MRI-screened men. Summary statistics will be used to explore baseline characteristics in relation to acceptance rates and prevalence of cancer. ETHICS AND DISSEMINATION ReIMAGINE Prostate Cancer Screening is a single-site screening study to assess the feasibility of MRI as a screening tool for prostate cancer. Ethical approval was granted by London-Stanmore Research Ethics Committee Heath Research Authority (reference 19/LO/1129). Study results will be published in peer-reviewed journals after completion of data analysis and used to inform the design of a multicentre screening study in the UK. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04063566).
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Affiliation(s)
- Teresa Marsden
- Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Derek J Lomas
- Department of Urology, Mayo Clinic, Rochester, New York, USA
| | - Neil McCartan
- Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Joanna Hadley
- Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Steve Tuck
- ReIMAGINE Consortium Patient Representative, University College London, London, UK
| | - Louise Brown
- MRC Clinical Trials Unit, University College London, London, UK
| | - Anna Haire
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | | | - Saran Green
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | | | - Ton Coolen
- London Institute for Mathematical Sciences, London, UK
| | - Aida Santaolalla
- Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK
| | - Elizabeth Isaac
- Centre for Medical Imaging, University College London, London, UK
| | | | - Douglas Kopcke
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Harbir Sidhu
- Centre for Medical Imaging, University College London, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, UK
| | - Mark Emberton
- Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Abstract
The management of prostate cancer continues to evolve rapidly, with substantial advances being made in understanding the genomic landscape and biology underpinning both primary and metastatic prostate cancer. Similarly, the emergence of more sensitive imaging methods has improved diagnostic and staging accuracy and refined surveillance strategies. These advances have introduced personalised therapeutics to clinical practice, with treatments targeting genomic alterations in DNA repair pathways now clinically validated. An important shift in the therapeutic framework for metastatic disease has taken place, with metastatic-directed therapies being evaluated for oligometastatic disease, aggressive management of the primary lesion shown to benefit patients with low-volume metastatic disease, and with several novel androgen pathway inhibitors significantly improving survival when used as a first-line therapy for metastatic disease. Research into the molecular characterisation of localised, recurrent, and progressive disease will undoubtedly have an impact on clinical management. Similarly, emerging research into novel therapeutics, such as targeted radioisotopes and immunotherapy, holds much promise for improving the lives of patients with prostate cancer.
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Affiliation(s)
- Shahneen Sandhu
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | | | - Edmund Chiong
- Department of Urology and Department of Surgery, National University of Singapore, Singapore
| | | | - Robert G Bristow
- Manchester Cancer Research Centre and University of Manchester, Manchester, UK
| | - Scott G Williams
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
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Affiliation(s)
- Caroline M Moore
- Division of Surgical and Interventional Science, University College London, London WC1E 6BT, UK.
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