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Chahine R, Mendiratta-Lala M, Consul N, Wang J, Stein EB, Roseland ME, Aslam A. What can go wrong when doing right? A pictorial review of iatrogenic genitourinary complications. Abdom Radiol (NY) 2024:10.1007/s00261-024-04384-8. [PMID: 38832944 DOI: 10.1007/s00261-024-04384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 06/06/2024]
Abstract
A growing number of treatments for genitourinary diseases can result in various iatrogenic complications. Multimodality imaging in the post-procedural setting is essential for early and accurate diagnosis to limit morbidity and mortality. We review common and uncommon treatment-induced pathologies affecting the genitourinary system via a case-based approach. We illustrate notable complications affecting the kidneys, ureters, bladder, and urethra induced by percutaneous procedures, external beam radiation, immunotherapy, laparoscopic/robotic pelvic surgery, and intravesicular BCG. Finally, we provide guidance on optimal imaging techniques for diagnosis and highlight the role of image-guided interventions for mitigation of complications.
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Affiliation(s)
- Reve Chahine
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA.
| | - Mishal Mendiratta-Lala
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Nikita Consul
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Jeffrey Wang
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Erica B Stein
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Molly E Roseland
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Anum Aslam
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
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2
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Samaratunga H, Hussey D, Le Fevre IK, Egevad L, Sarikwal A, Carim H, Delahunt B. Florid basal cell hyperplasia mimics high PI-RADS score prostate cancer on mpMRI. Pathology 2024; 56:413-415. [PMID: 37863712 DOI: 10.1016/j.pathol.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/29/2023] [Accepted: 07/09/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Hemamali Samaratunga
- Aquesta Uropathology, Toowong, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | - David Hussey
- St Vincent's Private Hospital, Northside, Chernside, Qld, Australia
| | | | - Lars Egevad
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | | | - Humza Carim
- I-Med Radiology Network, Strathpine, Brisbane, Qld, Australia
| | - Brett Delahunt
- Aquesta Uropathology, Toowong, Qld, Australia; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Malaghan Institute of Medical Research, Wellington, New Zealand.
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3
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Sudha Surasi DS, Kalva P, Hwang KP, Bathala TK. Pitfalls in Prostate MR Imaging Interpretation. Radiol Clin North Am 2024; 62:53-67. [PMID: 37973245 DOI: 10.1016/j.rcl.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Multiparametric MR imaging of the prostate is an essential diagnostic study in the evaluation of prostate cancer. Several entities including normal anatomic structures, benign lesions, and posttreatment changes can mimic prostate cancer. An in depth understanding of the pitfalls is important for accurate interpretation of prostate MR imaging.
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Affiliation(s)
- Devaki Shilpa Sudha Surasi
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1483, Houston, TX 77030, USA.
| | - Praneeth Kalva
- University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Ken-Pin Hwang
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1472, Houston, TX 77030, USA
| | - Tharakeswara Kumar Bathala
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1483, Houston, TX 77030, USA
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4
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Gaudiano C, Renzetti B, De Fino C, Corcioni B, Ciccarese F, Bianchi L, Schiavina R, Droghetti M, Giunchi F, Brunocilla E, Fiorentino M. Multiparametric magnetic resonance imaging for the differential diagnosis between granulomatous prostatitis and prostate cancer: a literature review to an intriguing diagnostic challenge. Front Oncol 2023; 13:1178430. [PMID: 37342186 PMCID: PMC10277616 DOI: 10.3389/fonc.2023.1178430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/22/2023] [Indexed: 06/22/2023] Open
Abstract
Multiparametric magnetic resonance imaging (mpMRI) is currently the most effective diagnostic tool for detecting prostate cancer (PCa) and evaluating adenocarcinoma-mimicking lesions of the prostate gland, among which granulomatous prostatitis (GP) represents the most interesting diagnostic challenge. GP consists of a heterogeneous group of chronic inflammatory lesions that can be differentiated into four types: idiopathic, infective, iatrogenic, and associated with systemic granulomatous disease. The incidence of GP is growing due to the increase in endourological surgical interventions and the adoption of intravesical instillation of Bacillus Calmette-Guerin in patients with non-muscle invasive bladder cancer; therefore, the difficulty lies in identifying specific features of GP on mpMRI to avoid the use of transrectal prostate biopsy as much as possible.
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Affiliation(s)
- Caterina Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Benedetta Renzetti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Cristina De Fino
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Beniamino Corcioni
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federica Ciccarese
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Bianchi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Droghetti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesca Giunchi
- Department of Pathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Coiner BL, Rais-Bahrami S, Gordetsky JB. Diagnosis and Pathologic Reporting of Prostate Cancer in the Era of MRI-Targeted Prostate Biopsy. Surg Pathol Clin 2022; 15:609-616. [PMID: 36344178 DOI: 10.1016/j.path.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Historically, the detection of prostate cancer relied upon a systematic yet random sampling of the prostate by transrectal ultrasound guided biopsy. This approach was a nontargeted technique that led to the under detection of cancers at biopsy and the upgrading of cancers at radical prostatectomy. Multiparametric MRI-targeted prostate biopsy allows for an image-directed approach to the identification of prostate cancer. MRI-targeted biopsy of the prostate is superior for the detection of clinically significant prostate cancer. As this technique has become more prevalent among urologists, pathologists need to recognize how this development impacts cancer diagnosis and reporting.
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Affiliation(s)
- Benjamin L Coiner
- Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN 37232, USA. https://twitter.com/bencoiner
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Faculty Office Tower 1107, 510 20th Street South, Birmingham, AL 35294, USA. https://twitter.com/RaisBahrami
| | - Jennifer B Gordetsky
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, C-3320 MCN, 1161 21st Avenue South, Nashville, TN 37232, USA.
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Şeref C, Acar Ö, Kılıç M, Vural M, Sağlıcan Y, Saraç H, Coşkun B, İnce Ü, Esen T, Lack NA. Histologically benign PI-RADS 4 and 5 lesions contain cancer-associated epigenetic alterations. Prostate 2022; 82:145-153. [PMID: 34672371 DOI: 10.1002/pros.24255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/31/2021] [Accepted: 09/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND The detection rate of clinically significant prostate cancer has improved with the use of multiparametric magnetic resonance imaging (mpMRI). Yet, even with MRI-guided biopsy 15%-35% of high-risk lesions (Prostate Imaging-Reporting and Data System [PI-RADS] 4 and 5) are histologically benign. It is unclear if these false positives are due to diagnostic/sampling errors or pathophysiological alterations. To better understand this, we tested histologically benign PI-RAD 4 and 5 lesions for common malignant epigenetic alterations. MATERIALS AND METHODS MRI-guided in-bore biopsy samples were collected from 45 patients with PI-RADS 4 (n = 31) or 5 (n = 14) lesions. Patients had a median clinical follow-up of 3.8 years. High-risk mpMRI patients were grouped based on their histology into biopsy positive for tumor (BPT; n = 28) or biopsy negative for tumor (BNT; n = 17). From these biopsy samples, DNA methylation of well-known tumor suppressor genes (APC, GSTP1, and RARβ2) was quantified. RESULTS Similar to previous work we observed high rates of promoter methylation at GSTP1 (92.7%), RARβ2 (57.3%), and APC (37.8%) in malignant BPT samples but no methylation in benign TURP chips. Interestingly, similar to the malignant samples the BNT biopsies also had increased methylation at the promoter of GSTP1 (78.8%) and RARβ2 (34.6%). However, despite these epigenetic alterations none of these BNT patients developed prostate cancer, and those who underwent repeat mpMRI (n = 8) demonstrated either radiological regression or stability. CONCLUSIONS Histologically benign PI-RADS 4 and 5 lesions harbor prostate cancer-associated epigenetic alterations.
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Affiliation(s)
- Ceren Şeref
- Department of Health Sciences, Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Ömer Acar
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
| | - Mert Kılıç
- Department of Urology, VKF American Hospital, Istanbul, Turkey
| | - Metin Vural
- Department of Radiology, VKF American Hospital, Istanbul, Turkey
| | - Yeşim Sağlıcan
- Department of Pathology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Hilal Saraç
- Department of Health Sciences, Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Bilgen Coşkun
- Department of Radiology, VKF American Hospital, Istanbul, Turkey
| | - Ümit İnce
- Department of Pathology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Tarık Esen
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
- Department of Urology, VKF American Hospital, Istanbul, Turkey
| | - Nathan A Lack
- Department of Health Sciences, Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
- Department of Medical Pharmacology, Koç University School of Medicine, Istanbul, Turkey
- Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
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Wang X, Liu W, Lei Y, Wu G, Lin F. Assessment of prostate imaging reporting and data system version 2.1 false-positive category 4 and 5 lesions in clinically significant prostate cancer. Abdom Radiol (NY) 2021; 46:3410-3417. [PMID: 33710384 DOI: 10.1007/s00261-021-03023-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine the incidence and false-positive rates of clinically significant prostate cancer (CSPC) in prostate imaging reporting and data system (PI-RADS) category 4 and 5 lesions using PI-RADS v2.1. METHODS One hundred and eighty-two lesions in 169 subjects with a PI-RADS score of 4 or 5 were included in our study. Lesions with clinically insignificant prostate cancer (CIPC) or benign pathologic findings were reviewed and categorized by a radiologist. The initial comparison of demographic and clinical data was performed by t-test and χ2 test, and then the logistic regression model was used to determine factors associated with CIPC or benign pathological findings. RESULTS Of the 182 PI-RADS category 4 and 5 lesions, 84.6% (154/182) were prostate cancer (PCa), 73.1% (133/182) were CSPC, and 26.9% (49/182) were CIPC or benign pathologic findings. The false-positive cases included 44.9% (22/49) with inflammation, 42.9% (21/49) with CIPC, 8.2% (4/49) with BPH nodules and 4.1% (2/49) with normal anatomy cases. In multivariate analysis, factors associated with CIPC or benign features included those in both the peripheral zone (PZ) and central gland (CG) (odds ratio [OR] 0.062; p = 0.003) and a low prostate-specific antigen density (PSAD) (OR 0.34; p = 0.012). CONCLUSION The integration of clinical information (PSAD and lesion location) into mpMRI to identify lesions helps with obtaining a clinically significant diagnosis and decision-making.
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Affiliation(s)
- Xiangyu Wang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen, 518035, China
| | - Weizong Liu
- Department of Ultrasonography, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen, 518035, China
| | - Yi Lei
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen, 518035, China
| | - Guangyao Wu
- Department of Radiology, Shenzhen University General Hospital, 1098 XueYuan Road, Shenzhen, 518055, China.
| | - Fan Lin
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen, 518035, China.
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Ambe Y, Nakamura M, Shirakawa N, Inatsu H, Amakawa R, Inoue Y, Yoshimatsu T, Miura S, Morikawa T, Kusakabe M, Shiga Y. Granulomatous prostatitis with high suspicion of prostatic adenocarcinoma on radiological imaging. IJU Case Rep 2021; 4:247-249. [PMID: 34258540 PMCID: PMC8255296 DOI: 10.1002/iju5.12300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Granulomatous prostatitis is a benign inflammatory condition of the prostate that may mimic prostatic adenocarcinoma on magnetic resonance imaging findings. Even in the era of multiparametric magnetic resonance imaging, the differential diagnosis of granulomatous prostatitis from malignancy remains difficult. CASE PRESENTATION A 69-year-old man with abnormal magnetic resonance imaging and positron emission tomography/magnetic resonance imaging findings, and a prostate-specific antigen value of 2.48 ng/mL underwent prostate needle biopsy. He had a history of urinary tract infection 3 months prior to presentation. Multiparametric magnetic resonance imaging showed low-intensity signals on T2-weighted images, slightly high-intensity signals on diffusion-weighted images, and low values on apparent diffusion coefficients. The prostate imaging-reporting and data system version 2 score was 3. Histological examination revealed granulomatous prostatitis. CONCLUSION For patients with preceding urinary tract infections, granulomatous prostatitis should be considered as a differential diagnosis, even when magnetic resonance imaging and positron emission tomography suggest prostatic adenocarcinoma.
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Affiliation(s)
- Yoshiki Ambe
- Departments ofDepartment ofUrologyNTT Medical Center HospitalShinagawa‐kuJapan
| | - Masaki Nakamura
- Departments ofDepartment ofUrologyNTT Medical Center HospitalShinagawa‐kuJapan
| | - Norihide Shirakawa
- Departments ofDepartment ofUrologyNTT Medical Center HospitalShinagawa‐kuJapan
| | - Hiroki Inatsu
- Departments ofDepartment ofUrologyNTT Medical Center HospitalShinagawa‐kuJapan
| | - Ryo Amakawa
- Departments ofDepartment ofUrologyNTT Medical Center HospitalShinagawa‐kuJapan
| | - Yasushi Inoue
- Departments ofDepartment ofUrologyNTT Medical Center HospitalShinagawa‐kuJapan
| | - Tadashi Yoshimatsu
- Departments ofDepartment ofUrologyNTT Medical Center HospitalShinagawa‐kuJapan
| | - Sakiko Miura
- Department ofDiagnostic PathologyNTT Medical Center HospitalShinagawa‐kuJapan
| | - Teppei Morikawa
- Department ofDiagnostic PathologyNTT Medical Center HospitalShinagawa‐kuJapan
| | - Masashi Kusakabe
- Department ofRadiologyNTT Medical Center HospitalShinagawa‐kuJapan
| | - Yoshiyuki Shiga
- Departments ofDepartment ofUrologyNTT Medical Center HospitalShinagawa‐kuJapan
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Han C, Zhu L, Liu X, Ma S, Liu Y, Wang X. Differential diagnosis of uncommon prostate diseases: combining mpMRI and clinical information. Insights Imaging 2021; 12:79. [PMID: 34132898 PMCID: PMC8208342 DOI: 10.1186/s13244-021-01024-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 05/31/2021] [Indexed: 01/03/2023] Open
Abstract
The differential diagnosis of abnormalities in the prostate is broad, covering common (acinar adenocarcinoma, benign prostatic hyperplasia, chronic prostatitis, hemorrhage, cysts, calcifications, atrophy and fibrosis) and less common conditions (tumors other than acinar adenocarcinoma, granulomatous prostatitis containing tuberculosis, abscesses and other conditions, and idiopathic disorders such as amyloidosis and exophytic benign prostatic hyperplasia). Recent advances in magnetic resonance imaging (MRI) of the prostate gland and imaging guidelines, such as the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1), have dramatically improved the ability to distinguish common abnormalities, especially the ability to detect clinically significant prostate cancer (csPCa). Overlap can exist in the clinical history and imaging features associated with various common/uncommon prostate abnormalities, and biopsy is often required but is invasive. Prostate abnormalities can be divided into two categories: category 1, diseases for which PI-RADS scores are suitable for use, and category 2, diseases for which PI-RADS scores are unsuitable for use. Radiologists must have an intimate knowledge of other diseases, especially uncommon conditions. Past relevant history, symptoms, age, serum prostate-specific antigen (PSA) levels, MRI manifestations, and the applicability of the PI-RADS assessment should be considered when diagnosing prostate abnormalities.
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Affiliation(s)
- Chao Han
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Lina Zhu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Road, ZhengzhouHenan Province, 450052, China
| | - Xiang Liu
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Shuai Ma
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yi Liu
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
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Shakur A, Hames K, O'Shea A, Harisinghani MG. Prostatitis: imaging appearances and diagnostic considerations. Clin Radiol 2021; 76:416-426. [PMID: 33632522 DOI: 10.1016/j.crad.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/14/2021] [Indexed: 02/07/2023]
Abstract
Acute and chronic inflammation of the prostate gland can be attributed to several underlying aetiologies, including but not limited to, bacterial prostatitis, granulomatous prostatitis, and Immunoglobulin G4-related prostatitis. In this review, we provide an overview of the general imaging appearances of the different types of prostatitis, their distinguishing features and characteristic appearances at cross-sectional imaging. Common imaging pitfalls are presented and illustrated with examples.
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Affiliation(s)
- A Shakur
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - K Hames
- Department of Radiology, Hamilton General Hospital, 237 Barton Street E, Hamilton, Ontario, L8L 2X2, Canada
| | - A O'Shea
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - M G Harisinghani
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
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Eusebi L, Carpagnano FA, Sortino G, Bartelli F, Guglielmi G. Prostate Multiparametric MRI: Common Pitfalls in Primary Diagnosis and How to Avoid Them. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00378-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Purpose of Review
To provide the radiologist with basic knowledge about normal and abnormal findings in the prostatic mp-MRI, taking a look at the possible diagnostic pitfalls commonly seen in daily clinical practice, allowing him to recognize and consequently avoid them.
Recent Findings
Prostate mp-MRI has now become commonly used in most diagnostic imaging centers, as a precise, accurate and above all non-invasive tool, useful in the diagnosis, staging and follow-up of prostate diseases, first of all prostatic carcinoma. For this reason, it is important to take into account the existence of numerous possible anatomic and pathologic processes which can mimick or masquerade as prostate cancer.
Summary
Through the combination of anatomical (T2WI) and functional sequences (DWI/ADC and DCE), the mp-MRI of the prostate provides all the information necessary for a correct classification of patients with prostate disease, cancer in particular. It is not uncommon, however, for the radiologist to make errors in the interpretation of imaging due to conditions, pathological or otherwise, that mimic prostate cancer and that, consequently, affect the diagnostic/therapeutic process of patients. The strategy, and what this pictorial review aims at, is to learn to recognize the potential pitfalls of the prostatic mp-MRI and avoid them.
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Abstract
Multiparametric MRI (mpMRI) of the prostate has evolved to be an integral component for the diagnosis, risk stratification, staging, and targeting of prostate cancer. However, anatomic and histologic mimics of prostate cancer on mpMRI exist. Anatomic feature that mimic prostate cancer on mpMRI include anterior fibromuscular stroma, normal central zone, periprostatic venous plexus, and thickened surgical capsule (transition zone pseudocapsule). Benign conditions such as post-biopsy hemorrhage, prostatitis or inflammation, focal prostate atrophy, benign prostatic hyperplasia nodules, and prostatic calcifications can also mimic prostate cancer on mpMRI. Technical challenges and other pitfalls such as image distortion, motion artifacts, and endorectal coil placements can also limit the efficacy of mpMRI. Knowledge of prostate anatomy, location of the lesion and its imaging features on different sequences, and being familiar with the common pitfalls are critical for the radiologists who interpret mpMRI. Therefore, this article reviews the pitfalls (anatomic structures and technical challenges) and benign lesions or abnormalities that may mimic prostate cancer on mpMRI and how to interpret them.
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13
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De Luca L, Crocetto F, Barone B, Creta M, Pesce S, Aveta A, Campanino MR, Imbimbo C, Longo N. Granulomatous prostatitis mimicking prostate cancer in a patient with psoriatic arthritis: a case report. Future Sci OA 2020; 6:FSO591. [PMID: 32802396 PMCID: PMC7421716 DOI: 10.2144/fsoa-2020-0031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Granulomatous prostatitis (GP) is an unusual and benign inflammatory condition of
the prostate, where autoimmunity has been recognized as a key factor in the
pathogenesis of GP in a subset of patients. Clinically, GP poses diagnostic
challenges as it may strongly mimic prostate cancer from a clinical, biochemical
and radiological point of view. The occurrence of GP in patients suffering from
psoriasis, a systemic autoimmune disease, has never been investigated. We
describe the case of GP in a patient with psoriatic arthritis presenting with an
increased prostate specific antigen level, and evidence of a nodular lesion
visualized by prostate multiparametric magnetic resonance imaging, which was
highly suspicious for aggressive prostate cancer. Granulomatous prostatitis is an uncommon inflammatory condition of the prostate
that can mimic prostate cancer due to increased prostate specific antigen levels
and suspect findings from both digital rectal exploration and prostate magnetic
resonance imaging. This condition is considered an autoimmune disorder in many
cases. We report the association between granulomatous prostatitis and
psoriasis, another autoimmune disease.
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Affiliation(s)
- Luigi De Luca
- Department of Neuroscience, Reproductive Sciences & Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Felice Crocetto
- Department of Neuroscience, Reproductive Sciences & Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Biagio Barone
- Department of Neuroscience, Reproductive Sciences & Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Massimiliano Creta
- Department of Neuroscience, Reproductive Sciences & Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Salvatore Pesce
- Department of Neuroscience, Reproductive Sciences & Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Achille Aveta
- Department of Neuroscience, Reproductive Sciences & Odontostomatology, University of Naples Federico II, Naples, Italy
| | | | - Ciro Imbimbo
- Department of Neuroscience, Reproductive Sciences & Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Nicola Longo
- Department of Neuroscience, Reproductive Sciences & Odontostomatology, University of Naples Federico II, Naples, Italy
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Gordetsky JB, Hirsch MS, Rais-Bahrami S. MRI-targeted prostate biopsy: key considerations for pathologists. Histopathology 2020; 77:18-25. [PMID: 32278319 DOI: 10.1111/his.14113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/27/2020] [Accepted: 04/03/2020] [Indexed: 01/11/2023]
Abstract
We discuss the role of the pathologist for MRI-targeted prostate biopsy with a focus on specimen processing, reporting of pathological findings and quality assurance in establishing a successful MRI-targeted biopsy programme. The authors discuss the current issues relevant to pathologists regarding MRI-targeted prostate biopsy. In addition, a brief review of the recently published literature was performed using an English literature search on PubMed with a focus on original investigations related to MRI-targeted prostate biopsy. Our search terms included the following: 'prostate cancer', 'pathology', 'histology', 'reporting', 'cores', 'imaging', 'MRI' and 'mpMRI'. Prostate multiparametric magnetic resonance imaging (mp-MRI) and MRI-targeted biopsy has been shown to improve the diagnosis of clinically significant prostatic adenocarcinoma and can affect the management of patients with prostate cancer. The current active surveillance guidelines were based on data from TRUS biopsies and not MRI-targeted biopsies. MRI-targeted biopsy acquires multiple cores of tissue from one or more suspicious lesions found on mp-MRI. The way in which multiple targeted core biopsies obtained from a single image-directed region of interest are analysed and reported can potentially alter the Gleason score and tumour burden as reported on biopsy, which could undoubtedly alter patient management. Pathologists play an important role in the reporting of MRI-targeted prostate biopsies. How we report prostate cancer grade and extent on these biopsies can influence patient management. In addition, the pathologist should be involved in the quality assurance for patients undergoing MRI-targeted prostate biopsy.
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Affiliation(s)
- Jennifer B Gordetsky
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.,O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL, USA
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15
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Pepe P, Pennisi M. Negative Biopsy Histology in Men With PI-RADS Score 5 in Daily Clinical Practice: Incidence of Granulomatous Prostatitis. Clin Genitourin Cancer 2020; 18:e684-e687. [PMID: 32389459 DOI: 10.1016/j.clgc.2020.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the biopsy histology of men who underwent transperineal multi-parametric magnetic resonance imaging (mpMRI)/transrectal ultrasound fusion biopsy for Prostate Imaging Reporting and Data System (PI-RADS) score 5 lesions. PATIENTS AND METHODS From January 2016 to June 2019, 105 men with PI-RADS score 5 underwent mpMRI/transrectal ultrasound fusion biopsy combined with systematic prostate biopsy. All the patients underwent a 3.0 Tesla pelvic mpMRI for the first time before prostate biopsy. In detail, the detection rate for clinically significant prostate cancer (PCa) and the follow-up of the patients without proven diagnosis of PCa has been reported. RESULTS In 91 (86.7%) of 105 patients, a stage T1c PCa was diagnosed, and 89 (84.5%) of 105 of them were classified as clinically significant PCa. Among the 16 (15.5%) of 105 patients with absence of cancer, 5 (31.5%) of 16 had an aspecific granulomatous prostatitis, 1 (6.2%) of 16 had a specific granulomatous prostatitis secondary to prostatic Mycobacterium Tubercolosis, and 10 (62.3%) of 16 had a diagnosis of normal parenchyma. The 6 patients with granulomatous prostatitis underwent specific antibiotic therapy followed by laboratory (ie, semen and urine cultures) and clinical evaluation. Six months from prostate biopsy, none of the 16 patients underwent repeat prostate biopsy because prostate-specific antigen (PSA) (15/16 cases) plus PSA density significantly decreased; in addition, in all the cases the initial PI-RADS score 5 was downgraded at mpMRI revaluation to PI-RADS score ≤ 3. CONCLUSION The reduction of PSA plus PSA density values and the downgrading of PI-RADS score to ≤ 3 allow avoiding a repeated prostate biopsy in men with initial mpMRI PI-RADS score 5 lesion and negative biopsy histology.
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Affiliation(s)
- Pietro Pepe
- Urology Unit, Cannizzaro Hospital, Catania, Italy.
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16
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Crocetto F, Barone B, De Luca L, Creta M. Granulomatous prostatitis: a challenging differential diagnosis to take into consideration. Future Oncol 2020; 16:805-806. [PMID: 32180450 DOI: 10.2217/fon-2020-0185] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Felice Crocetto
- Department of Neurosciences, Reproductive Sciences & Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Biagio Barone
- Department of Neurosciences, Reproductive Sciences & Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Luigi De Luca
- Department of Neurosciences, Reproductive Sciences & Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences & Odontostomatology, University of Naples Federico II, Naples, Italy
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17
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Granulomatous Prostatitis Mimicking Prostate Cancer. Urology 2020; 137:e3-e5. [DOI: 10.1016/j.urology.2019.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 12/22/2022]
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18
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Morote J, Celma A, Diaz F, Regis L, Roche S, Mast R, Semidey ME, de Torres IM, Planas J, Trilla E. Prostatic-specific antigen density behavior according to multiparametric magnetic resonance imaging result. Urol Oncol 2020; 38:410-417. [PMID: 32067845 DOI: 10.1016/j.urolonc.2019.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To analyze prostatic-specific antigen density (PSAD) according to the Prostate Imaging Reporting and Data System (PIRADSv.2) score, in order to determine how it should be used. METHODS This correlative series considered 952 men with prostatic-specific antigen >3 ng/ml and/or abnormal digital rectal examination who were subjected to prostatic biopsy (PB) between 2016 and 2017. Of these men, 768 had no previous 5-α-reductase inhibitor use or history of prostate cancer (CaP) and had previously undergone 3-T multiparametric magnetic resonance imaging (mpMRI). In this sample, 549 men were biopsy-naïve and 219 had at least 1 previous negative PB. A 12-core transrectal ultrasound-guided PB was performed in all participants, as well as at least 2-core targeted biopsies of every detected lesion with a PIRADSv.2 score ≥3. Significant CaP (sCaP) was defined as an International Society of Uropathologist grade >1 or tumor length >4 mm. RESULTS The overall CaP detection was 41.7%, with sCaP detected in 37.4%. sCaP was detected in 4.3% of PIRADSv.2 <3, 21.5% of PIRADSv.2 =3, 56.6% of PIRADSv.2 =4, and 78.5% of PIRADSv.2 =5, (P < 0.001). Insignificant CaP detection ranged from 6.5% to 1.5% respectively (P = 0.099). PSAD was an independent predictor of sCaP (odds ratios 1.971, 95% confidence interval [1.633, 2.378], P <0.001) and mpMRI (OR 3.179, 95%CI [2.593, 4.950], P < 0.001). Age (P = 0.013), family history of CaP (P = 0.021), and the type of PB (initial vs. repeated, P < 0.001) were also independent predictors of sCaP. PSAD was determined by PIRADSv.2 (P = 0.013) and the presence of sCaP (P < 0.001). PSAD increased with PIRADSv.2 score, even in men with CaP (P < 0.001) and slightly in men without CaP (P = 0.019). The area under the curve for mpMRI increased from 0.830 to 0.869 when PSAD was associated, (P < 0.001). The area under the curve of PSAD decreased from 0.727 in men with a PIRADSv.2 score <3 to 0.706 in those with a score of 5. CONCLUSIONS The efficacy of PSAD to detect sCaP decreases with PIRADSv.2. Predictors other than mpMRI and PSAD exist. Considering these conditions, independent predictors should be integrated in a nomogram and risk-calculator to personalize PB recommendation.
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Affiliation(s)
- Juan Morote
- Department of Urology, Vall d´Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Anna Celma
- Department of Urology, Vall d´Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Fernando Diaz
- Department of Urology, Vall d´Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Lucas Regis
- Department of Urology, Vall d´Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Sarai Roche
- Department of Radiology, Vall d´Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Richard Mast
- Department of Radiology, Vall d´Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - María E Semidey
- Department of Pathology, Vall d´Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Inés M de Torres
- Department of Pathology, Vall d´Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jacques Planas
- Department of Urology, Vall d´Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - Enrique Trilla
- Department of Urology, Vall d´Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
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Abstract
Magnetic resonance imaging (MRI) has been increasingly used in the detection, localization, and staging of prostate cancer. Because of its excellent soft tissue contrast and multiplane imaging, it can be also very useful in the evaluation of benign prostate diseases. Prostatic benign disorders have a high prevalence, vastly represented by benign prostatic hyperplasia and prostatitis. On the contrary, benign prostatic neoplasms are extremely rare, represented by multilocular cystadenoma, leiomyomas, hemangioma, and granular cell tumor, although these uncommon tumors have been most encountered due to widespread use of MRI. Congenital prostatic anomalies are associated with defects in the development of the prostate embryology, including hypoplasia, ectopia, and vascular malformations, abnormalities rarely seen on cross-sectional imaging. Prostatic cysts are the most common development abnormalities and occasionally are related to clinical symptoms, mainly due to infection and hemorrhage. As with prostate cancer, multiparametric MRI is a reliable tool for the diagnosis and management of benign prostatic diseases as well, providing additional information such morphological changes of the prostate, more accurate prostatic measurements, and functional characteristics of nonmalignant prostatic lesions. In this review, we discuss MRI findings of these benign prostatic diseases.
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20
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Urogenital tuberculosis - epidemiology, pathogenesis and clinical features. Nat Rev Urol 2019; 16:573-598. [PMID: 31548730 DOI: 10.1038/s41585-019-0228-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2019] [Indexed: 02/07/2023]
Abstract
Tuberculosis (TB) is the most common cause of death from infectious disease worldwide. A substantial proportion of patients presenting with extrapulmonary TB have urogenital TB (UG-TB), which can easily be overlooked owing to non-specific symptoms, chronic and cryptic protean clinical manifestations, and lack of clinician awareness of the possibility of TB. Delay in diagnosis results in disease progression, irreversible tissue and organ damage and chronic renal failure. UG-TB can manifest with acute or chronic inflammation of the urinary or genital tract, abdominal pain, abdominal mass, obstructive uropathy, infertility, menstrual irregularities and abnormal renal function tests. Advanced UG-TB can cause renal scarring, distortion of renal calyces and pelvic, ureteric strictures, stenosis, urinary outflow tract obstruction, hydroureter, hydronephrosis, renal failure and reduced bladder capacity. The specific diagnosis of UG-TB is achieved by culturing Mycobacterium tuberculosis from an appropriate clinical sample or by DNA identification. Imaging can aid in localizing site, extent and effect of the disease, obtaining tissue samples for diagnosis, planning medical or surgical management, and monitoring response to treatment. Drug-sensitive TB requires 6-9 months of WHO-recommended standard treatment regimens. Drug-resistant TB requires 12-24 months of therapy with toxic drugs with close monitoring. Surgical intervention as an adjunct to medical drug treatment is required in certain circumstances. Current challenges in UG-TB management include making an early diagnosis, raising clinical awareness, developing rapid and sensitive TB diagnostics tests, and improving treatment outcomes.
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21
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Lee SM, Wolfe K, Acher P, Liyanage SH. Multiparametric MRI appearances of primary granulomatous prostatitis. Br J Radiol 2019; 92:20180075. [PMID: 30964700 DOI: 10.1259/bjr.20180075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Radiological features of granulomatous prostatitis (GP) overlap with those of prostate adenocarcinoma. Identification of specific GP features may aid diagnosis. We aimed to evaluate the multiparametric MRI (mpMRI) features of GP. METHODS We retrospectively reviewed 16 patients from a cohort undergoing mpMRI and transperineal sector-guided prostate biopsies between July 2012 and May 2017. Images were analysed for lesion location, shape, size, extracapsular extension, signal intensity (SI), apparent diffusion coefficient (ADC) values, dynamic contrast enhancement (DCE) pattern and PI-RADS (Prostate Imaging - Reporting and Data System) v2 score. RESULTS Histology revealed 13 cases of nonspecific GP and 3 cases of xanthogranulomatous prostatitis. GP lesions were diffuse involving > 50% of the prostate ( n = 13) or nodular ( n = 3). Signal intensity on T 2 weighted imaging was low and high on diffusion-weighted imaging. ADC values were low (mean 702 ± 79 × 10-6 mm/s2 ). Five patients had DCE imaging with all cases 'positive' as per PI-RADS scoring, with two cases displaying further ring enhancement consistent with abscess formation. Overall PI-RADS score for all cases was 5, indicating high suspicion of prostate cancer. CONCLUSION GP is difficult to differentiate from prostate cancer, but typically gives diffuse changes involving > 50% of the gland on mpMRI, with extracapsular extension and rim-enhancing areas. It should be considered a differential diagnosis in patients with recent urinary tract infection (UTI) or prior Bacillus Calmette-Guerin (BCG) treatment. ADVANCES IN KNOWLEDGE Prostate MRI imaging features including diffuse changes, extracapsular extension and rim-enhancing areas, in patients with recent UTI or BCG treatment may help identify granulomatous prostatitis cases.
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Affiliation(s)
- Su-Min Lee
- 1 Department of Urology, Bristol Urological Institute, Southmead Hospital , Bristol , UK
| | - Konrad Wolfe
- 2 Department of Pathology, Southend University Hospital, Westcliff-on-Sea , Essex , UK
| | - Peter Acher
- 3 Department of Urology, Southend University Hospital, Westcliff-on-Sea , Essex , UK
| | - Sidath H Liyanage
- 4 Department of Radiology, Southend University Hospital, Westcliff-on-Sea , Essex , UK
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22
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Clinical Spectrum of Complications Induced by Intravesical Immunotherapy of Bacillus Calmette-Guérin for Bladder Cancer. JOURNAL OF ONCOLOGY 2019; 2019:6230409. [PMID: 30984262 PMCID: PMC6431507 DOI: 10.1155/2019/6230409] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/24/2019] [Accepted: 02/12/2019] [Indexed: 12/13/2022]
Abstract
Because of its proven efficacy, intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is an important treatment for nonmuscle invasive bladder cancer at high risk of recurrence or progression. However, approximately 8% of patients have to stop BCG instillation as a result of its complications. Complications induced by BCG therapy can have a variety of clinical manifestations. These adverse reactions may occur in conjunction with BCG instillation or may not develop until months or years after BCG cessation. An essential step in the management complications arising from BCG is early establishment of diagnosis, particularly for distant, disseminated, and obscure infections. Therefore we reviewed the literature on the potential complications after intravesical BCG immunotherapy for bladder cancer and provide an overview on the incidence, diagnosis, and treatment modality of genitourinary and systemic BCG-induced complications.
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23
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Gordetsky JB, Ullman D, Schultz L, Porter KK, del Carmen Rodriguez Pena M, Calderone CE, Nix JW, Ullman M, Bae S, Rais-Bahrami S. Histologic findings associated with false-positive multiparametric magnetic resonance imaging performed for prostate cancer detection. Hum Pathol 2019; 83:159-165. [DOI: 10.1016/j.humpath.2018.08.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/17/2018] [Accepted: 08/23/2018] [Indexed: 11/27/2022]
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24
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Lovegrove CE, Matanhelia M, Randeva J, Eldred-Evans D, Tam H, Miah S, Winkler M, Ahmed HU, Shah TT. Prostate imaging features that indicate benign or malignant pathology on biopsy. Transl Androl Urol 2018; 7:S420-S435. [PMID: 30363462 PMCID: PMC6178322 DOI: 10.21037/tau.2018.07.06] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Accurate diagnosis of clinically significant prostate cancer is essential in identifying patients who should be offered treatment with curative intent. Modifications to the Gleason grading system in recent years show that accurate grading and reporting at needle biopsy can improve identification of clinically significant prostate cancers. Extracapsular extension of prostate cancer has been demonstrated to be an adverse prognostic factor with greater risk of metastatic spread than organ-confined disease. Tumor volume may be an independent prognostic factor and should be considered in conjunction with other factors. Multi-parametric magnetic resonance imaging (MP-MRI) has become an increasingly important tool in the diagnosis and characterization of prostate cancer. MP-MRI allows T2-weighted (T2W) anatomical imaging to be combined with functional and physiological assessment. Diffusion-weighted imaging (DWI) has shown greater sensitivity, specificity and negative predictive value compared to prostate specific antigen (PSA) testing and T2W imaging alone and has a more positive correlation with Gleason score and tumour volume. Dynamic gadolinium contrast-enhanced (DCE) imaging can exhibit difficulties in distinguishing prostatitis from malignancy in the peripheral zone, and between benign prostatic hyperplasia (BPH) and malignancies in the transition zone (TZ). Computer aided diagnosis utilizes software to aid radiologists in detecting and diagnosing abnormalities from diagnostic imaging. New techniques of quantitative MRI, such as VERDICT MRI use tissue-specific factors to delineate different cellular and microstructural phenotypes, characterizing tissue properties with greater detail. Proton MR spectroscopic imaging (MRSI) is a more technically challenging imaging modality than DCE and DWI MRI. Over the last decade, choline and prostate-specific membrane antigen (PSMA) positron emission tomography (PET) have developed as better tools for staging than conventional imaging. While hyperpolarized MRI shows promise in improving the imaging and differentiation of benign and malignant lesions there is further work required. Accurate reading and interpretation of diagnostic investigations is key to accurate identification of abnormal areas requiring biopsy, sparing those in whom benign or indolent disease can be managed by non-invasive means. Embracing and advancing existing technologies is essential in furthering this process.
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Affiliation(s)
- Catherine Elizabeth Lovegrove
- 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
| | - Mudit Matanhelia
- 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
| | - Jagpal Randeva
- 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
| | - David Eldred-Evans
- 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
| | - Henry Tam
- 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
| | - Saiful Miah
- 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
| | - Mathias Winkler
- 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
| | - Hashim U Ahmed
- 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
| | - Taimur T Shah
- 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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Garrido-Abad P, Rodríguez-Cabello MÁ, González-Gordaliza C, Vera-Berón R, Platas-Sancho A. BCG instillations can mimic prostate cancer on multiparametric MRI. Int Braz J Urol 2018; 44:835-837. [PMID: 29570255 PMCID: PMC6092671 DOI: 10.1590/s1677-5538.ibju.2017.0621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 01/15/2018] [Indexed: 11/21/2022] Open
Affiliation(s)
- Pablo Garrido-Abad
- Department of Urology, Hospital Universitario Sanitas La Moraleja, Madrid, Spain
| | | | | | | | - Arturo Platas-Sancho
- Department of Urology, Hospital Universitario Sanitas La Moraleja, Madrid, Spain
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26
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Gordetsky JB, Truong M, Rais-Bahrami S. Reply to Evaluation of magnetic resonance imaging and targeted biopsy: The difficulty of finding the right reference standard. Cancer 2018; 124:1300-1301. [PMID: 29266389 DOI: 10.1002/cncr.31203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew Truong
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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