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Madendere S, Kilic M, Zoroglu H, Sarikaya AF, Veznikli M, Coskun B, Armutlu A, Kulac I, Gürses B, Kiremit MC, Baydar DE, Canda AE, Balbay MD, Vural M, Kordan Y, Esen T. Natural history of histologically benign PIRADS 4-5 lesions in multiparametric MRI: Real-life experience in an academic center. Prostate 2024; 84:1262-1267. [PMID: 38922915 DOI: 10.1002/pros.24764] [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: 02/22/2024] [Revised: 05/26/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION The follow-up findings of patients who underwent prostate biopsy for prostate image reporting and data system (PIRADS) 4 or 5 multiparametric magnetic resonance imaging (mpMRI) findings and had benign histology were retrospectively reviewed. METHODS There were 190 biopsy-naive patients. Patients with at least 12 months of follow-up between 2012 and 2023 were evaluated. All MRIs were interpreted by two very experienced uroradiologists. Of the patients, 125 had either cognitive or software fusion MR-targeted biopsies with 4 + 8/10 cores. The remaining 65 patients had in-bore biopsies with 4-5 cores. Prostate-specific antigen (PSA) levels below 4 ng/mL were defined as PSA regression following biopsy. PIRADS 1-3 lesions on new MRI images were classified as MRI regression. RESULTS Median patient age and PSA were 62 (39-82) years and six (0.4-33) ng/mL, respectively, at the initial work-up. During a median follow-up period of 44 months, 37 (19.4%) patients were lost to follow-up. Of the remaining 153 patients, 82 (53.6%) had persistently high PSA. Among them, 72 (87.8%) had repeat mpMRI within 6-24 months which showed regressive findings (PIRADS 1-3) in 53 patients (73.6%) and PIRADS 4-5 index lesion persistence in 19 cases (26.4%). The latter group was recommended to have rebiopsy. Of these 19 patients, 16 underwent MRI-targeted rebiopsy. Prostate cancer was diagnosed in six (37.5%) patients and of these four (25%) were clinically significant (>Grade Group 1). Totally, clinically significant prostate cancer was detected in 4/153 (2.6%) patients followed up. CONCLUSION Patients should be warned against the relative relaxing effect of a negative biopsy after identification of PIRADS 4-5 index lesion. While PSA decrease was observed in many patients during follow-up, persistent MRI findings were present in nearly a quarter of patients with persistently high PSA. A rebiopsy is warranted in these patients, with significant prostate cancer diagnosed in a quarter of patients with rebiopsy.
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Affiliation(s)
| | - Mert Kilic
- Department of Urology, VKV American Hospital, Istanbul, Turkey
| | - Hatice Zoroglu
- Department of Urology, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | | | - Mert Veznikli
- Department of Biostatistics, Koç University School of Medicine, Istanbul, Turkey
| | - Bilgen Coskun
- Department of Radiology, VKV American Hospital, Istanbul, Turkey
| | - Ayse Armutlu
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Ibrahim Kulac
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Bengi Gürses
- Department of Radiology, Koç University School of Medicine, Istanbul, Turkey
| | - Murat Can Kiremit
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Dilek Ertoy Baydar
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Abdullah Erdem Canda
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
- RMK AIMES, Rahmi M. Koç Academy of Interventional Medicine, Education, and Simulation, Istanbul, Turkey
| | - Mevlana Derya Balbay
- Department of Urology, VKV American Hospital, Istanbul, Turkey
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Metin Vural
- Department of Radiology, VKV American Hospital, Istanbul, Turkey
| | - Yakup Kordan
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Tarik Esen
- Department of Urology, VKV American Hospital, Istanbul, Turkey
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
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Ozbozduman K, Loc I, Durmaz S, Atasoy D, Kilic M, Yildirim H, Esen T, Vural M, Unlu MB. Machine learning prediction of Gleason grade group upgrade between in-bore biopsy and radical prostatectomy pathology. Sci Rep 2024; 14:5849. [PMID: 38462645 PMCID: PMC10925603 DOI: 10.1038/s41598-024-56415-5] [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] [Received: 12/30/2023] [Accepted: 03/06/2024] [Indexed: 03/12/2024] Open
Abstract
This study aimed to enhance the accuracy of Gleason grade group (GG) upgrade prediction in prostate cancer (PCa) patients who underwent MRI-guided in-bore biopsy (MRGB) and radical prostatectomy (RP) through a combined analysis of prebiopsy and MRGB clinical data. A retrospective analysis of 95 patients with prostate cancer diagnosed by MRGB was conducted where all patients had undergone RP. Among the patients, 64.2% had consistent GG results between in-bore biopsies and RP, whereas 28.4% had upgraded and 7.4% had downgraded results. GG1 biopsy results, lower biopsy core count, and fewer positive cores were correlated with upgrades in the entire patient group. In patients with GG > 1 , larger tumor sizes and fewer biopsy cores were associated with upgrades. By integrating MRGB data with prebiopsy clinical data, machine learning (ML) models achieved 85.6% accuracy in predicting upgrades, surpassing the 64.2% baseline from MRGB alone. ML analysis also highlighted the value of the minimum apparent diffusion coefficient ( ADC min ) for GG > 1 patients. Incorporation of MRGB results with tumor size, ADC min value, number of biopsy cores, positive core count, and Gleason grade can be useful to predict GG upgrade at final pathology and guide patient selection for active surveillance.
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Affiliation(s)
| | - Irem Loc
- Bogazici University Physics Department, Istanbul, Turkey
| | - Selahattin Durmaz
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Duygu Atasoy
- Department of Radiology, University of Koc School of Medicine, Istanbul, Turkey
| | - Mert Kilic
- Department of Urology, VKF American Hospital, Istanbul, Turkey
| | - Hakan Yildirim
- Department of Radiology, VKF American Hospital, Istanbul, Turkey
| | - Tarik Esen
- Department of Urology, VKF American Hospital, Istanbul, Turkey
- Department of Urology, University of Koc School of Medicine, Istanbul, Turkey
| | - Metin Vural
- Department of Radiology, VKF American Hospital, Istanbul, Turkey
| | - M Burcin Unlu
- Faculty of Engineering, Ozyegin University, Istanbul, Turkey
- Faculty of Aviation and Aeronautical Sciences Ozyegin University, Istanbul, Turkey
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Volz Y, Apfelbeck M, Pyrgidis N, Pfitzinger PL, Berg E, Ebner B, Enzinger B, Ivanova T, Atzler M, Kazmierczak PM, Clevert DA, Stief C, Chaloupka M. The Impact of Prostate Volume on the Prostate Imaging and Reporting Data System (PI-RADS) in a Real-World Setting. Diagnostics (Basel) 2023; 13:2677. [PMID: 37627939 PMCID: PMC10453915 DOI: 10.3390/diagnostics13162677] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Multiparametric magnetic resonance imaging (mpMRI) has emerged as a new cornerstone in the diagnostic pathway of prostate cancer. However, mpMRI is not devoid of factors influencing its detection rate of clinically significant prostate cancer (csPCa). Amongst others, prostate volume has been demonstrated to influence the detection rates of csPCa. Particularly, increasing volume has been linked to a reduced cancer detection rate. However, information about the linkage between PI-RADS, prostate volume and detection rate is relatively sparse. Therefore, the current study aims to assess the association between prostate volume, PI-RADS score and detection rate of csP-Ca, representing daily practice and contemporary mpMRI expertise. Thus, 1039 consecutive patients with 1151 PI-RADS targets, who underwent mpMRI-guided prostate biopsy at our tertiary referral center, were included. Prior mpMRI had been assessed by a plethora of 111 radiology offices, including academic centers and private practices. mpMRI was not secondarily reviewed in house before biopsy. mpMRI-targeted biopsy was performed by a small group of a total of ten urologists, who had performed at least 100 previous biopsies. Using ROC analysis, we defined cut-off values of prostate volume for each PI-RADS score, where the detection rate drops significantly. For PI-RADS 4 lesions, we found a volume > 61.5 ccm significantly reduced the cancer detection rate (OR 0.24; 95% CI 0.16-0.38; p < 0.001). For PI-RADS 5 lesions, we found a volume > 51.5 ccm to significantly reduce the cancer detection rate (OR 0.39; 95% CI 0.25-0.62; p < 0.001). For PI-RADS 3 lesions, none of the evaluated clinical parameters had a significant impact on the detection rate of csPCa. In conclusion, we show that enlarged prostate volume represents a major limitation in the daily practice of mpMRI-targeted biopsy. This study is the first to define exact cut-off values of prostate volume to significantly impair the validity of PI-RADS assessed in a real-world setting. Therefore, the results of mpMRI-targeted biopsy should be interpreted carefully, especially in patients with prostate volumes above our defined thresholds.
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Affiliation(s)
- Yannic Volz
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Maria Apfelbeck
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Nikolaos Pyrgidis
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Paulo L. Pfitzinger
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Elena Berg
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Benedikt Ebner
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Benazir Enzinger
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Troya Ivanova
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Michael Atzler
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Philipp M. Kazmierczak
- Interdisciplinary Ultrasound-Center, Department of Radiology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (D.-A.C.)
| | - Dirk-André Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (D.-A.C.)
| | - Christian Stief
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Michael Chaloupka
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
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Noh TI, Shim JS, Kang SH, Cheon J, Kang SG. Diagnostic performance of transperineal prostate targeted biopsy alone according to the PI-RADS score based on bi-parametric magnetic resonance imaging. Front Oncol 2023; 13:1142022. [PMID: 37035173 PMCID: PMC10080665 DOI: 10.3389/fonc.2023.1142022] [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: 01/11/2023] [Accepted: 03/10/2023] [Indexed: 04/11/2023] Open
Abstract
Purpose To compare the diagnostic performance of transperineal targeted biopsy (TB) or systematic biopsy (SB) alone based on combined TB+SB and radical prostatectomy (RP) specimen for detecting prostate cancer (PCa) according to the prostate imaging reporting and data system (PI-RADS) score. Materials and methods This study included 1077 men who underwent transperineal bi-parametric (bp) magnetic resonance imaging (MRI)-ultrasound (US) fusion TB+SB (bpMRI-US FTSB) between April 2019 and March 2022. To compare the performance of each modality (TB, SB, and combined TB+SB) with the RP specimen (as the standard) for detecting PCa and clinically significant PCa (csPCa), receiver operating characteristic (ROC) curves were plotted. Results PCa was detected in 581 of 1077 men (53.9%) using bpMRI-US FTSB. CsPCa was detected in 383 of 1077 men (35.6%), 17 of 285 (6.0%) with PI-RADS 0 to 2, 35 of 277 (12.6%) with PI-RADS 3, 134 of 274 (48.9%) with PI-RADS 4, and 197 of 241 (81.7%) with PI-RADS 5, respectively. The additional diagnostic value of TB vs. SB compared to combined TB+SB for diagnosing csPCa were 4.3% vs. 3.2% (p=0.844), 20.4% vs 5.1% (p<0.001), and 20.3% vs. 0.7% (p<0.001) with PI-RADS 3, 4, and 5, respectively. TB alone showed no significant difference in diagnostic performance for csPCa with combined TB+SB based on RP specimens in patients with PI-RADS 5 (p=0.732). Conclusion A need for addition of SB to TB in patients with PI-RADS 3 and 4 lesions, however, TB alone may be performed without affecting the management of patients with PI-RADS 5.
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Affiliation(s)
| | | | | | | | - Sung Gu Kang
- Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Woo HH, Khanani H, Thompson NJ, Sorensen BJ, Baskaranathan S, Bergersen P, Chalasani V, Dean T, Dias M, Symons J, Wines M, Jain A, Nassour AJ, Tarlinton LC. Multiparametric Magnetic Resonance Imaging of the Prostate and Prostate-specific Membrane Positron Emission Tomography Prior to Prostate Biopsy (MP4 Study). EUR UROL SUPPL 2022; 47:119-125. [PMID: 36601041 PMCID: PMC9806699 DOI: 10.1016/j.euros.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Background Prostate-specific membrane antigen (PSMA) positron emission tomography/computerised tomography (PET/CT) is increasingly being utilised in the diagnostic pathway for prostate cancer (PCa). Recent publications have suggested that this might help identify those who can avoid biopsy. Objective The primary objective of this study was to determine whether PET magnetic resonance imaging (MRI) fusion could negate the need to biopsy prior to prostatectomy in a selected population of men. Design setting and participant Multiparametric MRI (mpMRI) for PCa is our standard of care prior to prostate biopsy. Biopsy-naïve men with one or more Prostate Imaging Reporting and Data System (PI-RADS) 4 or 5 lesions ≥10 mm on mpMRI were invited to undergo PSMA PET/CT prior to biopsy. Following ethics approval, 60 men were recruited between September 2020 and March 2021. The key exclusion criteria included a previous history of PCa and previous prostate surgery or biopsy. Outcome measurements and statistical analysis A positive PET MRI fusion scan was defined as "consistent with" as per the Memorial Sloan Kettering Cancer Center lexicon of certainty, and concordance with biopsy results was analysed. Clinically significant PCa (csPCa) was defined as grade group (GG) ≥2 on pathology. A chi-square analysis was performed with statistical significance defined at p < 0.05. Results and limitations A total of 71 mpMRI lesions were positive on 61 (86%) PET MRI fusion scans. Fifty-nine of 61 lesions biopsied confirmed csPCa in 54 (92%). Of five of 59 lesions for which either biopsy was negative or low-grade cancer was found, three had rebiopsy of which two were confirmed to have csPCa corroborating with PET MRI fusion and one was reconfirmed to have GG1 only. For the remaining two, both had another lesion elsewhere in the gland confirming csPCa, and hence rebiopsy was not performed. Ultimately, 56 of 59 (95%) lesions with a positive PET MRI fusion scan were confirmed to have csPCa. All GG ≥3 cancers had a positive PET MRI fusion scan. Conclusions This prospective study of PET MRI fusion assessment of men with PI-RADS 4 or 5 lesion ≥10 mm on mpMRI confirms that the majority of men (95%) with a positive PET MRI fusion scan will have csPCa. This supports recently published retrospective data suggesting that selected men might avoid prostate biopsy prior to radical prostatectomy. Patient summary In this research, we have confirmed that prostate-specific membrane antigen positron emission tomography/computerised tomography in combination with magnetic resonance imaging could have an important role in enabling a diagnosis of prostate cancer. Using the combination of these scans, we could confidently predict the presence of aggressive prostate cancer in some men for which treatment is warranted. This means that there are some men who could possibility proceed directly to having prostate cancer surgery without the need for a confirmatory prostate biopsy.
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Affiliation(s)
- Henry H. Woo
- College of Health and Medicine, Australian National University, Canberra, Australia,SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,Department of Urology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Hadia Khanani
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Nadine J. Thompson
- SAN Radiology and Nuclear Medicine, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Brian J. Sorensen
- SAN Radiology and Nuclear Medicine, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Sris Baskaranathan
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,Department of Urology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Philip Bergersen
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,Department of Urology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Venu Chalasani
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,Department of Urology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Thomas Dean
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,Department of Urology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Max Dias
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,Department of Urology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - James Symons
- College of Health and Medicine, Australian National University, Canberra, Australia,SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,Department of Urology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Michael Wines
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,Department of Urology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Anika Jain
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Anthony-Joe Nassour
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Lisa C. Tarlinton
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW, Australia,SAN Radiology and Nuclear Medicine, Sydney Adventist Hospital, Sydney, NSW, Australia,Corresponding author. SAN Radiology and Nuclear Medicine, Sydney Adventist Hospital, 185 Fox Valley Road, Wahroonga, NSW 2076, Australia. Tel. +61 2 9480 9850; Fax: +61 2 9480 9845.
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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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Özkan A, Köseoğlu E, Kılıç M, Baydar DE, Sağlıcan Y, Balbay MD, Canda AE, Kordan Y, Kiremit MC, Çil B, Tuğcu V, Bakır B, Esen T. The Impact of Visible Tumor (PI-RADS ≥ 3) on Upgrading and Adverse Pathology at Radical Prostatectomy in Low Risk Prostate Cancer Patients: A Biopsy Core Based Analysis. Clin Genitourin Cancer 2021; 20:e61-e67. [PMID: 34750082 DOI: 10.1016/j.clgc.2021.09.007] [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] [Received: 06/17/2021] [Revised: 09/26/2021] [Accepted: 09/26/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The objective of this study was to investigate the impact of the characteristics of a single visible tumor (Prostate Imaging-Reporting and Data System [PI-RADS]≥3) on upgrading and adverse pathology at radical prostatectomy (RP) in biopsy naïve low risk prostate cancer (PCa) patients. MATERIALS AND METHODS We retrospectively reviewed 64 biopsy naïve patients from 3 different referral centers between 2018 and 2020 with a PSA<10, cT1c disease, a single PI-RADS≥ 3 index lesion in multiparametric-MRI (mp-MRI), all bearing a GG 1 tumor sampled software fusion biopsy, who underwent RP. Preoperative clinical variables including the localization, number and tumor burden of positive cores for each PI-RADS category were related to upgrading and adverse pathology (GG>2 and/or pT3 and/or lymph node positive disease) at RP. RESULTS Overall 37 patients (57.8%) were upgraded with a significant difference of upgrading in PI-RADS3 (30.0%) versus PI-RADS 4 (67.6%) (P = .007) and PI-RADS 4-5 (70.5%) lesions (P = .002). Thirty-three of 37 GG1 tumors were upgraded to GG2, while 6 of these 33 (18.2%) had adverse pathology as well. Overall 9 patients (14.1%) had adverse pathology at RP all harboring PI-RADS4-5 lesions. The number of positive cores differed significantly between the upgraded and nonupgraded patients. Adverse pathology group had significantly higher tumor volume at RP. CONCLUSION PI-RADS4-5 lesions are the independent predictors of upgrading and adverse pathology in low risk PCa with visible tumors. Upgrading and adverse pathology were closely related to the number of positive combined cores reflecting the role of tumor volume. This should be kept in mind in shared decision making of an individual patient with low risk disease and a visible tumor.
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Affiliation(s)
- Arif Özkan
- Department of Urology, Koc University Hospital Istanbul, İstanbul, Turkey
| | - Ersin Köseoğlu
- Department of Urology, Koc University Hospital Istanbul, İstanbul, Turkey
| | - Mert Kılıç
- Department of Urology, American Hospital Istanbul, İstanbul, Turkey
| | - Dilek Ertoy Baydar
- Department of Pathology, Koc University Hospital Istanbul, İstanbul, Turkey
| | - Yeşim Sağlıcan
- Department of Pathology, American Hospital Istanbul, İstanbul, Turkey
| | - Mevlana Derya Balbay
- Department of Urology, Koc University Hospital Istanbul, İstanbul, Turkey; Department of Urology, American Hospital Istanbul, İstanbul, Turkey
| | | | - Yakup Kordan
- Department of Urology, Koc University Hospital Istanbul, İstanbul, Turkey
| | - Murat Can Kiremit
- Department of Urology, Koc University Hospital Istanbul, İstanbul, Turkey
| | - Barbaros Çil
- Department of Radiology, Koc University Hospital Istanbul, İstanbul, Turkey
| | - Volkan Tuğcu
- Department of Urology, Liv Hospital Vadistanbul, İstanbul, Turkey
| | - Barış Bakır
- Department of Radiology, Istanbul University Faculty of Medicine, İstanbul, Turkey
| | - Tarık Esen
- Department of Urology, Koc University Hospital Istanbul, İstanbul, Turkey; Department of Urology, American Hospital Istanbul, İstanbul, Turkey
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Vural M, Coskun B, Kilic M, Durmaz S, Gumus T, Cengiz D, Onay A, Saglican Y, Colakoglu B, Akpek S, Yildirim H, Esen T, Rozanes I. In-bore MRI-guided prostate biopsy in a patient group with PI-RADS 4 and 5 targets: A single center experience. Eur J Radiol 2021; 141:109785. [PMID: 34091134 DOI: 10.1016/j.ejrad.2021.109785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/21/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the diagnostic yield of magnetic resonance imaging (MRI) guided in-bore biopsy in patients with high likelihood multiparametric MRI (mpMRI) findings, regarding overall and clinically significant prostate cancer (csPCa) detection rates and concordance of biopsy and radical prostatectomy (RP) Gleason scores (GS). METHODS This retrospective study consisted of 277 Prostate Imaging Reporting and Data System (PI-RADS) assessment category 4 and 5 targets in 246 patients (mean age, 65.7 years; median prostate specific antigen value, 7.75 ng/mL) who had undergone in-bore biopsy at our institution between 2012 and 2020. Eighty-one patients who underwent RP were eligible for the concordance analysis of biopsy and RP specimen GS. RESULTS Overall PCa detection rates were 80.5 % per patient (198/246) and 78 % per target (216/277) and 83.5 % and 67.4 % in primary (biopsy naive) and secondary (at least one negative prior biopsy) settings. csPCa was found in 63 % overall, 66 % of patients (132/200) in the primary, and 50 % of patients (23/46) in the secondary biopsy settings (p < 0.001). The prostate cancer detection rate was 68 % and 92 % in PI-RADS 4 and 5, respectively (p < 0.001). In the radical prostatectomy subcohort, 27.2 % of patients were upgraded, 8.6 % of patients were downgraded from needle biopsy. Significant complications occurred in 1.2 % of patients. CONCLUSIONS MRI-guided in-bore prostate biopsy has a high detection rate of csPCa in primary and secondary biopsy cohorts. Biopsy results were satisfactory in terms of the number of positive cores, cancer percentage in positive cores, and concordance of GS in needle biopsy and RP specimen.
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Affiliation(s)
- Metin Vural
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
| | - Bilgen Coskun
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
| | - Mert Kilic
- Department of Urology, VKF American Hospital, Istanbul, Turkey.
| | - Selahattin Durmaz
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Terman Gumus
- Department of Radiology, University of Koc School of Medicine, Istanbul, Turkey.
| | - Duygu Cengiz
- Department of Radiology, University of Koc School of Medicine, Istanbul, Turkey.
| | - Aslihan Onay
- Department of Radiology, TOBB University of Economics and Technology, Faculty of Medicine, Ankara, Turkey.
| | - Yesim Saglican
- Department of Pathology, Acibadem Maslak Hospital, Istanbul, Turkey.
| | - Bulent Colakoglu
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
| | - Sergin Akpek
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
| | - Hakan Yildirim
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
| | - Tarik Esen
- Department of Urology, VKF American Hospital, Istanbul, Turkey.
| | - Izzet Rozanes
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
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Gurgitano M, Ancona E, Maresca D, Summers PE, Alessi S, Maggioni R, Liguori A, Pandolfi M, Rodà GM, De Filippo M, Paolucci A, Petralia G. In-bore MRI targeted biopsy. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020012. [PMID: 33245071 PMCID: PMC8023080 DOI: 10.23750/abm.v91i10-s.10251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022]
Abstract
Clinical suspicion of Prostate Cancer (PCa) is largely based on increased prostate specific antigen (PSA) level and/or abnormal digital rectal examination (DRE) and/or positive imaging and, up today, biopsy is mandatory to confirm the diagnosis. The old model consisted of Standard Biopsy (SBx), that is random sampling of the prostate gland under ultrasound guidance (TRUS), in subjects with clinical suspicion of PCa. This involves the risk of not diagnosing a high percentage of tumors (up to 30%) and of an incorrect risk stratification. Multiparametric Magnetic Resonance Imaging (mpMRI) has transformed the diagnostic pathway of PCa, not only as an imaging method for detecting suspicious lesions, but also as an intraprocedural guidance for Target Biopsy (MRI-TBx), thus bridging the diagnostic gap. Several single and multicenter randomized trials, such as PROMIS, MRI first, PRECISION and that reported by Van der Leest et al. have confirmed the superiority of the "MRI pathway", consisting of mpMRI and MRI-TBx of suspicious lesions, over the "standard pathway" of SBx in all patients with elevated PSA and/or positive DRE. MRI-TBx appears to be advantageous in reducing the overall number of biopsies performed, as well as in reducing the diagnosis of clinically insignificant disease while maintaining or improving the diagnosis of clinically significant PCa (cs-PCa). Moreover, it shows a reduction in the diagnosis of ins-PCa, and therefore, of overdiagnosis, when using MRI-TBx without sacrificing performance in the diagnosis of cs-PCa.
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Affiliation(s)
- Martina Gurgitano
- Division of Radiology, IEO European institute of oncology IRCCS, Milan, Italy .
| | - Eleonora Ancona
- Division of Radiology, IEO European institute of oncology IRCCS, Milan, Italy .
| | - Duilia Maresca
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy.
| | - Paul Eugene Summers
- Division of Radiology, IEO European institute of oncology IRCCS, Milan, Italy .
| | - Sarah Alessi
- Division of Radiology, IEO European institute of oncology IRCCS, Milan, Italy .
| | - Roberta Maggioni
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy.
| | - Alessandro Liguori
- Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano Italy.
| | - Marco Pandolfi
- Radiology Unit, Istituto Clinico Città Studi Milano, via Niccolò Jommelli, 17, 20131 Milano, Italy .
| | - Giovanni Maria Rodà
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy.
| | - Massimo De Filippo
- Section of Radiology of Surgical Sciences, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, University of Parma, Parma, Italy.
| | - Aldo Paolucci
- Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano Italy.
| | - Giuseppe Petralia
- Precision Imaging and Research Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hematology, University of Milan, Milan, Italy..
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10
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Tilki D, Chandrasekar T. Localized Prostate Cancer: Exploring the Boundaries of Current Treatment Paradigms. Eur Urol Focus 2020; 6:199-200. [PMID: 32057738 DOI: 10.1016/j.euf.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/16/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
| | - Thenappan Chandrasekar
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA; Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
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