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Zhang C, Tu X, Dai J, Zhang Z, Shen C, Wu Q, Liu Z, Lin T, Qiu S, Yang L, Yang L, Zhang M, Cai D, Bao Y, Zeng H, Wei Q. Utilization trend of prebiopsy multiparametric magnetic resonance imaging and its impact on prostate cancer detection: Real-world insights from a high-volume center in southwest China. Prostate 2024; 84:539-548. [PMID: 38173301 DOI: 10.1002/pros.24669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/24/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Data on the utilization and effects of prebiopsy prostate multiparametric magnetic resonance imaging (mpMRI) to support its routine use in real-world setting are still scarce. OBJECTIVE To evaluate the change of clinical practice of prebiopsy mpMRI over time, and assess its diagnostic accuracy. DESIGN, SETTING, AND PARTICIPANTS We retrospectively analyzed data from 6168 patients who underwent primary prostate biopsy (PBx) between January 2011 and December 2021 and had prostate-specific antigen (PSA) values ranging from 3 to 100 ng/mL. INTERVENTION Prebiopsy MRI at the time of PBx. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We performed general linear regression and to elucidate trends in the annual use of prebiopsy mpMRI and conducted multivariable logistic regression to evaluate the potential benefits of incorporating prebiopsy mpMRI for prostate cancer (PCa) detection. RESULTS AND LIMITATIONS The utilization of prebiopsy mpMRI significantly increased from 9.2% in 2011 to 75.0% in 2021 (p < 0.001). In addition, prebiopsy mpMRI significantly reduced negative PBx by 8.6% while improving the detection of clinically significant PCa (csPCa) by 7.0%. Regression analysis showed that the utilization of prebiopsy mpMRI was significantly associated with a 48% (95% confidence interval [CI]: 1.19-1.84) and 36% (95% CI: 1.12-1.66) increased PCa detection rate in the PSA 3-10 ng/mL and 10-20 ng/mL groups, respectively; and a 34% increased csPCa detection rate in the PSA 10-20 ng/mL group (95% CI: 1.09-1.64). The retrospective design and the single center cohort constituted the limitations of this study. CONCLUSIONS Our study demonstrated a notable rise in the utilization of prebiopsy mpMRI in the past decade. The adoption of this imaging technique was significantly associated with an increased probability of detecting prostate cancer. PATIENT SUMMARY From 2011 to 2021, we demonstrated a steady increase in the utilization of prebiopsy mpMRI among biopsy-naïve men. We also confirmed the positive impact of prebiopsy mpMRI utilization on the detection of prostate cancer.
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Affiliation(s)
- Chichen Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Tu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jindong Dai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zilong Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Chenlan Shen
- Department of Laboratory Medicine, Med+X Center for Manufacturing, West China Hospital, Sichuan University, Chengdu, China
| | - Qiyou Wu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenhua Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Tianhai Lin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Qiu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Department of Molecular Oncology, Institute of Oncology Research (IOR), Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mengni Zhang
- Department of Pathology and Laboratory of Pathology, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Diming Cai
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Yige Bao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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Sun H, Wang L, Daskivich T, Qiu S, Han F, D'Agnolo A, Saouaf R, Christodoulou AG, Kim H, Li D, Xie Y. Retrospective T2 quantification from conventional weighted MRI of the prostate based on deep learning. FRONTIERS IN RADIOLOGY 2023; 3:1223377. [PMID: 37886239 PMCID: PMC10598780 DOI: 10.3389/fradi.2023.1223377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023]
Abstract
Purpose To develop a deep learning-based method to retrospectively quantify T2 from conventional T1- and T2-weighted images. Methods Twenty-five subjects were imaged using a multi-echo spin-echo sequence to estimate reference prostate T2 maps. Conventional T1- and T2-weighted images were acquired as the input images. A U-Net based neural network was developed to directly estimate T2 maps from the weighted images using a four-fold cross-validation training strategy. The structural similarity index (SSIM), peak signal-to-noise ratio (PSNR), mean percentage error (MPE), and Pearson correlation coefficient were calculated to evaluate the quality of network-estimated T2 maps. To explore the potential of this approach in clinical practice, a retrospective T2 quantification was performed on a high-risk prostate cancer cohort (Group 1) and a low-risk active surveillance cohort (Group 2). Tumor and non-tumor T2 values were evaluated by an experienced radiologist based on region of interest (ROI) analysis. Results The T2 maps generated by the trained network were consistent with the corresponding reference. Prostate tissue structures and contrast were well preserved, with a PSNR of 26.41 ± 1.17 dB, an SSIM of 0.85 ± 0.02, and a Pearson correlation coefficient of 0.86. Quantitative ROI analyses performed on 38 prostate cancer patients revealed estimated T2 values of 80.4 ± 14.4 ms and 106.8 ± 16.3 ms for tumor and non-tumor regions, respectively. ROI measurements showed a significant difference between tumor and non-tumor regions of the estimated T2 maps (P < 0.001). In the two-timepoints active surveillance cohort, patients defined as progressors exhibited lower estimated T2 values of the tumor ROIs at the second time point compared to the first time point. Additionally, the T2 difference between two time points for progressors was significantly greater than that for non-progressors (P = 0.010). Conclusion A deep learning method was developed to estimate prostate T2 maps retrospectively from clinically acquired T1- and T2-weighted images, which has the potential to improve prostate cancer diagnosis and characterization without requiring extra scans.
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Affiliation(s)
- Haoran Sun
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, United States
| | - Lixia Wang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Timothy Daskivich
- Minimal Invasive Urology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Shihan Qiu
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, United States
| | - Fei Han
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Alessandro D'Agnolo
- Imaging/Nuclear Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Rola Saouaf
- Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Anthony G. Christodoulou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, United States
| | - Hyung Kim
- Minimal Invasive Urology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, United States
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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Lophatananon A, Light A, Burns-Cox N, Maccormick A, John J, Otti V, McGrath J, Archer P, Anning J, McCracken S, Page T, Muir K, Gnanapragasam VJ. Re-evaluating the diagnostic efficacy of PSA as a referral test to detect clinically significant prostate cancer in contemporary MRI-based image-guided biopsy pathways. JOURNAL OF CLINICAL UROLOGY 2023; 16:264-273. [PMID: 37614642 PMCID: PMC7614972 DOI: 10.1177/20514158211059057] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Introduction Modern image-guided biopsy pathways at diagnostic centres have greatly refined the investigations of men referred with suspected prostate cancer. However, the referral criteria from primary care are still based on historical prostate-specific antigen (PSA) cut-offs and age-referenced thresholds. Here, we tested whether better contemporary pathways and biopsy methods had improved the predictive utility value of PSA referral thresholds. Methods PSA referral thresholds, age-referenced ranges and PSA density (PSAd) were assessed for positive predictive value (PPV) in detection of clinically significant prostate cancer (csPCa - histological ⩾ Grade Group 2). Data were analysed from men referred to three diagnostics centres who used multi-parametric magnetic resonance imaging (mpMRI)-guided prostate biopsies for disease characterisation. Findings were validated in a separate multicentre cohort. Results: Data from 2767 men were included in this study. The median age, PSA and PSAd were 66.4 years, 7.3 ng/mL and 0.1 ng/mL2, respectively. Biopsy detected csPCa was found in 38.7%. The overall area under the curve (AUC) for PSA was 0.68 which is similar to historical performance. A PSA threshold of ⩾ 3 ng/mL had a PPV of 40.3%, but this was age dependent (PPV: 24.8%, 32.7% and 56.8% in men 50-59 years, 60-69 years and ⩾ 70 years, respectively). Different PSA cut-offs and age-reference ranges failed to demonstrate better performance. PSAd demonstrated improved AUC (0.78 vs 0.68, p < 0.0001) and improved PPV compared to PSA. A PSAd of ⩾ 0.10 had a PPV of 48.2% and similar negative predictive value (NPV) to PSA ⩾ 3 ng/mL and out-performed PSA age-reference ranges. This improved performance was recapitulated in a separate multi-centre cohort (n = 541). Conclusion The introduction of MRI-based image-guided biopsy pathways does not appear to have altered PSA diagnostic test characteristics to positively detect csPCa. We find no added value to PSA age-referenced ranges, while PSAd offers better PPV and the potential for a single clinically useful threshold (⩾0.10) for all age groups. Level of evidence IV.
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Affiliation(s)
- Artitaya Lophatananon
- Division of Population Health, Health Services Research & Primary Care Centre, University of Manchester, UK
| | - Alexander Light
- Division of Urology, Department of Surgery, University of Cambridge, UK
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, UK
| | | | | | - Joseph John
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust and University of Exeter, UK
| | - Vanessa Otti
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust and University of Exeter, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust and University of Exeter, UK
| | - Pete Archer
- Department of Urology, Southend Hospital, UK
| | | | - Stuart McCracken
- Department of Urology, South Tyneside and Sunderland NHS Trust, UK
| | - Toby Page
- Department of Urology, Newcastle Hospitals NHS Trust, UK
| | - Ken Muir
- Division of Population Health, Health Services Research & Primary Care Centre, University of Manchester, UK
| | - Vincent J Gnanapragasam
- Division of Urology, Department of Surgery, University of Cambridge, UK
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, UK
- Cambridge Urology Translational Research and Clinical Trials Office, Addenbrooke’s Hospital, UK
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Bryant RJ, Yamamoto H, Eddy B, Kommu S, Narahari K, Omer A, Leslie T, Catto JWF, Rosario DJ, Good DW, Gray R, Liew MPC, Lopez JF, Campbell T, Reynard JM, Tuck S, Barber VS, Medeghri N, Davies L, Parkes M, Hewitt A, Landeiro F, Wolstenholme J, Macpherson R, Verrill C, Marian IR, Williams R, Hamdy FC, Lamb AD. Protocol for the TRANSLATE prospective, multicentre, randomised clinical trial of prostate biopsy technique. BJU Int 2023; 131:694-704. [PMID: 36695816 DOI: 10.1111/bju.15978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Primary objectives: to determine whether local anaesthetic transperineal prostate (LATP) biopsy improves the detection of clinically significant prostate cancer (csPCa), defined as International Society of Urological Pathology (ISUP) Grade Group ≥2 disease (i.e., any Gleason pattern 4 disease), compared to transrectal ultrasound-guided (TRUS) prostate biopsy, in biopsy-naïve men undergoing biopsy based on suspicion of csPCa. SECONDARY OBJECTIVES to compare (i) infection rates, (ii) health-related quality of life, (iii) patient-reported procedure tolerability, (iv) patient-reported biopsy-related complications (including bleeding, bruising, pain, loss of erectile function), (v) number of subsequent prostate biopsy procedures required, (vi) cost-effectiveness, (vii) other histological parameters, and (viii) burden and rate of detection of clinically insignificant PCa (ISUP Grade Group 1 disease) in men undergoing these two types of prostate biopsy. PATIENTS AND METHODS The TRANSLATE trial is a UK-wide, multicentre, randomised clinical trial that meets the criteria for level-one evidence in diagnostic test evaluation. TRANSLATE is investigating whether LATP biopsy leads to a higher rate of detection of csPCa compared to TRUS prostate biopsy. Both biopsies are being performed with an average of 12 systematic cores in six sectors (depending on prostate size), plus three to five target cores per multiparametric/bi-parametric magnetic resonance imaging lesion. LATP biopsy is performed using an ultrasound probe-mounted needle-guidance device (either the 'Precision-Point' or BK UA1232 system). TRUS biopsy is performed according to each hospital's standard practice. The study is 90% powered to detect a 10% difference (LATP biopsy hypothesised at 55% detection rate for csPCa vs 45% for TRUS biopsy). A total of 1042 biopsy-naïve men referred with suspected PCa need to be recruited. CONCLUSIONS This trial will provide robust prospective data to determine the diagnostic ability of LATP biopsy vs TRUS biopsy in the primary diagnostic setting.
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Affiliation(s)
- Richard J Bryant
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Hide Yamamoto
- Department of Urology, Maidstone and Tunbridge Wells NHS Trust, Maidstone Hospital, Maidstone, UK
| | - Ben Eddy
- Department of Urology, East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, UK
| | - Sashi Kommu
- Department of Urology, East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, UK
| | - Krishna Narahari
- Department of Urology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Altan Omer
- Department of Urology, University Hospitals Coventry and Warwickshire NHS Trust, University Hospital, Coventry, UK
| | - Tom Leslie
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Urology, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes Hospital, Milton Keynes, UK
| | - James W F Catto
- Academic Urology Unit, University of Sheffield and Department of Urology, Sheffield University Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Derek J Rosario
- Academic Urology Unit, University of Sheffield and Department of Urology, Sheffield University Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Daniel W Good
- Department of Urology, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - Rob Gray
- Department of Urology, Buckinghamshire Healthcare NHS Trust, Wycombe Hospital, High Wycombe, UK
| | - Matthew P C Liew
- Department of Urology, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - J Francisco Lopez
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Teresa Campbell
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - John M Reynard
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Steve Tuck
- Oxfordshire Prostate Cancer Support Group, Oxford, UK
| | - Vicki S Barber
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nadjat Medeghri
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lucy Davies
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Matthew Parkes
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Aimi Hewitt
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Filipa Landeiro
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jane Wolstenholme
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ruth Macpherson
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Clare Verrill
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Ioana R Marian
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Roxanne Williams
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Freddie C Hamdy
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alastair D Lamb
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Wagaskar VG, Levy M, Ratnani P, Sullimada S, Gerenia M, Schlussel K, Choudhury S, Gabriele M, Haas I, Haines K, Tewari A. A SelectMDx/magnetic resonance imaging-based nomogram to diagnose prostate cancer. Cancer Rep (Hoboken) 2022; 6:e1668. [PMID: 36168681 PMCID: PMC9875685 DOI: 10.1002/cnr2.1668] [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: 09/22/2021] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND 70%-80% of prostate cancer (PCa) biopsies performed in the US annually may be unnecessary. Specific antigen testing (PSA) and tans rectal ultrasound (TRUS) are imprecise predictive methods for risk of PCa. Novel strategies are critical to guide biopsy decision-making. AIM We assessed the utility and accuracy of combining Select MDx and multiparametric magnetic resonance imaging (mpMRI) scores for predicting risk of PCa. METHODS AND RESULTS Our study was conducted at Mount Sinai hospital at Urology department in New York City from January 2020 to April 2021. Total 129 men performed select MDx test. Indications for prostate biopsy were high-risk Select MDx score, suspicious DRE, PI-RADS scores 3/4/5 on mpMRI, or any combination of these. Fifty-one percentage of 129 patients underwent systemic or combined systemic and MRI/US (ultrasound) fusion biopsy; All men underwent 3 T MRI of Prostate w/wo contrast using standard protocols prior to biopsy. A single surgeon performed prostate biopsies. Gleason score ≥3 + 3 on biopsy is defined as outcome. Descriptive statistics were calculated as cross tables. Binary logistic regression model is used to determine the outcome. The nomogram was based on the coefficients of the logit function. ROCs were plotted and decision curve analysis was performed. Using both high-risk Select MDx and PI-RADS scores of 4/5, 87% of biopsies could have been avoided, while detecting 64% of PCa and missing 36%. If biopsies were performed on men with positive Select MDx or PI-RADS 4/5 results, 16% of biopsies could have been avoided while detecting all PCa. Combining these scores improved specificity and accuracy for the detection of PCa over either used alone. Study limitations include limited sample size, sole institution study, and risk or overfitting for the proposed model which may limit generalizability. CONCLUSION Combining SelectMDx and mpMRI PI-PADS scores of 4/5 may be useful for PCa biopsy decision-making.
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Affiliation(s)
- Vinayak G. Wagaskar
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Micah Levy
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Parita Ratnani
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Sharmila Sullimada
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Mae Gerenia
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Kacie Schlussel
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Samia Choudhury
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Marla Gabriele
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Ian Haas
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Kenneth Haines
- Department of PathologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Ash Tewari
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
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Meng S, Chen L, Zhang Q, Wang N, Liu A. Multiparametric MRI-based nomograms in predicting positive surgical margins of prostate cancer after laparoscopic radical prostatectomy. Front Oncol 2022; 12:973285. [PMID: 36172161 PMCID: PMC9510973 DOI: 10.3389/fonc.2022.973285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/11/2022] [Indexed: 11/26/2022] Open
Abstract
Background Positive surgical margins (PSMs) are an independent risk factor of biochemical recurrence in patients with prostate cancer (PCa) after laparoscopic radical prostatectomy; however, limited MRI-based predictive tools are available. This study aimed to develop a novel nomogram combining clinical and multiparametric MRI (mpMRI) parameters to reduce PSMs by improving surgical planning. Methods One hundred and three patients with PCa (55 patients with negative surgical margins [NSMs] and 48 patients with PSMs) were included in this retrospective study. The following parameters were obtained using GE Functool post-processing software: diffusion-weighted imaging (DWI); intravoxel incoherent motion model (IVIM); and diffusion kurtosis imaging (DKI). Patients were divided into different training sets and testing sets for different targets according to a ratio of 7:3. The least absolute shrinkage and selection operator (LASSO) regression algorithm was used to analyze the data set to select the optimal MRI predictors. Preoperatively clinical parameters used to build a clinical nomogram (C-nomogram). Multivariable logistic regression analysis was used to build an MRI nomogram (M-nomogram) by introducing the MRI parameters. Based on the MRI and clinical parameters, build an MRI combined with clinical parameters nomogram (MC-nomogram). Comparisons with the M-nomogram and MC-nomogram were based on discrimination, calibration, and decision curve analysis (DCA). A 3-fold cross-validation method was used to assess the stability of the nomogram. Results There was no statistical difference in AUC between the C-nomogram (sensitivity=64%, specificity=65% and AUC=0.683), the M-nomogram (sensitivity=57%, specificity=88% and AUC=0.735) and the MC-nomogram (sensitivity= 64%, specificity=82% and AUC=0.756). The calibration curves of the three nomograms used to predict the risk of PSMs in patients with PCa showed good agreement. The net benefit of the MC-nomogram was higher than the others (range, 0.2-0.7). Conclusions The mpMRI-based nomogram can predict PSMs in PCa patients. Although its AUC (0.735) is not statistically different from that of the clinical-based nomogram AUC (0.683). However, mpMRI-based nomogram has higher specificity (88% VS. 63%), model stability, and clinical benefit than clinical-based nomogram. And the predictive ability of mpMRI plus clinical parameters for PSMs is further improved.
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Kuhlmann PK, Chen M, Luu M, Naser-Tavakolian A, Kim HL, Saouaf R, Daskivich TJ. Predictors of disparity between targeted and in-zone systematic cores during transrectal MR/US-fusion prostate biopsy. Urol Oncol 2022; 40:162.e1-162.e7. [DOI: 10.1016/j.urolonc.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/16/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
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8
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Song C, Park SY. Prostate cancer: diagnostic yield of modified transrectal ultrasound-guided twelve-core combined biopsy (targeted plus systematic biopsies) using prebiopsy magnetic resonance imaging. Abdom Radiol (NY) 2021; 46:4974-4983. [PMID: 34181040 DOI: 10.1007/s00261-021-03179-5] [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: 01/24/2021] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to analyze the diagnostic yield of modified transrectal ultrasound (TRUS)-guided 12-core combined biopsy (CB) using prebiopsy magnetic resonance imaging (MRI) for detecting clinically significant prostate cancer (csPCa). METHODS This retrospective study included 130 consecutive patients who underwent modified TRUS-guided 12-core CB using cognitive fusion for lesions of Prostate Imaging-Reporting and Data System (PI-RADS) category ≥ 3. The 12-core CB comprised 3-6-core targeted biopsy (TB) and systematic biopsy (SB). For SB, tissue sampling in TB regions was omitted, and 3-core sampling (i.e., apex, mid, and base) in the contralateral peripheral zone of TB was mandatory. csPCa was defined as International Society of Urological Pathology (ISUP) grade ≥ 2 cancer. The per-patient cancer detection rates (CDRs) according to biopsy type or PI-RADS category were investigated. RESULTS The CDRs of TB, SB, and CB for csPCa were 47.7% (62/130 patients), 29.2% (38/130), and 52.3% (68/130), respectively. For csPCa, the CDRs of TB and CB according to PI-RADS categories of 3, 4, or 5 were 25.0% (8/32) and 31.3% (10/32), 41.2% (28/68) and 45.6% (31/68), or 86.7% (26/30) and 90.0% (27/30), respectively. In 6 (4.6%) patients, csPCa was detected only by SB. In 18 (13.8%) patients, SB detected PCa of a higher ISUP grade than TB. In 11 (8.5%) patients, SB detected csPCa at contralateral peripheral zone of TB. CONCLUSION Modified TRUS-guided 12-core CB using prebiopsy MRI seems to be feasible. It may reduce total biopsy cores in patients who are suitable for CB based on prebiopsy MRI findings.
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Affiliation(s)
- Chorog Song
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sung Yoon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Patient- and tumor-level risk factors for MRI-invisible prostate cancer. Prostate Cancer Prostatic Dis 2021; 24:794-801. [PMID: 33568751 DOI: 10.1038/s41391-021-00330-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/21/2020] [Accepted: 01/20/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Multiparametric MRI is highly sensitive for detection of clinically significant prostate cancer, but has a 10-20% false negative rate. It is unknown if there are clinical factors that predict MRI invisibility. We sought to identify predictors of MRI-invisible (MRI(-)) disease. METHODS Men undergoing MRI/US-fusion targeted + systematic biopsy by two surgeons at our institution from 2015 to 2018 were reviewed. Patient demographics, clinical data, MRI metrics, and biopsy pathology results were obtained by chart review. An MRI(-) tumor was defined as a positive systematic biopsy in a zone without an MRI lesion. Factors associated with presence of MRI(-) tumors were identified using stepwise multivariable logistic regression. RESULTS Of 194 men included in the analysis, 79 (41%) and 25 (13%) men had GG1+ and GG2+ MRI(-) tumors, respectively. On multivariable analysis, only Black race was associated with presence of GG1+ MRI(-) tumors (OR 2.2, 95% CI 1.02-4.96). Black race (OR 3.5, 95% CI 1.24-9.87) and higher PSA density (OR 2.0, 95% CI 1.34-3.20) were associated with presence of GG2+ MRI(-) tumors. In non-Black and Black men, detection of MRI(-) tumors on systematic biopsy upgraded patients from no disease to GG2+ disease 1% and 11% of the time, respectively, and from GG1 to GG2+ disease 42% and 60% of the time, respectively. CONCLUSIONS Black race and PSA density were associated with presence of MRI(-) prostate cancer. Further study on racial differences is warranted based on these results. Surgeons should consider pre-biopsy risk factors before deciding to omit systematic prostate biopsy regardless of mpMRI results.
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10
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Kuci Emruli V, Liljedahl L, Axelsson U, Richter C, Theorin L, Bjartell A, Lilja H, Donovan J, Neal D, Hamdy FC, Borrebaeck CAK. Identification of a serum biomarker signature associated with metastatic prostate cancer. Proteomics Clin Appl 2021; 15:e2000025. [PMID: 33580906 DOI: 10.1002/prca.202000025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Improved early diagnosis and determination of aggressiveness of prostate cancer (PC) is important to select suitable treatment options and to decrease over-treatment. The conventional marker is total prostate specific antigen (PSA) levels in blood, but lacks specificity and ability to accurately discriminate indolent from aggressive disease. EXPERIMENTAL DESIGN In this study, we sought to identify a serum biomarker signature associated with metastatic PC. We measured 157 analytes in 363 serum samples from healthy subjects, patients with non-metastatic PC and patients with metastatic PC, using a recombinant antibody microarray. RESULTS A signature consisting of 69 proteins differentiating metastatic PC patients from healthy controls was identified. CONCLUSIONS AND CLINICAL RELEVANCE The clinical value of this biomarker signature requires validation in larger independent patient cohorts before providing a new prospect for detection of metastatic PC.
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Affiliation(s)
- Venera Kuci Emruli
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Leena Liljedahl
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Ulrika Axelsson
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Corinna Richter
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Lisa Theorin
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Hans Lilja
- Department of Translational Medicine, Lund University, Malmö, Sweden.,Department of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,The Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Jenny Donovan
- Bristol Medical School, University of Bristol, Bristol, UK
| | - David Neal
- The Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Freddie C Hamdy
- The Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Carl A K Borrebaeck
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
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11
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Predicting the risk of prostate cancer in asymptomatic men: a cohort study to develop and validate a novel algorithm. Br J Gen Pract 2021; 71:e364-e371. [PMID: 33875417 PMCID: PMC8087311 DOI: 10.3399/bjgp20x714137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 09/08/2020] [Indexed: 12/02/2022] Open
Abstract
Background Diagnosis of prostate cancer at an early stage can potentially identify tumours when intervention may improve treatment options and survival. Aim To develop and validate an equation to predict absolute risk of prostate cancer in asymptomatic men with prostate specific antigen (PSA) tests in primary care. Design and setting Cohort study using data from English general practices, held in the QResearch database. Method Routine data were collected from 1098 QResearch English general practices linked to mortality, hospital, and cancer records for model development. Two separate sets of practices were used for validation. In total, there were 844 455 men aged 25–84 years with PSA tests recorded who were free of prostate cancer at baseline in the derivation cohort; the validation cohorts comprised 292 084 and 316 583 men. The primary outcome was incident prostate cancer. Cox proportional hazards models were used to derive 10-year risk equations. Measures of performance were determined in both validation cohorts. Results There were 40 821 incident cases of prostate cancer in the derivation cohort. The risk equation included PSA level, age, deprivation, ethnicity, smoking status, serious mental illness, diabetes, BMI, and family history of prostate cancer. The risk equation explained 70.4% (95% CI = 69.2 to 71.6) of the variation in time to diagnosis of prostate cancer (R2) (D statistic 3.15, 95% CI = 3.06 to 3.25; Harrell’s C-index 0.917, 95% CI = 0.915 to 0.919). Two-step approach had higher sensitivity than a fixed PSA threshold at identifying prostate cancer cases (identifying 68.2% versus 43.9% of cases), high-grade cancers (49.2% versus 40.3%), and deaths (67.0% versus 31.5%). Conclusion The risk equation provided valid measures of absolute risk and had higher sensitivity for incident prostate cancer, high-grade cancers, and prostate cancer mortality than a simple approach based on age and PSA threshold.
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12
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Wagaskar VG, Levy M, Ratnani P, Moody K, Garcia M, Pedraza AM, Parekh S, Pandav K, Shukla B, Prasad S, Sobotka S, Haines K, Punnen S, Wiklund P, Tewari A. Clinical Utility of Negative Multiparametric Magnetic Resonance Imaging in the Diagnosis of Prostate Cancer and Clinically Significant Prostate Cancer. EUR UROL SUPPL 2021; 28:9-16. [PMID: 34337520 PMCID: PMC8317880 DOI: 10.1016/j.euros.2021.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
Background Multiparametric magnetic resonance imaging (MRI) is increasingly used to diagnose prostate cancer (PCa). It is not yet established whether all men with negative MRI (Prostate Imaging-Reporting and Data System version 2 score <3) should undergo prostate biopsy or not. Objective To develop and validate a prediction model that uses clinical parameters to reduce unnecessary prostate biopsies by predicting PCa and clinically significant PCa (csPCa) for men with negative MRI findings who are at risk of harboring PCa. Design setting and participants This was a retrospective analysis of 200 men with negative MRI at risk of PCa who underwent prostate biopsy (2014-2020) with prostate-specific antigen (PSA) >4 ng/ml, 4Kscore of >7%, PSA density ≥0.15 ng/ml/cm3, and/or suspicious digital rectal examination. The validation cohort included 182 men from another centre (University of Miami) with negative MRI who underwent systematic prostate biopsy with the same criteria. Outcome measurements and statistical analysis csPCa was defined as Gleason grade group ≥2 on biopsy. Multivariable logistic regression analysis was performed using coefficients of logit function for predicting PCa and csPCa. Nomogram validation was performed by calculating the area under receiver operating characteristic curves (AUC) and comparing nomogram-predicted probabilities with actual rates of PCa and csPCa. Results and limitations Of 200 men in the development cohort, 18% showed PCa and 8% showed csPCa on biopsy. Of 182 men in the validation cohort, 21% showed PCa and 6% showed csPCa on biopsy. PSA density, 4Kscore, and family history of PCa were significant predictors for PCa and csPCa. The AUC was 0.80 and 0.87 for prediction of PCa and csPCa, respectively. There was agreement between predicted and actual rates of PCa in the validation cohort. Using the prediction model at threshold of 40, 47% of benign biopsies and 15% of indolent PCa cases diagnosed could be avoided, while missing 10% of csPCa cases. The small sample size and number of events are limitations of the study. Conclusions Our prediction model can reduce the number of prostate biopsies among men with negative MRI without compromising the detection of csPCa. Patient summary We developed a tool for selection of men with negative MRI (magnetic resonance imaging) findings for prostate cancer who should undergo prostate biopsy. This risk prediction tool safely reduces the number of men who need to undergo the procedure.
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Affiliation(s)
- Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Micah Levy
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Kate Moody
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Mariely Garcia
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Adriana M Pedraza
- Department of Urology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogota, Colombia
| | - Sneha Parekh
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Krunal Pandav
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Bhavya Shukla
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sonya Prasad
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sanoj Punnen
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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13
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Aslim EJ, Law YXT, Fook-Chong SMC, Ho HSS, Yuen JSP, Lau WKO, Lee LS, Cheng CWS, Ngo NT, Law YM, Tay KJ. Defining prostate cancer size and treatment margin for focal therapy: does intralesional heterogeneity impact the performance of multiparametric MRI? BJU Int 2021; 128:178-186. [PMID: 33539650 PMCID: PMC8360156 DOI: 10.1111/bju.15355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To evaluate the impact of intralesional heterogeneity on the performance of multiparametric magnetic resonance imaging (mpMRI) in determining cancer extent and treatment margins for focal therapy (FT) of prostate cancer. PATIENTS AND METHODS We identified men who underwent primary radical prostatectomy for organ- confined prostate cancer over a 3-year period. Cancer foci on whole-mount histology were marked out, coding low-grade (LG; Gleason 3) and high-grade (HG; Gleason 4-5) components separately. Measurements of entire tumours were grouped according to intralesional proportion of HG cancer: 0%, <50% and ≥50%; the readings were corrected for specimen shrinkage and correlated with matching lesions on mpMRI. Separate measurements were also taken of HG cancer components only, and correlated against entire lesions on mpMRI. Size discrepancies were used to derive the optimal tumour size and treatment margins for FT. RESULTS There were 122 MRI-detected cancer lesions in 70 men. The mean linear specimen shrinkage was 8.4%. The overall correlation between histology and MRI dimensions was r = 0.79 (P < 0.001). Size correlation was superior for tumours with high burden (≥50%) compared to low burden (<50%) of HG cancer (r = 0.84 vs r = 0.63; P = 0.007). Size underestimation by mpMRI was more likely for larger tumours (51% for >12 mm vs 26% for ≤12 mm) and those containing HG cancer (44%, vs 20% for LG only). Size discrepancy analysis suggests an optimal tumour size of ≤12 mm and treatment margins of 5-6 mm for FT. For tumours ≤12 mm in diameter, applying 5- and 6-mm treatment margins would achieve 98.6% and 100% complete tumour ablation, respectively. For tumours of all sizes, using the same margins would ablate >95% of the HG cancer components. CONCLUSIONS Multiparametric MRI performance in estimating prostate cancer size, and consequently the treatment margin for FT, is impacted by tumour size and the intralesional heterogeneity of cancer grades.
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Affiliation(s)
| | - Yu Xi Terence Law
- Department of Urology, National University Hospital, Singapore City, Singapore
| | | | - Henry Sun Sien Ho
- Department of Urology, Singapore General Hospital, Singapore City, Singapore
| | - John Shyi Peng Yuen
- Department of Urology, Singapore General Hospital, Singapore City, Singapore
| | - Weber Kam On Lau
- Department of Urology, Singapore General Hospital, Singapore City, Singapore
| | - Lui Shiong Lee
- Department of Urology, Sengkang General Hospital, Singapore City, Singapore
| | | | - Nye Thane Ngo
- Department of Anatomical Pathology, Singapore General Hospital, Singapore City, Singapore
| | - Yan Mee Law
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore City, Singapore
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore City, Singapore
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14
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Fiard G, Norris JM, Nguyen TA, Stavrinides V, Olivier J, Emberton M, Moore CM. What to expect from a non-suspicious prostate MRI? A review. Prog Urol 2020; 30:986-999. [PMID: 33008718 DOI: 10.1016/j.purol.2020.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/06/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Many guidelines now recommend multiparametric MRI (mpMRI) prior to an initial or repeat prostate biopsy. However, clinical decision making for men with a non-suspicious mpMRI (Likert or PIRADS score 1-2) varies. OBJECTIVES To review the most recent literature to answer three questions. (1) Should we consider systematic biopsy if mpMRI is not suspicious? (2) Are there additional predictive factors that can help decide which patient should have a biopsy? (3) Can the low visibility of some cancers be explained and what are the implications? SOURCES A narrative review was performed in Medline databases using two searches with the terms "MRI" and "prostate cancer" and ("diagnosis" or "biopsy") and ("non-suspicious" or "negative" or "invisible"); "prostate cancer MRI visible". References of the selected articles were screened for additional articles. STUDY SELECTION Studies published in the last 5 years in English language were assessed for eligibility and selected if data was available to answer one of the three study questions. RESULTS Considering clinically significant cancer as ISUP grade≥2, the negative predictive value (NPV) of mpMRI in various settings and populations ranges from 76% to 99%, depending on cancer prevalence and the type of confirmatory reference test used. NPV is higher among patients with prior negative biopsy (88-96%), and lower for active surveillance patients (85-90%). The PSA density (PSAd) with a threshold of PSAd<0.15ng/ml/ml was the most studied and relevant predictive factor used in combination with mpMRI to rule out clinically significant cancer. Finally, mpMRI-invisible tumours appear to differ from a histopathological and genetic point of view, conferring clinical advantage to invisibility. LIMITATIONS Most published data come from expert centres and results may not be reproducible in all settings. CONCLUSION mpMRI has high diagnostic accuracy and in cases of negative mpMRI, PSA density can be used to determine which patient should have a biopsy. Growing knowledge of the mechanisms and genetics underlying MRI visibility will help develop more accurate risk calculators and biomarkers.
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Affiliation(s)
- G Fiard
- UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Department of Urology, Grenoble Alpes University Hospital, Grenoble, France; Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France.
| | - J M Norris
- UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - T A Nguyen
- Department of urology, université de Brest, CHRU, Brest, France
| | - V Stavrinides
- UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - J Olivier
- UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of urology, Lille university, CHU Lille, Lille, France
| | - M Emberton
- UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - C M Moore
- UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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15
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Role of metabolic imaging in diagnosis of primary, metastatic, and recurrent prostate cancer. Curr Opin Oncol 2020; 32:223-231. [PMID: 32195681 DOI: 10.1097/cco.0000000000000625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW The present review describes the current role of metabolic imaging techniques such as multiparametric MRI (mpMRI), magnetic resonance spectroscopic imaging (MRSI), hyperpolarized MRSI, and positron emission tomography (PET) in the diagnosis of primary prostate cancer, surveillance of low-grade disease, detection of metastases, and evaluation of biochemical recurrence after therapy. RECENT FINDINGS The natural history of prostate cancer ranges from indolent disease that is optimally monitored by active surveillance, to highly aggressive disease that can be lethal. Current diagnostic methods remain imperfect in noninvasively distinguishing between silent versus aggressive tumors. Hence, there is a high demand for noninvasive imaging techniques that offer insight into biological behavior of prostate cancer cells. Characterization of prostate cancer metabolism is a promising area to provide such insights. SUMMARY Metabolic imaging may allow for greater detection and ultimately characterization of tumor based on aggressiveness and spread. Hence, it has the potential to monitor tumor activity, predict prognostic outcomes, and guide individualized therapies.
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16
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Sathianathen NJ, Omer A, Harriss E, Davies L, Kasivisvanathan V, Punwani S, Moore CM, Kastner C, Barrett T, Van Den Bergh RC, Eddy BA, Gleeson F, Macpherson R, Bryant RJ, Catto JWF, Murphy DG, Hamdy FC, Ahmed HU, Lamb AD. Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in the Detection of Clinically Significant Prostate Cancer in the Prostate Imaging Reporting and Data System Era: A Systematic Review and Meta-analysis. Eur Urol 2020; 78:402-414. [PMID: 32444265 DOI: 10.1016/j.eururo.2020.03.048] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/28/2020] [Indexed: 01/24/2023]
Abstract
CONTEXT Prebiopsy multiparametric magnetic resonance imaging (mpMRI) is increasingly used in prostate cancer diagnosis. The reported negative predictive value (NPV) of mpMRI is used by some clinicians to aid in decision making about whether or not to proceed to biopsy. OBJECTIVE We aim to perform a contemporary systematic review that reflects the latest literature on optimal mpMRI techniques and scoring systems to update the NPV of mpMRI for clinically significant prostate cancer (csPCa). EVIDENCE ACQUISITION We conducted a systematic literature search and included studies from 2016 to September 4, 2019, which assessed the NPV of mpMRI for csPCa, using biopsy or clinical follow-up as the reference standard. To ensure that studies included in this analysis reflect contemporary practice, we only included studies in which mpMRI findings were interpreted according to the Prostate Imaging Reporting and Data System (PIRADS) or similar Likert grading system. We define negative mpMRI as either (1) PIRADS/Likert 1-2 or (2) PIRADS/Likert 1-3; csPCa was defined as either (1) Gleason grade group ≥2 or (2) Gleason grade group ≥3. We calculated NPV separately for each combination of negative mpMRI and csPCa. EVIDENCE SYNTHESIS A total of 42 studies with 7321 patients met our inclusion criteria and were included for analysis. Using definition (1) for negative mpMRI and csPCa, the pooled NPV for biopsy-naïve men was 90.8% (95% confidence interval [CI] 88.1-93.1%). When defining csPCa using definition (2), the NPV for csPCa was 97.1% (95% CI 94.9-98.7%). Calculation of the pooled NPV using definition (2) for negative mpMRI and definition (1) for csPCa yielded the following: 86.8% (95% CI 80.1-92.4%). Using definition (2) for both negative mpMRI and csPCa, the pooled NPV from two studies was 96.1% (95% CI 93.4-98.2%). CONCLUSIONS Multiparametric MRI of the prostate is generally an accurate test for ruling out csPCa. However, we observed heterogeneity in the NPV estimates, and local institutional data should form the basis of decision making if available. PATIENT SUMMARY The negative predictive values should assist in decision making for clinicians considering not proceeding to biopsy in men with elevated age-specific prostate-specific antigen and multiparametric magnetic resonance imaging reported as negative (or equivocal) on Prostate Imaging Reporting and Data System/Likert scoring. Some 7-10% of men, depending on the setting, will miss a diagnosis of clinically significant cancer if they do not proceed to biopsy. Given the institutional variation in results, it is of upmost importance to base decision making on local data if available.
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Affiliation(s)
- Niranjan J Sathianathen
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia; Department of Urology, University of Minnesota, Minneapolis, MN, USA.
| | - Altan Omer
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Eli Harriss
- University of Oxford, Bodleian Health Care Libraries, Oxford, UK
| | - Lucy Davies
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Shonit Punwani
- Department of Urology, University College London Hospital, London, UK
| | - Caroline M Moore
- Department of Urology, University College London Hospital, London, UK
| | - Christof Kastner
- CamPARI Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tristan Barrett
- CamPARI Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Ben A Eddy
- Department of Urology, Canterbury Hospital, Canterbury, Kent, UK
| | - Fergus Gleeson
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Ruth Macpherson
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Richard J Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Declan G Murphy
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Hashim U Ahmed
- Department of Surgery and Cancer, Division of Surgery, Faculty of Medicine, Imperial College London, London, UK
| | - Alastair D Lamb
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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17
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Elkhoury FF, Felker ER, Kwan L, Sisk AE, Delfin M, Natarajan S, Marks LS. Comparison of Targeted vs Systematic Prostate Biopsy in Men Who Are Biopsy Naive: The Prospective Assessment of Image Registration in the Diagnosis of Prostate Cancer (PAIREDCAP) Study. JAMA Surg 2020; 154:811-818. [PMID: 31188412 DOI: 10.1001/jamasurg.2019.1734] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Magnetic resonance imaging (MRI) guidance improves the accuracy of prostate biopsy for the detection of clinically significant prostate cancer, but the optimal use of such guidance is not yet clear. Objective To determine the cancer detection rate (CDR) of targeting MRI-visible lesions vs systematic prostate sampling in the diagnosis of clinically significant prostate cancer in men who were biopsy naive. Design, Setting, and Participants This paired cohort trial, known as the Prospective Assessment of Image Registration in the Diagnosis of Prostate Cancer (PAIREDCAP) study, was conducted in an academic medical center from January 2015 to April 2018. Men undergoing first-time prostate biopsy were enrolled. Paired-cohort participants were a consecutive series of men with MRI-visible lesions (defined by a Prostate Imaging Reporting & Data System version 2 score ≥ 3), who each underwent 3 biopsy methods at the same sitting: first, a systematic biopsy; second, an MRI-lesion biopsy targeted by cognitive fusion; and third, an MRI-lesion targeted by software fusion. Another consecutive series of men without MRI-visible lesions underwent systematic biopsies to help determine the false-negative rate of MRI during the trial period. Main Outcomes and Measures The primary end point was the detection rate of clinically significant prostate cancer (Gleason grade group ≥2) overall and by each biopsy method separately. The secondary end points were the effects of the Prostate Imaging Reporting & Data System version 2 grade, prostate-specific antigen density, and prostate volume on the primary end point. Tertiary end points were the false-negative rate of MRI and concordance of biopsy-method results by location of detected cancers within the prostate. Results A total of 300 men participated; 248 had MRI-visible lesions (mean [SD] age, 65.5 [7.7] years; 197 were white [79.4%]), and 52 were control participants (mean [SD] age, 63.6 [5.9] years; 39 were white [75%]). The overall CDR was 70% in the paired cohort group, achieved by combining systematic and targeted biopsy results. The CDR by systematic sampling was 15% in the group without MRI-visible lesions. In the paired-cohort group, CDRs varied from 47% (116 of 248 men) when using cognitive fusion biopsy alone, to approximately 60% when using systematic biopsy (149 of 248 men) or either fusion method alone (154 of 248 men), to 70% (174 of 248 men) when combining systematic and targeted biopsy. Discordance of tumor locations suggests that the different biopsy methods detect different tumors. Thus, combining targeting and systematic sampling provide greatest sensitivity for detection of clinically significant prostate cancer. For all biopsy methods, the Prostate Imaging Reporting & Data System version 2 grade and prostate-specific antigen density were directly associated with CDRs, and prostate volume was inversely associated. Conclusions and Relevance An MRI-visible lesion in men undergoing first-time prostate biopsy identifies those with a heightened risk of clinically significant prostate cancer. Combining targeted and systematic biopsy offers the best chances of detecting the cancer.
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Affiliation(s)
- Fuad F Elkhoury
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles
| | - Ely R Felker
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles
| | - Anthony E Sisk
- Department of Pathology, David Geffen School of Medicine, University of California, Los Angeles
| | - Merdie Delfin
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles
| | - Shyam Natarajan
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles.,Department of Bioengineering, University of California, Los Angeles
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles
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18
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Gnanapragasam VJ, Leonard K, Sut M, Ilie C, Ord J, Roux J, Prieto MCH, Warren A, Tamer P. Multicentre clinical evaluation of the safety and performance of a simple transperineal access system for prostate biopsies for suspected prostate cancer: The CAMbridge PROstate Biopsy DevicE (CamPROBE) study. JOURNAL OF CLINICAL UROLOGY 2020; 13:364-370. [PMID: 33072331 PMCID: PMC7521793 DOI: 10.1177/2051415820932773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/16/2020] [Indexed: 01/26/2023]
Abstract
Objectives: To report the prospective multicentre clinical evaluation of a first-in-man disposable device, Cambridge Prostate Biopsy Device, to undertake local anaesthetic outpatient transperineal prostate biopsies. Material and methods: Disposable single-use Cambridge Prostate Biopsy devices were manufactured based on a previous prototype. The lead site developed a user training course and disseminated the method to other sites. The Cambridge Prostate Biopsy Device (CamPROBE) was offered as an alternative to transrectal ultrasound guided biopsy to men due for a biopsy as part of their clinical management. Data on safety (infections and device performance), clinical utility, patient reported experience, biopsy quality and cancer detection were collected. Procedure time and local anaesthetic use was recorded in the lead site. The study was funded by a United Kingdom National Institute for Health Research (NIHR) i4i product development award. Results: A total of 40 patients were recruited (median age 69 y) across six sites; five sites were new to the procedure. Overall, 19/40 were first prostate biopsies and 21/40 repeat procedures. Both image-targeted and systematic biopsy cores taken. There were no infections, device deficiencies or safety issues reported. The procedure was well tolerated with excellent patient-reported perception and low pain scores (median of 3, scale 0–10). Histopathology quality was good and the overall cancer diagnosis rate (first diagnostic procedures) was 68% (13/19) and for significant cancers (⩾ histological Grade Group 2), 47% (9/19). In the lead centre (most experienced), median procedure time was 25 minutes, and median local anaesthetic use 11 ml (n=17). Conclusions: Data from this device evaluation study demonstrate that the United Kingdom-developed Cambridge Prostate Biopsy Device/method for transperineal biopsies is safe, transferable and maintains high diagnostic yields. The procedure is well tolerated by patients, suited to the local anaesthetic outpatient setting and could directly replace transrectal ultrasound guided biopsy. Level of evidence: Level III
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Affiliation(s)
- Vincent J Gnanapragasam
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge University Hospitals NHS Foundation Trust, United Kingdom.,Academic Urology Group, Department of Surgery, University of Cambridge, United Kingdom.,Department of Urology, Cambridge University Hospitals Trust, United Kingdom
| | - Kelly Leonard
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - Michal Sut
- Department of Urology, North West Anglia NHS Trust, United Kingdom
| | - Cristian Ilie
- Department of Urology, The Queen Elizabeth Hospital Foundation Trust, United Kingdom
| | - Jonathan Ord
- Department of Urology, Cheltenham and Gloucester Hospital, United Kingdom
| | - Jacques Roux
- Department of Urology, West Hertfordshire Hospitals NHS Trust, United Kingdom
| | | | - Anne Warren
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - Priya Tamer
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
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Mannaerts CK, Engelbrecht MRW, Postema AW, van Kollenburg RAA, Hoeks CMA, Savci-Heijink CD, Van Sloun RJG, Wildeboer RR, De Reijke TM, Mischi M, Wijkstra H. Detection of clinically significant prostate cancer in biopsy-naïve men: direct comparison of systematic biopsy, multiparametric MRI- and contrast-ultrasound-dispersion imaging-targeted biopsy. BJU Int 2020; 126:481-493. [PMID: 32315112 DOI: 10.1111/bju.15093] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To compare and evaluate a multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy (TBx) strategy, contrast-ultrasound-dispersion imaging (CUDI)-TBx strategy and systematic biopsy (SBx) strategy for the detection of clinically significant prostate cancer (csPCa) in biopsy-naïve men. PATIENTS AND METHODS A prospective, single-centre paired diagnostic study included 150 biopsy-naïve men, from November 2015 to November 2018. All men underwent pre-biopsy mpMRI and CUDI followed by a 12-core SBx taken by an operator blinded from the imaging results. Men with suspicious lesions on mpMRI and/or CUDI also underwent MRI-TRUS fusion-TBx and/or cognitive CUDI-TBx after SBx by a second operator. A non-inferiority analysis of the mpMRI- and CUDI-TBx strategies in comparison with SBx for International Society of Urological Pathology Grade Group [GG] ≥2 PCa in any core with a non-inferiority margin of 1 percentage point was performed. Additional analyses for GG ≥2 PCa with cribriform growth pattern and/or intraductal carcinoma (CR/IDC), and GG ≥3 PCa were performed. Differences in detection rates were tested using McNemar's test with adjusted Wald confidence intervals. RESULTS After enrolment of 150 men, an interim analysis was performed. Both the mpMRI- and CUDI-TBx strategies were inferior to SBx for GG ≥2 PCa detection and the study was stopped. SBx found significantly more GG ≥2 PCa: 39% (56/142), as compared with 29% (41/142) and 28% (40/142) for mpMRI-TBx and CUDI-TBx, respectively (P < 0.05). SBx found significantly more GG = 1 PCa: 14% (20/142) compared to 1% (two of 142) and 3% (four of 142) with mpMRI-TBx and CUDI-TBx, respectively (P < 0.05). Detection of GG ≥2 PCa with CR/IDC and GG ≥3 PCa did not differ significantly between the strategies. The mpMRI- and CUDI-TBx strategies were comparable in detection but the mpMRI-TBx strategy had less false-positive findings (18% vs 53%). CONCLUSIONS In our study in biopsy-naïve men, the mpMRI- and CUDI-TBx strategies had comparable PCa detection rates, but the mpMRI-TBX strategy had the least false-positive findings. Both strategies were inferior to SBx for the detection of GG ≥2 PCa, despite reduced detection of insignificant GG = 1 PCa. Both strategies did not significantly differ from SBx for the detection of GG ≥2 PCa with CR/IDC and GG ≥3 PCa.
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Affiliation(s)
- Christophe K Mannaerts
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc R W Engelbrecht
- Department of Radiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnoud W Postema
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Rob A A van Kollenburg
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Caroline M A Hoeks
- Department of Radiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Cemile Dilara Savci-Heijink
- Department of Pathology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruud J G Van Sloun
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Rogier R Wildeboer
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Theo M De Reijke
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Hessel Wijkstra
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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20
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Diagnostic Performance of Mass Enhancement on Dynamic Contrast-Enhanced MRI for Predicting Clinically Significant Peripheral Zone Prostate Cancer. AJR Am J Roentgenol 2020; 214:792-799. [PMID: 32069077 DOI: 10.2214/ajr.19.22072] [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] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Current criteria for positive findings on dynamic contrast-enhanced MRI (DCE-MRI) are unclear. We compared the diagnostic performance of mass enhancement on DCE-MRI versus conventional DCE-MRI criteria for identifying clinically significant prostate cancer (csPCa) in the peripheral zone (PZ). MATERIALS AND METHODS. A total of 173 consecutive patients with MRI- and surgically proven prostate cancer (PCa) were evaluated. Two readers independently interpreted DCE-MRI examinations of the PZ. Criteria denoting a positive DCE-MRI examination included conventional criteria from the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) and mass enhancement. The diagnostic performance of and interreader agreement for the two types of enhancement criteria in identifying csPCa in the PZ that met Epstein criteria were investigated. RESULTS. The proportion of csPCa in the PZ was 69.3% (120/173). For both readers, the specificity and positive predictive value of mass enhancement were increased compared with conventional enhancement criteria (specificity, 75.5% vs 5.7% [for reader 1] and 84.9% vs 30.2% [for reader 2], respectively; positive predictive value, 87.1% vs 70.6% [for reader 1] and 91.5% vs 75.3% [for reader 2], respectively). The AUC value of mass enhancement was higher than that of conventional criteria (for reader 1, 0.744 [95% CI, 0.672-0.807] vs 0.528 [95% CI, 0.451-0.605] [p < 0.001], respectively; for reader 2, 0.783 [95% CI, 0.714-0.842] vs 0.602 [95% CI, 0.497-0.700] [p < 0.001], respectively). The weighted kappa value for agreement between the two readers was 0.206 for conventional criteria and 0.613 for mass enhancement. CONCLUSION. PZ lesions with mass enhancement on DCE-MRI are more likely to be csPCa. This enhancement pattern may need to be considered as one of the criteria in PI-RADS.
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Padhani AR, Barentsz J, Villeirs G, Rosenkrantz AB, Margolis DJ, Turkbey B, Thoeny HC, Cornud F, Haider MA, Macura KJ, Tempany CM, Verma S, Weinreb JC. PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway. Radiology 2019; 292:464-474. [PMID: 31184561 DOI: 10.1148/radiol.2019182946] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
High-quality evidence shows that MRI in biopsy-naive men can reduce the number of men who need prostate biopsy and can reduce the number of diagnoses of clinically insignificant cancers that are unlikely to cause harm. In men with prior negative biopsy results who remain under persistent suspicion, MRI improves the detection and localization of life-threatening prostate cancer with greater clinical utility than the current standard of care, systematic transrectal US-guided biopsy. Systematic analyses show that MRI-directed biopsy increases the effectiveness of the prostate cancer diagnosis pathway. The incorporation of MRI-directed pathways into clinical care guidelines in prostate cancer detection has begun. The widespread adoption of the Prostate Imaging Reporting and Data System (PI-RADS) for multiparametric MRI data acquisition, interpretation, and reporting has promoted these changes in practice. The PI-RADS MRI-directed biopsy pathway enables the delivery of key diagnostic benefits to men suspected of having cancer based on clinical suspicion. Herein, the PI-RADS Steering Committee discusses how the MRI pathway should be incorporated into routine clinical practice and the challenges in delivering the positive health impacts needed by men suspected of having clinically significant prostate cancer.
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Affiliation(s)
- Anwar R Padhani
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Jelle Barentsz
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Geert Villeirs
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Andrew B Rosenkrantz
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Daniel J Margolis
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Baris Turkbey
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Harriet C Thoeny
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - François Cornud
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Masoom A Haider
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Katarzyna J Macura
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Clare M Tempany
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Sadhna Verma
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
| | - Jeffrey C Weinreb
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, Middlesex HA6 2RN, England (A.R.P.); Department of Radiology and Nuclear Medicine Radboud University Medical Center, Nijmegen, the Netherlands (J.B.); Department of Radiology, Ghent University Hospital, Ghent, Belgium (G.V.); Department of Radiology, NYU Langone Medical Center, New York, NY (A.B.R.); Weill Cornell Imaging, Cornell University, New York, NY (D.J.M.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Department of Radiology, Hôpital Cantonal de Fribourg HFR, University of Fribourg, Fribourg, Switzerland (H.C.T.); Paris Descartes University, Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France (F.C.); University of Toronto, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.J.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio (S.V.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.W.)
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22
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Gnanapragasam VJ, Barrett T. The Quest for the Optimal Prostate Biopsy Regime for the 21st Century. Eur Urol 2019; 75:741-742. [PMID: 30616948 DOI: 10.1016/j.eururo.2018.12.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/17/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Vincent J Gnanapragasam
- Translational Prostate Cancer Group, University of Cambridge, Cambridge, UK; Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK; Urological Malignancies Programme, CRUK Cambridge Cancer Centre, Cambridge, UK.
| | - Tristan Barrett
- Translational Prostate Cancer Group, University of Cambridge, Cambridge, UK; Urological Malignancies Programme, CRUK Cambridge Cancer Centre, Cambridge, UK; Department of Radiology, University of Cambridge, Cambridge, UK
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