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Jawli A, Nabi G, Huang Z. The Performance of Different Parametric Ultrasounds in Prostate Cancer Diagnosis: Correlation with Radical Prostatectomy Specimens. Cancers (Basel) 2024; 16:1502. [PMID: 38672584 PMCID: PMC11047975 DOI: 10.3390/cancers16081502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Prostate cancer is a prevalent cancer among men. Multiparametric ultrasound [mpUS] is a diagnostic instrument that uses various types of ultrasounds to diagnose it. This systematic review aims to evaluate the performance of different parametric ultrasounds in diagnosing prostate cancer by associating with radical prostatectomy specimens. METHODOLOGY A review was performed on various ultrasound parameters using five databases. Systematic review tools were utilized to eliminate duplicates and identify relevant results. Reviewers used the Quality Assessment of Diagnostic Accuracy Results [QUADAS-2] to evaluate the bias and applicability of the study outcomes. RESULT Between 2012 and 2023, eleven studies were conducted to evaluate the performance of the different ultrasound parametric procedures in detecting prostate cancer using grayscale TRUS, SWE, CEUS, and mpUS. The high sensitivity of these procedures was found at 55%, 88.6%, 81%, and 74%, respectively. The specificity of these procedures was found to be 93.4%, 97%, 88%, and 59%, respectively. This high sensitivity and specificity may be associated with the large lesion size. The studies revealed that the sensitivity of these procedures in diagnosing clinically significant prostate cancer was 55%, 73%, 70%, and 74%, respectively, while the specificity was 61%, 78.2%, 62%, and 59%, respectively. CONCLUSIONS The mpUS procedure provides high sensitivity and specificity in PCa detection, especially for clinically significant prostate cancer.
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Affiliation(s)
- Adel Jawli
- Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK
- Department of Clinical Radiology, Sheikh Jaber Al-Ahmad Al-Sabah Hospital, Ministry of Health, Kuwait City 13001, Kuwait
| | - Ghulam Nabi
- Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK
| | - Zhihong Huang
- Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, UK
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2
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Li M, Zelchan R, Orlova A. The Performance of FDA-Approved PET Imaging Agents in the Detection of Prostate Cancer. Biomedicines 2022; 10:biomedicines10102533. [PMID: 36289795 PMCID: PMC9599369 DOI: 10.3390/biomedicines10102533] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/01/2022] [Accepted: 10/06/2022] [Indexed: 11/23/2022] Open
Abstract
Positron emission tomography (PET) incorporated with X-ray computed tomography (PET/CT) or magnetic resonance imaging (PET/MRI) is increasingly being used as a diagnostic tool for prostate cancer (PCa). In this review, we describe and evaluate the clinical performance of some Food and Drug Administration (FDA)-approved agents used for visualizing PCa: [18F]FDG, [11C]choline, [18F]FACBC, [68Ga]Ga-PSMA-11, [18F]DCFPyL, and [18F]-NaF. We carried out a comprehensive literature search based on articles published from 1 January 2010 to 1 March 2022. We selected English language articles associated with the discovery, preclinical study, clinical study, and diagnostic performance of the imaging agents for the evaluation. Prostate-specific membrane antigen (PSMA)-targeted imaging agents demonstrated superior diagnostic performance in both primary and recurrent PCa, compared with [11C]choline and [18F]FACBC, both of which target dividing cells and are used especially in patients with low prostate-specific antigen (PSA) values. When compared to [18F]-NaF (which is suitable for the detection of bone metastases), PSMA-targeted agents were also capable of detecting lesions in the lymph nodes, soft tissues, and bone. However, a limitation of PSMA-targeted imaging was the heterogeneity of PSMA expression in PCa, and consequently, a combination of two PET tracers was proposed to overcome this obstacle. The preliminary studies indicated that the use of PSMA-targeted scanning is more cost efficient than conventional imaging modalities for high-risk PCa patients. Furthering the development of imaging agents that target PCa-associated receptors and molecules could improve PET-based diagnosis of PCa.
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Affiliation(s)
- Mei Li
- Department of Medicinal Chemistry, Uppsala University, 751 23 Uppsala, Sweden
- Liaoning Medical Device Test Institute, Shenyang 110171, China
| | - Roman Zelchan
- Department of Nuclear Medicine, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 5 Kooperativny St., 634009 Tomsk, Russia
- Research Centrum for Oncotheranostics, Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, 634050 Tomsk, Russia
| | - Anna Orlova
- Department of Medicinal Chemistry, Uppsala University, 751 23 Uppsala, Sweden
- Research Centrum for Oncotheranostics, Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, 634050 Tomsk, Russia
- Science for Life Laboratory, Uppsala University, 752 37 Uppsala, Sweden
- Correspondence:
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3
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Satya P, Adams Jr. J, Venkataraman SS, Kumar D, Narayanan R, Nacev A, Macaluso Jr. JN. Office-Based, Single-Sided, Low-Field MRI-Guided Prostate Biopsy. Cureus 2022; 14:e25021. [PMID: 35719765 PMCID: PMC9198285 DOI: 10.7759/cureus.25021] [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] [Accepted: 05/14/2022] [Indexed: 11/11/2022] Open
Abstract
This paper describes the workflow of transperineal prostate biopsy (TBx) using the single-sided, low-field Promaxo MRI system (Promaxo Inc., Oakland, California, United States) operating at a field strength ranging between 58 and 74 millitesla (mT). Prostate cancer (PCa) is the leading cause of cancer-related death and the second most frequently diagnosed cancer in men. Systematic biopsy (SBx) with 12-14 cores is the preferred standard of care procedure. The blinded approach of SBx, however, results in several shortcomings, including high rates of false negatives and increased infection rates due to the transrectal approach. The evolution of clinical use and scientific research using different prostate biopsy modalities is discussed, including the potential for the Promaxo MRI system to mitigate logistical constraints often associated with standard magnetic resonance (MR)-guided biopsy through the utilization of an office-based, low-field MRI.
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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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Thangarasu M, Jayaprakash SP, Selvaraj N, Bafna S, Paul R, Mahesh C, Jain N, Balakrishnan A, Sivaraman A. A Prospective Study on the Efficacy of Cognitive Targeted Transrectal Ultrasound Prostate Biopsy in Diagnosing Clinically Significant Prostate Cancer. Res Rep Urol 2021; 13:207-213. [PMID: 33981634 PMCID: PMC8107046 DOI: 10.2147/rru.s300868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/20/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose We present our study, done to identify the diagnostic yield of cognitive targeted biopsy using mpMRI data, to diagnose clinically significant prostate cancers, in a cohort of biopsy and treatment naive men. Materials and Methods This is a prospective, single institutional study, done from September 2018 to March 2020 in 75 biopsy naive men. The patients with 3, 4 and 5 PIRADS scores underwent mpMRI cognitive target biopsy (mpMRI CTB) followed by standard biopsy (SB) in the same setting by two different urologists. Diagnostic yield of biopsy cores, complications, and stage migration of Gleason’s grades was analyzed. Results Out of 75 patients, 34.6% had abnormal digital rectal examination (DRE), and the median serum PSA was 10.6 (4.5–20) ng/mL. Total MRI suspicious lesions were 163. Out of 1263 SB cores, 371 cores were positive for cancer (29.35%), and out of 326 mpMRI CTB cores, 120 were positive for cancer (36.8%) (P<0.0001). Histopathological examination (HPE) revealed 88%, 92%, and 100% clinically significant cancers in PIRADS 3, 4 and 5 lesions. SB and mpMRI CTB in combination have better cancer detection yield than either of the modality when used alone (P-<0.0001). Clavien-Dindo grade 1 and grade 4a complication were seen in 47 (62.6%) and three (4%) patients. Conclusion In biopsy-naive men with suspected prostate cancer and equivocal DRE, the addition of pre-biopsy mpMRI detects greater numbers of people with clinically significant prostate cancer when compared with SB alone. Combining SB with mpMRI CTB has a superior diagnosing ability when compared with either of the biopsy modalities when used alone.
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Affiliation(s)
| | | | - Nivash Selvaraj
- Department of Urology, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - Sandeep Bafna
- Department of Urology, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - Rajesh Paul
- Department of Urology, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | | | - Nitesh Jain
- Department of Urology, Apollo Main Hospital, Chennai, Tamil Nadu, India
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Sandahl M, Pedersen BG, Ulhøi BP, Borre M, Sørensen KD. Risk stratification in men with a negative prostate biopsy: an interim analysis of a prospective cohort study. BJU Int 2021; 128:702-712. [PMID: 33964113 DOI: 10.1111/bju.15443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
OBJECTIVE To investigate whether a risk score for prostate cancer (PCa) lifetime risk can be used to optimise triaging of patients with a negative prostate biopsy, but under sustained suspicion of PCa. PATIENTS AND METHODS In this prospective clinical study, we included, and risk scored patients who had a PCa-negative transrectal ultrasonography (TRUS)-guided prostate biopsy, but elevated prostate-specific antigen (PSA), a suspicious prostate digital rectal examination and/or a positive family history (FH) of PCa. The risk score estimated individual lifetime risk of PCa, based on a polygenic risk score (33 single nucleotide polymorphisms), age, and FH of PCa. Patients were followed, under urological supervision, for up to 4 years with annual controls, always including PSA measurements. Multiparametric magnetic resonance imaging (mpMRI) and/or prostate biopsy was performed at selected annual controls depending on risk score and at the urologist's/patient's discretion, which means that the follow-up differed based on the risk score. RESULTS We included 429 patients. After risk scoring, 376/429 (88%) patients were allocated to a normal-risk group (<30% PCa lifetime risk) and 53/429 (12%) to a high-risk group (≥30% PCa lifetime risk). The high-risk group had significantly different follow-up, with more biopsy and mpMRI sessions compared to the normal-risk group. PCa was detected in 89/429 (21%) patients, with 67/376 (18%) patients diagnosed in the normal-risk group and 22/53 (42%) in the high-risk group. There was no statistically significant difference in the cumulative incidence of PCa between the normal-risk group and the high-risk group after 4 years of follow-up. Currently, 67/429 (16%) patients are still being followed in this ongoing study. CONCLUSION In a 4-year perspective, our PCa lifetime risk score did not demonstrate significant prognostic value for triaging patients, with a negative TRUS-guided biopsy and sustained suspicion of PCa.
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Affiliation(s)
- Mads Sandahl
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bodil Ginnerup Pedersen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Michael Borre
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Karina Dalsgaard Sørensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Molecular Medicine (MOMA), Aarhus University Hospital, Aarhus, Denmark
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Dhinagar NJ, Speier W, Sarma KV, Raman A, Kinnaird A, Raman SS, Marks LS, Arnold CW. Semi-automated PIRADS scoring via mpMRI analysis. J Med Imaging (Bellingham) 2020; 7:064501. [PMID: 33392358 DOI: 10.1117/1.jmi.7.6.064501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/11/2020] [Indexed: 11/14/2022] Open
Abstract
Purpose: Prostate cancer (PCa) is the most common solid organ cancer and second leading cause of death in men. Multiparametric magnetic resonance imaging (mpMRI) enables detection of the most aggressive, clinically significant PCa (csPCa) tumors that require further treatment. A suspicious region of interest (ROI) detected on mpMRI is now assigned a Prostate Imaging-Reporting and Data System (PIRADS) score to standardize interpretation of mpMRI for PCa detection. However, there is significant inter-reader variability among radiologists in PIRADS score assignment and a minimal input semi-automated artificial intelligence (AI) system is proposed to harmonize PIRADS scores with mpMRI data. Approach: The proposed deep learning model (the seed point model) uses a simulated single-click seed point as input to annotate the lesion on mpMRI. This approach is in contrast to typical medical AI-based approaches that require annotation of the complete lesion. The mpMRI data from 617 patients used in this study were prospectively collected at a major tertiary U.S. medical center. The model was trained and validated to classify whether an mpMRI image had a lesion with a PIRADS score greater than or equal to PIRADS 4. Results: The model yielded an average receiver-operator characteristic (ROC) area under the curve (ROC-AUC) of 0.704 over a 10-fold cross-validation, which is significantly higher than the previously published benchmark. Conclusions: The proposed model could aid in PIRADS scoring of mpMRI, providing second reads to promote quality as well as offering expertise in environments that lack a radiologist with training in prostate mpMRI interpretation. The model could help identify tumors with a higher PIRADS for better clinical management and treatment of PCa patients at an early stage.
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Affiliation(s)
- Nikhil J Dhinagar
- University of California, Los Angeles, David Geffen School of Medicine, Department of Radiological Sciences, Los Angeles, California, United States
| | - William Speier
- University of California, Los Angeles, David Geffen School of Medicine, Department of Radiological Sciences, Los Angeles, California, United States
| | - Karthik V Sarma
- University of California, Los Angeles, David Geffen School of Medicine, Department of Radiological Sciences, Los Angeles, California, United States
| | - Alex Raman
- University of California, Los Angeles, David Geffen School of Medicine, Department of Radiological Sciences, Los Angeles, California, United States
| | - Adam Kinnaird
- University of California, Los Angeles, David Geffen School of Medicine, Department of Urology, Los Angeles, California, United States.,University of Alberta, Division of Urology, Department of Surgery, Edmonton, Alberta, Canada
| | - Steven S Raman
- University of California, Los Angeles, David Geffen School of Medicine, Department of Radiological Sciences, Los Angeles, California, United States
| | - Leonard S Marks
- University of California, Los Angeles, David Geffen School of Medicine, Department of Urology, Los Angeles, California, United States
| | - Corey W Arnold
- University of California, Los Angeles, David Geffen School of Medicine, Department of Radiological Sciences, Los Angeles, California, United States.,University of California, Los Angeles, David Geffen School of Medicine, Department of Pathology and Laboratory Medicine, Los Angeles, California, United States
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8
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Fu Y, Lei Y, Wang T, Patel P, Jani AB, Mao H, Curran WJ, Liu T, Yang X. Biomechanically constrained non-rigid MR-TRUS prostate registration using deep learning based 3D point cloud matching. Med Image Anal 2020; 67:101845. [PMID: 33129147 DOI: 10.1016/j.media.2020.101845] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 08/17/2020] [Accepted: 08/31/2020] [Indexed: 01/04/2023]
Abstract
A non-rigid MR-TRUS image registration framework is proposed for prostate interventions. The registration framework consists of a convolutional neural networks (CNN) for MR prostate segmentation, a CNN for TRUS prostate segmentation and a point-cloud based network for rapid 3D point cloud matching. Volumetric prostate point clouds were generated from the segmented prostate masks using tetrahedron meshing. The point cloud matching network was trained using deformation field that was generated by finite element analysis. Therefore, the network implicitly models the underlying biomechanical constraint when performing point cloud matching. A total of 50 patients' datasets were used for the network training and testing. Alignment of prostate shapes after registration was evaluated using three metrics including Dice similarity coefficient (DSC), mean surface distance (MSD) and Hausdorff distance (HD). Internal point-to-point registration accuracy was assessed using target registration error (TRE). Jacobian determinant and strain tensors of the predicted deformation field were calculated to analyze the physical fidelity of the deformation field. On average, the mean and standard deviation were 0.94±0.02, 0.90±0.23 mm, 2.96±1.00 mm and 1.57±0.77 mm for DSC, MSD, HD and TRE, respectively. Robustness of our method to point cloud noise was evaluated by adding different levels of noise to the query point clouds. Our results demonstrated that the proposed method could rapidly perform MR-TRUS image registration with good registration accuracy and robustness.
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Affiliation(s)
- Yabo Fu
- Department of Radiation Oncology, Emory University, 1365 Clifton Road NE, Atlanta, GA 30322, United States
| | - Yang Lei
- Department of Radiation Oncology, Emory University, 1365 Clifton Road NE, Atlanta, GA 30322, United States
| | - Tonghe Wang
- Department of Radiation Oncology, Emory University, 1365 Clifton Road NE, Atlanta, GA 30322, United States; Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States
| | - Pretesh Patel
- Department of Radiation Oncology, Emory University, 1365 Clifton Road NE, Atlanta, GA 30322, United States; Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States
| | - Ashesh B Jani
- Department of Radiation Oncology, Emory University, 1365 Clifton Road NE, Atlanta, GA 30322, United States; Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States
| | - Hui Mao
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, United States
| | - Walter J Curran
- Department of Radiation Oncology, Emory University, 1365 Clifton Road NE, Atlanta, GA 30322, United States; Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States
| | - Tian Liu
- Department of Radiation Oncology, Emory University, 1365 Clifton Road NE, Atlanta, GA 30322, United States; Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States
| | - Xiaofeng Yang
- Department of Radiation Oncology, Emory University, 1365 Clifton Road NE, Atlanta, GA 30322, United States; Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States.
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Labra A, González F, Silva C, Franz G, Pinochet R, Gupta RT. MRI/TRUS fusion vs. systematic biopsy: intra-patient comparison of diagnostic accuracy for prostate cancer using PI-RADS v2. Abdom Radiol (NY) 2020; 45:2235-2243. [PMID: 32249349 DOI: 10.1007/s00261-020-02481-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the efficacy of multiparametric magnetic resonance/transrectal ultrasound fusion (MRI/TRUS fusion) biopsy versus systematic biopsy and its association with PI-RADS v2 categories in patients with suspected prostate cancer. MATERIALS AND METHODS 122 patients undergoing both MRI/TRUS fusion and systematic biopsy, with suspicion of prostate cancer, with suspicious findings on MRI based on PI-RADS v2, were included between April 2016 and March 2017. Comparison of tumor detection rates using each technique and combined techniques was performed for all lesions as well as those that are traditionally difficult to access (i.e., anterior lesions). RESULTS Prostate cancer was detected in 83/122 patients (68%) with 74.6% clinically significant lesions (Gleason 3 + 4 or greater). There was a statistically significant difference in presence of clinically significant prostate cancer in PI-RADS v2 categories of 3, 4, and 5 (20%, 52% and 77%, respectively, p < 0.001). Fusion biopsy was positive in a significantly higher percentage of patients versus systematic biopsy (56% versus 48%, respectively, p < 0.05). The fusion biopsy alone was positive in 20%. Of 34 patients with anterior lesions on MRI, 44% were detected only by fusion biopsy, with a joint yield of 71%. In patients with previous negative systematic biopsies, 48.7% lesions were found by fusion biopsy with 20.5% being exclusively positive by this method. The percentage of positive cores for fusion biopsies was significantly higher than for systematic biopsies (26% vs. 12.3%, p < 0.001). CONCLUSION The incorporation of MRI/TRUS fusion biopsy significantly improves the detection rate of prostate cancer versus systematic biopsy, particularly for anterior lesions.
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Affiliation(s)
- Andrés Labra
- Universidad del Desarrollo, Servicio de Radiologia, Facultad de Medicina Clínica Alemana De Santiago, 5951 Vitacura, 9160002, Santiago, Chile
| | - Fernando González
- Universidad del Desarrollo, Servicio de Radiologia, Facultad de Medicina Clínica Alemana De Santiago, 5951 Vitacura, 9160002, Santiago, Chile
- Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC, 27710, USA
| | - Claudio Silva
- Universidad del Desarrollo, Servicio de Radiologia, Facultad de Medicina Clínica Alemana De Santiago, 5951 Vitacura, 9160002, Santiago, Chile
| | - Gerhard Franz
- Universidad del Desarrollo, Servicio de Radiologia, Facultad de Medicina Clínica Alemana De Santiago, 5951 Vitacura, 9160002, Santiago, Chile
| | - Rodrigo Pinochet
- Department of Surgery, Division of Urology, Clínica Alemana de Santiago, 5951 Vitacura, 9160002, Santiago, Chile
| | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC, 27710, USA.
- Duke Cancer Institute Center for Prostate and Urologic Cancers, 20 Duke Medicine Circle, DUMC Box 103861, Durham, NC, 27710, USA.
- Department of Surgery, Division of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, DUMC Box 2804, Durham, NC, 27710, USA.
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10
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Transrectal ultrasound-guided targeted biopsy of transition zone prostate cancer under cognitive registration with prebiopsy MRI and sonographic findings. Clin Radiol 2019; 75:157.e21-157.e27. [PMID: 31677880 DOI: 10.1016/j.crad.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/01/2019] [Indexed: 11/24/2022]
Abstract
AIM To evaluate retrospectively the diagnostic usefulness of transrectal ultrasound (TRUS)-guided targeted biopsy (TB) for transition zone (TZ) prostate cancer (PCa) in patients with prebiopsy magnetic resonance imaging (MRI). MATERIALS AND METHODS A consecutive series of 38 patients who underwent TRUS-guided TB of TZ lesions were evaluated. TB (mean core number, 2.4±0.6; range, 2-4) was performed by a single experienced radiologist under cognitive registration between prebiopsy MRI and TRUS. Tumour echogenicity on TRUS and Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2) scoring on MRI for targeted TZ lesions were assessed. The interrupted midline sign was defined as a focal lesion traversing the midline of the TZ leading to discontinuity of the midline on both MRI and TRUS. TZ PCa with a Gleason score of 7 or greater was defined as clinically significant PCa (csPCa). RESULTS The cancer detection rate of TRUS-guided TB for TZ lesions was 78.9% (30/38) for any PCa and 42.1% (16/38) for csPCa. Echogenicity of TZ PCa on TRUS was various and half did not show low echogenicity (low, 50%; intermediate, 26.7%; and high, 23.3%). The interrupted midline sign was identified in 50% (19/38) of patients, which was highly predictive of TZ PCa (94.7%, 18/19). CONCLUSION TRUS-guided TB under cognitive registration based on prebiopsy MRI findings is useful to detect TZ PCa. Knowledge of the sonographic features of TZ PCa may help to target TZ PCa accurately under cognitive registration.
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11
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Cao R, Mohammadian Bajgiran A, Afshari Mirak S, Shakeri S, Zhong X, Enzmann D, Raman S, Sung K. Joint Prostate Cancer Detection and Gleason Score Prediction in mp-MRI via FocalNet. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:2496-2506. [PMID: 30835218 DOI: 10.1109/tmi.2019.2901928] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Multi-parametric MRI (mp-MRI) is considered the best non-invasive imaging modality for diagnosing prostate cancer (PCa). However, mp-MRI for PCa diagnosis is currently limited by the qualitative or semi-quantitative interpretation criteria, leading to inter-reader variability and a suboptimal ability to assess lesion aggressiveness. Convolutional neural networks (CNNs) are a powerful method to automatically learn the discriminative features for various tasks, including cancer detection. We propose a novel multi-class CNN, FocalNet, to jointly detect PCa lesions and predict their aggressiveness using Gleason score (GS). FocalNet characterizes lesion aggressiveness and fully utilizes distinctive knowledge from mp-MRI. We collected a prostate mp-MRI dataset from 417 patients who underwent 3T mp-MRI exams prior to robotic-assisted laparoscopic prostatectomy. FocalNet was trained and evaluated in this large study cohort with fivefold cross validation. In the free-response receiver operating characteristics (FROC) analysis for lesion detection, FocalNet achieved 89.7% and 87.9% sensitivity for index lesions and clinically significant lesions at one false positive per patient, respectively. For the GS classification, evaluated by the receiver operating characteristics (ROC) analysis, FocalNet received the area under the curve of 0.81 and 0.79 for the classifications of clinically significant PCa (GS ≥ 3 + 4) and PCa with GS ≥ 4 + 3, respectively. With the comparison to the prospective performance of radiologists using the current diagnostic guideline, FocalNet demonstrated comparable detection sensitivity for index lesions and clinically significant lesions, only 3.4% and 1.5% lower than highly experienced radiologists without statistical significance.
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Zhu G, Wang Q. Comparisons between magnetic resonance/ultrasound fusion-guided biopsy and standard biopsy in the diagnosis of prostate cancer: A prospective cohort study. Medicine (Baltimore) 2018; 97:e11962. [PMID: 30200076 PMCID: PMC6133427 DOI: 10.1097/md.0000000000011962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Prostate-specific antigen is not useful for detection of prostate cancer in Chinese men. The major problems in prostate cancer patients are overdiagnosis and overtreatment. The objective of the study was to test the hypothesis that targeted biopsy is an accurate diagnostic tool for prostate cancer detection than standard biopsy in Chinese men.Total, 998 patients whom multiparticulate multiparametric magnetic resonance imaging had revealed at least 1 lesion in the prostate were included in a cohort. Patients were subjected to magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided biopsy followed US-guided biopsy. Benefits of a diagnostic test were evaluated by decision curve analysis. Patients who were diagnosed as having prostate cancer by either of biopsies were subjected to radical prostatectomies followed by whole-mounted pathology (n = 578). Spearman rank correlation was performed between the biopsy results and the subtype of prostate cancer at 99% of confidence level.With respect to whole-mounted pathology, for US-guided biopsy, MRI/US fusion-guided biopsy, and combined data of both biopsies, sensitivities were 0.973, 0.983, and 0.973 and accuracies were 0.837, 0.91, and 0.917, respectively. MRI/US fusion-guided biopsy (P = .165) and combined data of both biopsies (P = .182) had the same specificity to whole-mount pathology. However, a US-guided biopsy had not the same specificity to whole-mount pathology (P = .0003). Decision-making zones for radical prostatectomy of different biopsies were in the order of combined data of both biopsies >MRI/US fusion-guided biopsy >US-guided biopsy.Only the targeted biopsy is recommended for the diagnosis of prostate cancer.
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Affiliation(s)
- Guangbin Zhu
- Department of Radiology, the Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong
| | - Quan Wang
- Department of the medical image, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, China
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Combined Analysis of Biparametric MRI and Prostate-Specific Antigen Density: Role in the Prebiopsy Diagnosis of Gleason Score 7 or Greater Prostate Cancer. AJR Am J Roentgenol 2018; 211:W166-W172. [PMID: 30016148 DOI: 10.2214/ajr.17.19253] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The objective of our study was to investigate the diagnostic performance of prebiopsy biparametric MRI (bpMRI) and prostate-specific antigen density (PSAD) for Gleason score (GS) 7 or greater prostate cancer (PCa). MATERIALS AND METHODS Sixty-eight consecutive patients who underwent prebiopsy bpMRI and biopsy were included. Pathologic results of systemic and targeted biopsies were the reference standard. Qualitative analyses comprised Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) and modified PI-RADSv2 (mPI-RADSv2). Quantitative analyses comprised mean apparent diffusion coefficient (ADC) of tumor, 10th percentile ADC of tumor, mean ADC ratio (ADCR) between benign tissues and PCa, and 10th percentile ADCR between benign tissues and PCa. The AUCs of the following combined models for GS 7 or greater PCa were investigated: model 1, PSAD and PI-RADSv2; model 2, PSAD and mPI-RADSv2; model 3, PSAD and mean ADC; model 4, PSAD and 10th percentile ADC; model 5, PSAD and mean ADCR; and model 6, PSAD and 10th percentile ADCR. RESULTS The rate of GS 7 or greater PCa was 45.6% (31/68). AUCs of bpMRI parameters were 0.816 for PI-RADSv2, 0.838 for mPI-RADSv2, 0.820 for mean ADC, 0.823 for 10th percentile ADC, 0.780 for mean ADCR, and 0.763 for 10th percentile ADCR (p > 0.05 in all comparisons), whereas AUCs of prostate-specific antigen (PSA)-based parameters were 0.650 for PSA and 0.745 for PSAD (PSA vs PSAD, p = 0.017). AUCs of the combined models from 1 to 6 were 0.860, 0.880, 0.837, 0.844, 0.811, and 0.806, respectively, for biopsy GS 7 or greater PCa (p > 0.05 in all comparisons). CONCLUSION Combined analysis of prebiopsy bpMRI and PSAD is useful for identifying GS 7 or greater PCa.
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Chen W, Lin M, Gibson E, Bastian-Jordan M, Cool DW, Kassam Z, Liang H, Feng G, Ward AD, Chiu B. A self-tuned graph-based framework for localization and grading prostate cancer lesions: An initial evaluation based on multiparametric magnetic resonance imaging. Comput Biol Med 2018; 96:252-265. [DOI: 10.1016/j.compbiomed.2018.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 11/26/2022]
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Chilali O, Puech P, Lakroum S, Diaf M, Mordon S, Betrouni N. Gland and Zonal Segmentation of Prostate on T2W MR Images. J Digit Imaging 2018; 29:730-736. [PMID: 27363993 DOI: 10.1007/s10278-016-9890-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
For many years, prostate segmentation on MR images concerned only the extraction of the entire gland. Currently, in the focal treatment era, there is a continuously increasing need for the separation of the different parts of the organ. In this paper, we propose an automatic segmentation method based on the use of T2W images and atlas images to segment the prostate and to isolate the peripheral and transition zones. The algorithm consists of two stages. First, the target image is registered with each zonal atlas image then the segmentation is obtained by the application of an evidential C-Means clustering. The method was evaluated on a representative and multi-centric image base and yielded mean Dice accuracy values of 0.81, 0.70, and 0.62 for the prostate, the transition zone, and peripheral zone, respectively.
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Affiliation(s)
- O Chilali
- INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, University of Lille, 59000, Lille, France
- Automatic Department, Mouloud Mammeri University, Tizi-Ouzou, Algeria
| | - P Puech
- INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, University of Lille, 59000, Lille, France
- CHRU Lille, Radiology Department, Claude Huriez Hospital, 59000, Lille, France
| | - S Lakroum
- INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, University of Lille, 59000, Lille, France
| | - M Diaf
- Automatic Department, Mouloud Mammeri University, Tizi-Ouzou, Algeria
| | - S Mordon
- INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, University of Lille, 59000, Lille, France
| | - N Betrouni
- INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, University of Lille, 59000, Lille, France.
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Biopsy Needle Integrated with Electrical Impedance Sensing Microelectrode Array towards Real-time Needle Guidance and Tissue Discrimination. Sci Rep 2018; 8:264. [PMID: 29321531 PMCID: PMC5762724 DOI: 10.1038/s41598-017-18360-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 12/10/2017] [Indexed: 01/28/2023] Open
Abstract
A biopsy needle with electrical impedance sensor array based on stainless steel microelectrodes (EIS needle) was developed for real-time four electrode measurement and multi-spot sensing of tissues during the biopsy process. The sensor performance was characterized by using saline solutions with various concentrations, which proved accurate, stable and reliable electrical impedance measurement. The capability of impedance-based tissue sensing was verified by the conductivity measurement of agarose hydrogel based phantom mimicking cancer tissue. Furthermore, multi-spot impedance sensing during needle insertion was demonstrated using porcine meat with muscle and fat layers, which exhibited a clear discrimination between different types of tissues. Also, the electrical impedance difference between normal and fatty livers of mouse model was measured by the EIS needle. We could successfully demonstrate that the EIS needle can provide localized and accurate characterization of biological tissues at the needle tip.
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Deep Adversarial Context-Aware Landmark Detection for Ultrasound Imaging. MEDICAL IMAGE COMPUTING AND COMPUTER ASSISTED INTERVENTION – MICCAI 2018 2018. [DOI: 10.1007/978-3-030-00937-3_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Verma S, Choyke PL, Eberhardt SC, Oto A, Tempany CM, Turkbey B, Rosenkrantz AB. The Current State of MR Imaging-targeted Biopsy Techniques for Detection of Prostate Cancer. Radiology 2017; 285:343-356. [PMID: 29045233 DOI: 10.1148/radiol.2017161684] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Systematic transrectal ultrasonography (US)-guided biopsy is the standard approach for histopathologic diagnosis of prostate cancer. However, this technique has multiple limitations because of its inability to accurately visualize and target prostate lesions. Multiparametric magnetic resonance (MR) imaging of the prostate is more reliably able to localize significant prostate cancer. Targeted prostate biopsy by using MR imaging may thus help to reduce false-negative results and improve risk assessment. Several commercial devices are now available for targeted prostate biopsy, including in-gantry MR imaging-targeted biopsy and real-time transrectal US-MR imaging fusion biopsy systems. This article reviews the current status of MR imaging-targeted biopsy platforms, including technical considerations, as well as advantages and challenges of each technique. © RSNA, 2017.
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Affiliation(s)
- Sadhna Verma
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Peter L Choyke
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Steven C Eberhardt
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Aytekin Oto
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Clare M Tempany
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Baris Turkbey
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Andrew B Rosenkrantz
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
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Ultrasound Elastography of the Prostate Using an Unconstrained Modulus Reconstruction Technique: A Pilot Clinical Study. Transl Oncol 2017; 10:744-751. [PMID: 28735201 PMCID: PMC5522957 DOI: 10.1016/j.tranon.2017.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/15/2017] [Accepted: 06/15/2017] [Indexed: 12/04/2022] Open
Abstract
A novel full-inversion-based technique for quantitative ultrasound elastography was investigated in a pilot clinical study on five patients for non-invasive detection and localization of prostate cancer and quantification of its extent. Conventional-frequency ultrasound images and radiofrequency (RF) data (~5 MHz) were collected during mechanical stimulation of the prostate using a transrectal ultrasound probe. Pre and post-compression RF data were used to construct the strain images. The Young's modulus (YM) images were subsequently reconstructed using the derived strain images and the stress distribution estimated iteratively using finite element (FE) analysis. Tumor regions determined based on the reconstructed YM images were compared to whole-mount histopathology images of radical prostatectomy specimens. Results indicated that tumors were significantly stiffer than the surrounding tissue, demonstrating a relative YM of 2.5 ± 0.8 compared to normal prostate tissue. The YM images had a good agreement with the histopathology images in terms of tumor location within the prostate. On average, 76% ± 28% of tumor regions detected based on the proposed method were inside respective tumor areas identified in the histopathology images. Results of a linear regression analysis demonstrated a good correlation between the disease extents estimated using the reconstructed YM images and those determined from whole-mount histopathology images (r2 = 0.71). This pilot study demonstrates that the proposed method has a good potential for detection, localization and quantification of prostate cancer. The method can potentially be used for prostate needle biopsy guidance with the aim of decreasing the number of needle biopsies. The proposed technique utilizes conventional ultrasound imaging system only while no additional hardware attachment is required for mechanical stimulation or data acquisition. Therefore, the technique may be regarded as a non-invasive, low cost and potentially widely-available clinical tool for prostate cancer diagnosis.
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Development of multi-spot impedance sensing biopsy needle based on attachable and flexible sensor film. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:4788-4791. [PMID: 28269341 DOI: 10.1109/embc.2016.7591798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We demonstrate the biopsy needle capable of multi-spot impedance sensing based on attachable and flexible sensor film. In order to directly integrate sensor electrodes into curved surface of biopsy needle, attachable and thin polyimide substrate was used. Sensor electrodes were easily manipulated due to advantage of conventional microfabrication technique and this enable capability of multi-spot impedance sensing. To verify validity of proposed method, attachability of sensor film and real-time response of multi-spot sensing of fabricated biopsy needle was investigated.
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Bansal S, Gupta NP, Yadav R, Khera R, Ahlawat K, Gautam D, Ahlawat R, Gautam G. Multiparametric magnetic resonance imaging-transrectal ultrasound fusion prostate biopsy: A prospective, single centre study. Indian J Urol 2017; 33:134-139. [PMID: 28469301 PMCID: PMC5396401 DOI: 10.4103/0970-1591.203414] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Transrectal rectal ultrasound (TRUS)-guided systematic biopsy is the gold standard for diagnosis of prostate cancer. However, systematic biopsy has high false-negative rate and often misses anteriorly located tumors. Magnetic resonance imaging (MRI)-TRUS fusion biopsy can potentially improve cancer detection by better visualization and targeting of cancer focus. We evaluated the role of fusion biopsy in detection of prostate cancer and the association of prostate imaging reporting and data system (PI-RADS) score for predicting cancer risk and its aggression. Methods: Ninety-six consecutive men with suspected prostate cancer underwent MRI-TRUS fusion-targeted biopsy of suspicious lesions and standard 12 core biopsy from May 2014 to July 2015 in our institution. All patients underwent 3.0 T multiparametric MRI before biopsy. mp-MRI included T2W, DWI, DCE and MRS sequences to identify lesions suspicious for prostate cancer. Suspected lesions were scored according to PI-RADS scoring system. Comparison of cancer detection between standard 12 core biopsy and MRI-TRUS fusion biopsy was done. Detection of prostate cancer was primary end point of this study. Results: Mean age was 64.4 years and median prostate-specific antigen was 8.6 ng/ml. Prostate cancer was detected in 57 patients (59.3%). Of these 57 patients, 8 patients (14%) were detected by standard 12 core biopsy only, 7 patients (12.3%) with MRI-TRUS fusion biopsy only, and 42 patients (73.7%) by both techniques. Of the 7 patients, detected with MRI-TRUS fusion biopsy alone, 6 patients (85.7%) had Gleason ≥7 disease. Prostate cancer was detected on either standard 12 core biopsy or MRI-TRUS fusion biopsy in 0%, 42.8%, 74%, and 89.3% patients of suspicious lesions of highest PI-RADS score 2, 3, 4, and 5, respectively. Conclusions: MRI-TRUS fusion prostate biopsy improves cancer detection rate when combined with standard 12 cores biopsy and detects more intermediate or high-grade prostate cancer (Gleason ≥7). With increasing PI-RADS score, there is an increase chance of detection of cancer as well as its aggressiveness.
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Affiliation(s)
- Somendra Bansal
- Department of Urology, Kidney and Urology Institute, Medanta - The Medicity, Gurgaon, India
| | - Narmada P Gupta
- Department of Urology, Kidney and Urology Institute, Medanta - The Medicity, Gurgaon, India
| | - Rajiv Yadav
- Department of Urology, Kidney and Urology Institute, Medanta - The Medicity, Gurgaon, India
| | - Rakesh Khera
- Department of Urology, Kidney and Urology Institute, Medanta - The Medicity, Gurgaon, India
| | - Kulbir Ahlawat
- Division of Radiology and Nuclear Medicine, Medanta - The Medicity, Gurgaon, India
| | - Dheeraj Gautam
- Department of Pathology and Laboratory Medicine, Medanta - The Medicity, Gurgaon, Gurgaon, India
| | - Rajesh Ahlawat
- Department of Urology and Renal Transplant, Fortis Escorts Heart Institute and Research Centre, New Delhi, India
| | - Gagan Gautam
- Department of Uro-oncology, Max Institute of Cancer Care, New Delhi, India
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Olson MC, Atwell TD, Mynderse LA, King BF, Welch T, Goenka AH. CT-guided transgluteal biopsy for systematic sampling of the prostate in patients without rectal access: a 13-year single-center experience. Eur Radiol 2016; 27:3326-3332. [DOI: 10.1007/s00330-016-4694-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/12/2016] [Accepted: 12/02/2016] [Indexed: 11/24/2022]
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Huang H, Wang W, Lin T, Zhang Q, Zhao X, Lian H, Guo H. Comparison of the complications of traditional 12 cores transrectal prostate biopsy with image fusion guided transperineal prostate biopsy. BMC Urol 2016; 16:68. [PMID: 27855661 PMCID: PMC5114768 DOI: 10.1186/s12894-016-0185-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 11/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the complications of traditional transrectal (TR) prostate biopsy and image fusion guided transperineal (TP) prostate biopsy in our center. METHODS Two hundred and fourty-two patients who underwent prostate biopsy from August 2014 to January 2015were reviewed. Among them, 144 patients underwent systematic 12-core transrectal ultrasonography (TRUS) guided prostate biopsy (TR approach) while 98 patients underwent free-hand transperineal targeted biopsy with TRUS and multi-parameter magnetic resonance imaging (mpMRI) fusion images (TP approach). The complications of the two groups were presented and a simple statistical analysis was performed to compare the two groups. RESULTS The cohort of our study include242 patients, including 144 patients underwent TR biopsies while 98 patients underwentTP biopsies. There was no significant difference of major complications, including sepsis, bleeding and other complication requiring admissionbetween the two groups (P > 0.05). The incidence rate of infection and rectal bleeding in TR was much higher than TP (p < 0.05), but the incidence rate of perineal swelling in TP was much higher than TR (p < 0.05). There were no significant differences of minor complications including hematuria, lower urinary tract symptoms (LUTS), dysuria, and acuteurinary retention between the two groups (p > 0.05). CONCLUSION The present study supports the safety of both techniques. Free-handTP targeted prostate biopsy with real-time fusion imaging of mpMRI and TR ultrasound is a good approach for prostate biopsy.
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Affiliation(s)
- Haifeng Huang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008 China
| | - Wei Wang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008 China
| | - Tingsheng Lin
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008 China
| | - Qing Zhang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008 China
| | - Xiaozhi Zhao
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008 China
| | - Huibo Lian
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008 China
| | - Hongqian Guo
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008 China
- Institute of Urology, Nanjing University, Nanjing, 210008 China
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Hameed A, Al-Rashida M, Uroos M, Abid Ali S, Khan KM. Schiff bases in medicinal chemistry: a patent review (2010-2015). Expert Opin Ther Pat 2016; 27:63-79. [PMID: 27774821 DOI: 10.1080/13543776.2017.1252752] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Schiff bases are synthetically accessible and structurally diverse compounds, typically obtained by facile condensation between an aldehyde, or a ketone with primary amines. Schiff bases contain an azomethine (-C = N-) linkage that stitches together two or more biologically active aromatic/heterocyclic scaffolds to form various molecular hybrids with interesting biological properties. Schiff bases are versatile metal complexing agents and have been known to coordinate all metals to form stable metal complexes with vast therapeutic applications. Areas covered: This review aims to provide a comprehensive overview of the various patented therapeutic applications of Schiff bases and their metal complexes from 2010 to 2015. Expert opinion: Schiff bases are a popular class of compounds with interesting biological properties. Schiff bases are also versatile metal complexing ligands and have been used to coordinate almost all d-block metals as well as lanthanides. Therapeutically, Schiff bases and their metal complexes have been reported to exhibit a wide range of biological activities such as antibacterial including antimycobacterial, antifungal, antiviral, antimalarial, antiinflammatory, antioxidant, pesticidal, cytotoxic, enzyme inhibitory, and anticancer including DNA damage.
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Affiliation(s)
- Abdul Hameed
- a H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences , University of Karachi , Karachi , Pakistan
| | - Mariya Al-Rashida
- b Department of Chemistry , Forman Christian College (A Chartered University) , Lahore , Pakistan
| | - Maliha Uroos
- c Institute of Chemistry , University of the Punjab , Lahore , Pakistan
| | - Syed Abid Ali
- a H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences , University of Karachi , Karachi , Pakistan
| | - Khalid Mohammed Khan
- a H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences , University of Karachi , Karachi , Pakistan
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Rampun A, Tiddeman B, Zwiggelaar R, Malcolm P. Computer aided diagnosis of prostate cancer: A texton based approach. Med Phys 2016; 43:5412. [PMID: 27782724 PMCID: PMC5035312 DOI: 10.1118/1.4962031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 08/02/2016] [Accepted: 08/19/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE In this paper the authors propose a texton based prostate computer aided diagnosis approach which bypasses the typical feature extraction process such as filtering and convolution which can be computationally expensive. The study focuses the peripheral zone because 75% of prostate cancers start within this region and the majority of prostate cancers arising within this region are more aggressive than those arising in the transitional zone. METHODS For the model development, square patches were extracted at random locations from malignant and benign regions. Subsequently, extracted patches were aggregated and clustered using k-means clustering to generate textons that represent both regions. All textons together form a texton dictionary, which was used to construct a texton map for every peripheral zone in the training images. Based on the texton map, histogram models for each malignant and benign tissue samples were constructed and used as a feature vector to train our classifiers. In the testing phase, four machine learning algorithms were employed to classify each unknown sample tissue based on its corresponding feature vector. RESULTS The proposed method was tested on 418 T2-W MR images taken from 45 patients. Evaluation results show that the best three classifiers were Bayesian network (Az = 92.8% ± 5.9%), random forest (89.5% ± 7.1%), and k-NN (86.9% ± 7.5%). These results are comparable to the state-of-the-art in the literature. CONCLUSIONS The authors have developed a prostate computer aided diagnosis method based on textons using a single modality of T2-W MRI without the need for the typical feature extraction methods, such as filtering and convolution. The proposed method could form a solid basis for a multimodality magnetic resonance imaging based systems.
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Affiliation(s)
- Andrik Rampun
- Department of Computer Science, Aberystwyth University, Aberystwyth, Ceredigion SY23 3DB, United Kingdom
| | - Bernie Tiddeman
- Department of Computer Science, Aberystwyth University, Aberystwyth, Ceredigion SY23 3DB, United Kingdom
| | - Reyer Zwiggelaar
- Department of Computer Science, Aberystwyth University, Aberystwyth, Ceredigion SY23 3DB, United Kingdom
| | - Paul Malcolm
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich NR4 7UY, United Kingdom
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Mussi TC, Garcia RG, Queiroz MRG, Lemos GC, Baroni RH. Prostate cancer detection using multiparametric 3 - tesla MRI and fusion biopsy: preliminary results. Int Braz J Urol 2016; 42:897-905. [PMID: 27532112 PMCID: PMC5066885 DOI: 10.1590/s1677-5538.ibju.2015.0204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/18/2016] [Indexed: 11/30/2022] Open
Abstract
Objective: To evaluate the diagnostic efficacy of transrectal ultrasonography (US) biopsy with imaging fusion using multiparametric (mp) magnetic resonance imaging (MRI) in patients with suspicion of prostate cancer (PCa), with an emphasis on clinically significant tumors according to histological criteria. Materials and Methods: A total of 189 consecutive US/MRI fusion biopsies were performed obtaining systematic and guided samples of suspicious areas on mpMRI using a 3 Tesla magnet without endorectal coil. Clinical significance for prostate cancer was established based on Epstein criteria. Results: In our casuistic, the average Gleason score was 7 and the average PSA was 5.0ng/mL. Of the 189 patients that received US/MRI biopsies, 110 (58.2%) were positive for PCa. Of those cases, 88 (80%) were clinically significant, accounting for 46.6% of all patients. We divided the MRI findings into 5 Likert scales of probability of having clinically significant PCa. The positivity of US/MRI biopsy for clinically significant PCa was 0%, 17.6% 23.5%, 53.4% and 84.4% for Likert scores 1, 2, 3, 4 and 5, respectively. There was a statistically significant difference in terms of biopsy results between different levels of suspicion on mpMRI and also when biopsy results were divided into groups of clinically non-significant versus clinically significant between different levels of suspicion on mpMRI (p-value <0.05 in both analyzes). Conclusion: We found that there is a significant difference in cancer detection using US/MRI fusion biopsy between low-probability and intermediate/high probability Likert scores using mpMRI.
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Affiliation(s)
- Thais Caldara Mussi
- Departamento de Radiologia e Diagnóstico por Imagem do Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Rodrigo Gobbo Garcia
- Departamento de Intervenção Guiada por Imagem do Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | | | - Gustavo Caserta Lemos
- Departamento de Urologia do Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Ronaldo Hueb Baroni
- Departamento de Radiologia e Diagnóstico por Imagem do Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
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Ueno Y, Tamada T, Bist V, Reinhold C, Miyake H, Tanaka U, Kitajima K, Sugimura K, Takahashi S. Multiparametric magnetic resonance imaging: Current role in prostate cancer management. Int J Urol 2016; 23:550-7. [PMID: 27184019 DOI: 10.1111/iju.13119] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 04/07/2016] [Indexed: 12/31/2022]
Abstract
Digital rectal examination, serum prostate-specific antigen screening and transrectal ultrasound-guided biopsy are conventionally used as screening, diagnostic and surveillance tools for prostate cancer. However, they have limited sensitivity and specificity. In recent years, the role of multiparametric magnetic resonance imaging has steadily grown, and is now part of the standard clinical management in many institutions. In multiparametric magnetic resonance imaging, the morphological assessment of T2-weighted imaging is correlated with diffusion-weighted imaging, dynamic contrast-enhanced imaging perfusion and/or magnetic resonance spectroscopic imaging. Multiparametric magnetic resonance imaging is currently regarded as the most sensitive and specific imaging technique for the evaluation of prostate cancer, including detection, staging, localization and aggressiveness evaluation. This article presents an overview of multiparametric magnetic resonance imaging, and discusses the current role of multiparametric magnetic resonance imaging in the different fields of prostate cancer management.
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Affiliation(s)
- Yoshiko Ueno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Vipul Bist
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Utaru Tanaka
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazuhiro Kitajima
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Department of Nuclear Medicine and PET Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuro Sugimura
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satoru Takahashi
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Scarpato KR, Barocas DA. Use of mpMRI in active surveillance for localized prostate cancer. Urol Oncol 2016; 34:320-5. [PMID: 27036218 DOI: 10.1016/j.urolonc.2016.02.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/21/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In an effort to limit prostate cancer (PCa) overdiagnosis and overtreatment, which have occurred in response to widespread prostate specific antigen testing, numerous strategies aimed at improved risk stratification of patients with PCa have evolved. Multiparametric magnetic resonance imaging (MRI) is being used in concert with prostate specific antigen testing and prostate biopsies to improve sensitivity and specificity of these tests. There are limited data on how multiparametric MRI can be incorporated into active surveillance (AS) protocols. EVIDENCE ACQUISITION A PubMed literature search of available English language publications on PCa, AS, and MRI was conducted. Appropriate articles were selected and included for review. Bibliographies were also used to expand our search. EVIDENCE SYNTHESIS Data from 41 studies were reviewed. AS inclusion criteria and protocols varied among studies, as did indications for use of MRI. Technological improvements are briefly highlighted. Studies are broadly categorized and discussed according to the role of MRI in patient selection, disease staging, and monitoring in AS protocols. CONCLUSIONS Although improvements in MRI technology have been useful for biopsy guidance and in the diagnosis and staging of PCa, this literature search demonstrates that more prospective research is needed, specifically regarding how this promising technology can be incorporated into AS protocols.
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Affiliation(s)
- Kristen R Scarpato
- Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville TN 37232.
| | - Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville TN 37232
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31
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Hauth E, Hohmuth H, Cozub-Poetica C, Bernand S, Beer M, Jaeger H. Multiparametric MRI of the prostate with three functional techniques in patients with PSA elevation before initial TRUS-guided biopsy. Br J Radiol 2015; 88:20150422. [PMID: 26268144 DOI: 10.1259/bjr.20150422] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Multiparametric MRI (mp-MRI) of the prostate is increasingly being used for local staging and detection of recurrence of prostate cancer (PCA). In patients with elevated prostate-specific antigen (PSA), mp-MRI could provide information on the position of the cancer, allowing adjustments to be made to the needle depth and direction before repeat transrectal ultrasound (TRUS)-guided biopsy to ensure accurate sampling of lesions. The purpose of the prospective study was to evaluate mp-MRI of the prostate in patients with PSA elevation before initial TRUS-guided biopsy. METHODS mp-MRI was performed in 94 patients using a 1.5-T scanner (MAGNETOM Aera(®); Siemens Healthcare, Erlangen, Germany) and 16-channel phased-array body coil (Siemens Healthcare). T2 weighted images (T2WI), diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) MRI and MR spectroscopy were obtained. TRUS-guided random biopsies and additional targeted biopsies of suspicious MRI areas were performed. RESULTS Additional targeted biopsies were obtained in 17 of 43 (40%) patients with PCA. 11 of 17 targeted biopsies contained PCA. 5 of 11 PCAs were diagnosed only by additional targeted biopsies. Sensitivity of mp-MRI in patients was 97.7% and specificity was 11.8%. mp-MRI was false negative in one patient. Sensitivity of mp-MRI in 207 lesions was 80.9% and specificity was 44.7%. In a logistic regression model, the apparent diffusion coefficient value was the only significant parameter to differentiate malignant and benign lesions. CONCLUSION mp-MRI should be performed in patients with PSA elevation before initial TRUS-guided biopsy to allow additional targeted biopsies from suspicious areas of MRI. We recommend mp-MRI with T2WI, DWI, DCE MRI and MR spectroscopy. DWI as the most reliable technique should be used in every mp-MRI. ADVANCES IN KNOWLEDGE DWI is the most reliable technique in mp-MRI of the prostate.
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Affiliation(s)
| | | | | | | | - Meinrad Beer
- 3 Department of Diagnostic and Interventional Radiology, University Hospital, Ulm, Germany
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Sequeiros T, Bastarós JM, Sánchez M, Rigau M, Montes M, Placer J, Planas J, de Torres I, Reventós J, Pegtel DM, Doll A, Morote J, Olivan M. Urinary biomarkers for the detection of prostate cancer in patients with high-grade prostatic intraepithelial neoplasia. Prostate 2015; 75:1102-13. [PMID: 25845829 DOI: 10.1002/pros.22995] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/04/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION High-grade prostatic intraepithelial neoplasia (HGPIN) is a recognized precursor stage of PCa. Men who present HGPIN in a first prostate biopsy face years of active surveillance including repeat biopsies. This study aimed to identify non-invasive prognostic biomarkers that differentiate early on between indolent HGPIN cases and those that will transform into actual PCa. METHODS We measured the expression of 21 candidate mRNA biomarkers using quantitative PCR in urine sediment samples from a cohort of 90 patients with initial diagnosis of HGPIN and a posterior follow up of at least two years. Uni- and multivariate statistical analyses were applied to analyze the candidate biomarkers and multiplex models using combinations of these biomarkers. RESULTS PSMA, PCA3, PSGR, GOLM, KLK3, CDH1, and SPINK1 behaved as predictors for PCa presence in repeat biopsies. Multiplex models outperformed (AUC = 0.81-0.86) the predictive power of single genes, including the FDA-approved PCA3 (AUC = 0.70). With a fixed sensitivity of 95%, the specificity of our multiplex models was of 41-58%, compared to the 30% of PCA3. The PPV of our models (30-38%) was also higher than the PPV of PCA3 (27%), suggesting that benign cases could be more accurately identified. Applying statistical models, we estimated that 33% to 47% of repeat biopsies could be prevented with a multiplex PCR model, representing an easy applicable and significant advantage over the current gold standard in urine sediment. DISCUSSION Using multiplex RTqPCR-based models in urine sediment it is possible to improve the current diagnostic method of choice (PCA3) to differentiate between benign HGPIN and PCa cases.
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Affiliation(s)
- Tamara Sequeiros
- Group of Biomedical Research in Urology, Vall d'Hebron Research Institute (VHIR) and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Juan M Bastarós
- Department of Urology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Milagros Sánchez
- Group of Biomedical Research in Urology, Vall d'Hebron Research Institute (VHIR) and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Marina Rigau
- Group of Biomedical Research in Urology, Vall d'Hebron Research Institute (VHIR) and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Melania Montes
- Group of Biomedical Research in Urology, Vall d'Hebron Research Institute (VHIR) and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - José Placer
- Department of Urology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Jaques Planas
- Department of Urology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Inés de Torres
- Department of Pathology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Jaume Reventós
- Group of Biomedical Research in Urology, Vall d'Hebron Research Institute (VHIR) and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Departament de Ciències Bàsiques, Universitat Internacional de Catalunya, Barcelona, Spain
- IDIBELL- Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - D Michiel Pegtel
- Department of Pathology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Andreas Doll
- Group of Biomedical Research in Urology, Vall d'Hebron Research Institute (VHIR) and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Departament de Ciències Bàsiques, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Juan Morote
- Group of Biomedical Research in Urology, Vall d'Hebron Research Institute (VHIR) and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Urology, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Mireia Olivan
- Group of Biomedical Research in Urology, Vall d'Hebron Research Institute (VHIR) and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Abstract
OBJECTIVE Prostate tumors occasionally have unusual manifestations on multiparametric MR images that can present a diagnostic dilemma and result in a false-negative interpretation. This article presents examples of such "hiding places" of prostate tumors, four in the peripheral zone and four in the central gland. CONCLUSION The provided pointers in multiparametric MRI assessment can aid the radiologist in achieving an accurate diagnosis of tumor in the eight scenarios described.
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Lopes PM, Sepúlveda L, Ramos R, Sousa P. The role of transrectal ultrasound in the diagnosis of prostate cancer: new contributions. Radiol Bras 2015; 48:7-11. [PMID: 25798001 PMCID: PMC4366021 DOI: 10.1590/0100-3984.2013.0010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 06/06/2014] [Indexed: 11/22/2022] Open
Abstract
Objective The present study was aimed at evaluating the contribution of transrectal prostate
ultrasound in the screening for prostate neoplasias and in the guidance of
prostate biopsies. Materials and Methods Prospective study developed over a one-year period. All the patients with
indication for prostate biopsy were evaluated. Regardless of PSA values, the
patients underwent ultrasound in order to identify suspicious nodules (confirmed
by two observers). Sextant biopsy was subsequently performed. In cases of finding
suspicious nodules, an additional puncture directed to such nodules was done. Results In a total of 155 cases the prevalence of malignancy was of 53%. Suspicious
nodules were detected in 34 patients, and 25 where malignant (positive predictive
value of 74%). The specificity and sensitivity for suspicious nodules were 88% and
31% respectively. Comparatively with the randomly obtained sextant specimens, the
rate of findings of neoplasia was higher in the specimens obtained with puncture
directed to the nodule (p = 0.032). No statistically significant
difference was observed in the Gleason score for both types of specimens
(p = 0.172). Conclusion The high positive predictive value and the high rate of findings of neoplasia in
specimens of suspicious nodules should be taken into consideration in the future.
The authors suggest a biopsy technique similar to the one described in the present
study (sextant biopsy plus puncture directed to the suspicious nodule).
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Affiliation(s)
- Pedro Marinho Lopes
- Intern Physician, Unit of Radiology, Hospital Distrital de Santarém, Santarém, Portugal
| | - Luís Sepúlveda
- Intern Physician, Unit of Urology, Centro Hospital de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Rui Ramos
- MDs, Radiologists, Centro Hospital de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Pedro Sousa
- MDs, Radiologists, Centro Hospital de Trás-os-Montes e Alto Douro, Vila Real, Portugal
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35
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Abstract
Nearly all prostate biopsies are performed via the transrectal ultrasound (TRUS)-guided technique which suffers from its inability to accurately visualize and target suspicious lesions. Advances in prostate MR imaging now allow for the detection of suspicious regions of the prostate gland, opening the door for lesion-directed biopsy techniques. The ability to obtain a definitive histologic grade has become increasingly important due to the rise of active surveillance as a popular method to approach low-grade cancer. Biopsies obtained with MR guidance or MR imaging/transrectal ultrasound fusion can accurately identify and characterize cancers and thus appropriately stratify patients for specific therapies.
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Noebauer-Huhmann IM, Amann G, Krssak M, Panotopoulos J, Szomolanyi P, Weber M, Czerny C, Breitenseher M, Grabner G, Bogner W, Nemec S, Dominkus M, Funovics P, Windhager R, Trattnig S. Use of diagnostic dynamic contrast-enhanced (DCE)-MRI for targeting of soft tissue tumour biopsies at 3T: preliminary results. Eur Radiol 2015; 25:2041-8. [DOI: 10.1007/s00330-014-3576-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 12/04/2014] [Accepted: 12/18/2014] [Indexed: 11/29/2022]
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Cho HJ, Shin SC, Cho JM, Kang JY, Yoo TK. The role of transurethral resection of the prostate for patients with an elevated prostate-specific antigen. Prostate Int 2014; 2:196-202. [PMID: 25599076 PMCID: PMC4286732 DOI: 10.12954/pi.14060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/01/2014] [Indexed: 12/20/2022] Open
Abstract
Purpose The aim of this study was to define the clinical significance of transurethral resection of the prostate (TURP) in patients with benign prostate hyperplasia (BPH) and an elevated prostate-specific antigen (PSA) level. Methods We retrospectively evaluated patients with BPH, lower urinary tract symptoms (LUTS; International Prostate Symptom Score [IPSS]≥8), an elevated serum PSA level (≥4 ng/mL), and previous negative transrectal ultrasonography (TRUS) guided prostate biopsy. The PSA level after TURP was monitored by long-term follow-up. The tumor detection rate on resected prostate tissue, IPSS, maximal urinary flow rate (Qmax), and postvoid residual urine (PVR) were analyzed. Results One-hundred and eighty-six patients were enrolled. Histological examination of resected tissue by TURP revealed prostate cancer in 12 of these patients (6.5%). Among 174 patients without prostate cancer, the mean PSA level and the PSA normalization rate in 112 patients followed up at postoperative day (POD) 3 months were 1.26±0.13 ng/mL and 94.6%, respectively. The mean PSA level and the PSA normalization rate were 1.28±1.01 ng/mL and 95.7% in 47 patients at 1st year, 1.17±0.82 ng/mL and 97.1% in 34 patients at second years, and 1.34±1.44 ng/mL and 97.2% in 36 patients at third years of TURP. One patient showed a dramatic increase in the PSA level was diagnosed with prostate cancer at 7 years after TURP. IPSS, quality of life, Qmax, and PVR were improved significantly at POD 3 months compared to baseline (P<0.05), respectively. Conclusions TURP significantly reduced the serum PSA level, which was maintained for at least 3 years. This could be helpful to screen the prostate cancer using PSA value in the patient with previous negative biopsy and elevated PSA. In addition, TURP improves IPSS, Qmax, and PVR in patients with BPH, moderate LUTS, and an elevated PSA level.
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Affiliation(s)
- Hee Ju Cho
- Department of Urology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Soon Cheol Shin
- Department of Urology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Jeong Man Cho
- Department of Urology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Jung Yoon Kang
- Department of Urology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Tag Keun Yoo
- Department of Urology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
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Hong CW, Rais-Bahrami S, Walton-Diaz A, Shakir N, Su D, George AK, Merino MJ, Turkbey B, Choyke PL, Wood BJ, Pinto PA. Comparison of magnetic resonance imaging and ultrasound (MRI-US) fusion-guided prostate biopsies obtained from axial and sagittal approaches. BJU Int 2014; 115:772-9. [PMID: 25045781 DOI: 10.1111/bju.12871] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare cancer detection rates and concordance between magnetic resonance imaging and ultrasound (MRI-US) fusion-guided prostate biopsy cores obtained from axial and sagittal approaches. PATIENTS AND METHODS Institutional records of MRI-US fusion-guided biopsy were reviewed. Detection rates for all cancers, Gleason ≥3 + 4 cancers, and Gleason ≥4 + 3 cancers were computed. Agreement between axial and sagittal cores for cancer detection, and frequency where one was upgraded the other was computed on a per-target and per-patient basis. RESULTS In all, 893 encounters from 791 patients that underwent MRI-US fusion-guided biopsy in 2007-2013 were reviewed, yielding 4688 biopsy cores from 2344 targets for analysis. The mean age and PSA level at each encounter was 61.8 years and 9.7 ng/mL (median 6.45 ng/mL). Detection rates for all cancers, ≥3 + 4 cancers, and ≥4 + 3 cancers were 25.9%, 17.2%, and 8.1% for axial cores, and 26.1%, 17.6%, and 8.6% for sagittal cores. Per-target agreement was 88.6%, 93.0%, and 96.5%, respectively. On a per-target basis, the rates at which one core upgraded or detected a cancer missed on the other were 8.3% and 8.6% for axial and sagittal cores, respectively. Even with the inclusion of systematic biopsies, omission of axial or sagittal cores would have resulted in missed detection or under-characterisation of cancer in 4.7% or 5.2% of patients, respectively. CONCLUSION Cancer detection rates, Gleason scores, and core involvement from axial and sagittal cores are similar, but significant cancer may be missed if only one core is obtained for each target. Discordance between axial and sagittal cores is greatest in intermediate-risk scenarios, where obtaining multiple cores may improve tissue characterisation.
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Affiliation(s)
- Cheng W Hong
- Center for Interventional Oncology, Clinical Center, National Institutes of Health (NIH), Bethesda, MD, USA
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The role of MRI in prostate cancer active surveillance. BIOMED RESEARCH INTERNATIONAL 2014; 2014:203906. [PMID: 25525592 PMCID: PMC4266760 DOI: 10.1155/2014/203906] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/22/2014] [Accepted: 08/23/2014] [Indexed: 01/04/2023]
Abstract
Prostate cancer is the most common cancer diagnosis in American men, excluding skin cancer. The clinical behavior of prostate cancer varies from low-grade, slow growing tumors to high-grade aggressive tumors that may ultimately progress to metastases and cause death. Given the high incidence of men diagnosed with prostate cancer, conservative treatment strategies such as active surveillance are critical in the management of prostate cancer to reduce therapeutic complications of radiation therapy or radical prostatectomy. In this review, we will review the role of multiparametric MRI in the selection and follow-up of patients on active surveillance.
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41
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Abstract
PURPOSE OF REVIEW A variety of techniques have emerged for the optimization of prostate biopsy. In this review, we summarize and critically discuss the most recent developments regarding the optimal systematic biopsy and sampling labeling along with multiparametric MRI and magnetic resonance-targeted biopsies. RECENT FINDINGS The use of 10-12-core-extended sampling protocols increases cancer detection rates compared with traditional sextant sampling and reduces the likelihood that patients will require a repeat biopsy, ultimately allowing more accurate risk stratification without increasing the likelihood of detecting insignificant cancers. As the number of cores increases above 12 cores, the increase in diagnostic yield becomes marginal. However, the limitations of this technique include undersampling, oversampling, and the need for repetitive biopsy. MRI and magnetic resonance-targeted biopsies have demonstrated superiority over systematic biopsies for the detection of clinically significant disease and representation of disease burden, while deploying fewer cores and may have applications in men undergoing initial or repeat biopsy and those with low-risk cancer on or considering active surveillance. SUMMARY A 12-core systematic biopsy that incorporates apical and far-lateral cores in the template distribution allows maximal cancer detection, avoidance of a repeat biopsy while minimizing the detection of insignificant prostate cancers. MRI-guided prostate biopsy has an evolving role in both initial and repeat prostate biopsy strategies, as well as active surveillance, potentially improving sampling efficiency, increasing the detection of clinically significant cancers, and reducing the detection of insignificant cancers.
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Hong CW, Amalou H, Xu S, Turkbey B, Yan P, Kruecker J, Pinto PA, Choyke PL, Wood BJ. Prostate biopsy for the interventional radiologist. J Vasc Interv Radiol 2014; 25:675-84. [PMID: 24581731 PMCID: PMC4308315 DOI: 10.1016/j.jvir.2013.12.568] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/14/2013] [Accepted: 12/22/2013] [Indexed: 01/04/2023] Open
Abstract
Prostate biopsies are usually performed by urologists in the office setting using transrectal ultrasound (US) guidance. The current standard of care involves obtaining 10-14 cores from different anatomic sections. Biopsies are usually not directed into a specific lesion because most prostate cancers are not visible on transrectal US. Color Doppler, US contrast agents, elastography, magnetic resonance (MR) imaging, and MR imaging/US fusion are proposed as imaging methods to guide prostate biopsies. Prostate MR imaging and fusion biopsy create opportunities for diagnostic and interventional radiologists to play an increasingly important role in the screening, evaluation, diagnosis, targeted biopsy, surveillance, and focal therapy of patients with prostate cancer.
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Affiliation(s)
- Cheng William Hong
- Center for Interventional Oncology, Clinical Center, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892
| | - Hayet Amalou
- Center for Interventional Oncology, Clinical Center, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892
| | - Sheng Xu
- Center for Interventional Oncology, Clinical Center, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892
| | - Pingkun Yan
- Center for Interventional Oncology, Clinical Center, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892; Philips Research North America, Briarcliff Manor, New York
| | - Jochen Kruecker
- Center for Interventional Oncology, Clinical Center, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892; Philips Research North America, Briarcliff Manor, New York
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892
| | - Bradford J Wood
- Center for Interventional Oncology, Clinical Center, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892.
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Wu X, Zhang F, Chen R, Zheng W, Yang X. Recent advances in imaging-guided interventions for prostate cancers. Cancer Lett 2014; 349:114-9. [PMID: 24769076 DOI: 10.1016/j.canlet.2014.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 04/02/2014] [Accepted: 04/16/2014] [Indexed: 11/26/2022]
Abstract
The numbers of patients diagnosed with prostate cancers is increasing due to the widespread application of prostate-specific antigen screening and subsequent prostate biopsies. The methods of systemic administration of therapeutics are not target-specific and thus cannot efficiently destroy prostate tumour cells while simultaneously sparing the surrounding normal tissues and organs. Recent advances in imaging-guided minimally invasive therapeutic techniques offer considerable potential for the effective management of prostate cancers. An objective understanding of the feasibility, effectiveness, morbidity, and deficiencies of these interventional techniques is essential for both clinical practice and scientific progress. This review presents the recent advances in imaging-guided interventional techniques for the diagnosis and treatment of prostate cancers.
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Affiliation(s)
- Xia Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, China; Image-Guided Bio-Molecular Intervention Research and Section of Vascular & Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican Street, Seattle, WA 98109, USA.
| | - Feng Zhang
- Image-Guided Bio-Molecular Intervention Research and Section of Vascular & Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican Street, Seattle, WA 98109, USA.
| | - Ran Chen
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University,3 East Qingchun Road, Hangzhou 310016, China.
| | - Weiliang Zheng
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, China.
| | - Xiaoming Yang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, China; Image-Guided Bio-Molecular Intervention Research and Section of Vascular & Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican Street, Seattle, WA 98109, USA.
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Rojas-Jiménez A, Otero-Garcia M, Mateos-Martin A. Stromal prostatic sarcoma: a rare tumor with rare clinical and imaging presentation. J Radiol Case Rep 2014; 7:24-31. [PMID: 24421945 DOI: 10.3941/jrcr.v7i7.1177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Adult prostatic stromal sarcoma is a rare malignant tumor. The main presenting symptom is urinary retention secondary to bladder outlet obstruction. Prostatic Specific Antigen level can be normal. Imaging features show a prostate mass with or without pelvic organ invasion depending on the aggressiveness of the tumor. We present a patient with prostatic stromal sarcoma who debuted with urinary obstruction, leukocytosis and neutrophilia, prostate enlargement, and hypodense prostate areas on CT images, simulating prostatitis with abscess formation.
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Affiliation(s)
- Anamaría Rojas-Jiménez
- Department of Radiology, Complejo Hospitalario Universitario de VIGO (CHUVI), Pontevedra, Spain
| | - Milagros Otero-Garcia
- Department of Radiology, Complejo Hospitalario Universitario de VIGO (CHUVI), Pontevedra, Spain
| | - Alejandro Mateos-Martin
- Department of Pathology, Complejo Hospitalario Universitario de VIGO (CHUVI), Pontevedra, Spain
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Shukla-Dave A, Hricak H. Role of MRI in prostate cancer detection. NMR IN BIOMEDICINE 2014; 27:16-24. [PMID: 23495081 DOI: 10.1002/nbm.2934] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/08/2013] [Accepted: 01/25/2013] [Indexed: 06/01/2023]
Abstract
The standard approach for the detection of prostate cancer--prostate-specific antigen (PSA) screening followed by transrectal ultrasonography (TRUS)-guided biopsy--has low sensitivity and provides limited information about the true extent and aggressiveness of the cancer. Improved methods are needed to assess the extent and aggressiveness of the cancer and to identify patients who will benefit from therapy. In recent years, there has been tremendous development of acquisition and processing tools for physiological and metabolic MRI techniques which play a potential role in the detection, localization and characterization of prostate cancer, such as dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted MRI (DW-MRI) and/or proton MR spectroscopic imaging ((1)H MRSI). The standard protocol for prostate MRI without the use of a contrast agent involves multi-planar T1 -weighted MRI, T2 -weighted MRI and DW-MRI. This review discusses the potential role of MRI in the detection of prostate cancer, specifically describing the status of MRI as a tool for guiding targeted prostate biopsies and for detecting cancer in the untreated and treated gland. In addition, future areas of MRI research are briefly discussed. Groups conducting clinical trials should consider the recommendations put forward by the European Consensus Meeting, which state that the minimum requirements for prostate MRI are T1 -weighted MRI, T2 -weighted MRI, DCE-MRI (which involves the use of a contrast agent) and DW-MRI with a pelvic phased-array coil and propose the use of transperineal template mapping biopsies as the optimal reference standard.
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Affiliation(s)
- Amita Shukla-Dave
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Srimathveeravalli G, Kim C, Petrisor D, Ezell P, Coleman J, Hricak H, Solomon SB, Stoianovici D. MRI-safe robot for targeted transrectal prostate biopsy: animal experiments. BJU Int 2013; 113:977-85. [PMID: 24118992 DOI: 10.1111/bju.12335] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To study the feasibility and safety of using a magnetic resonance imaging (MRI)-safe robot for assisting MRI-guided transrectal needle placement and biopsy in the prostate, using a canine model. To determine the accuracy and precision afforded by the use of the robot while targeting a desired location in the organ. MATERIALS AND METHODS In a study approved by the Institutional Animal Care and Use Committee, six healthy adult male beagles with prostates of at least 15 × 15 mm in size at the largest transverse section were chosen for the procedure. The probe portion of the robot was placed into the rectum of the dog, images were acquired and image-to-robot registration was performed. Images acquired after placement of the robot were reviewed and a radiologist selected targets for needle placement in the gland. Depending on the size of the prostate, up to a maximum of six needle placements were performed on each dog. After needle placement, robot-assisted core biopsies were performed on four dogs that had larger prostate volumes and extracted cores were analysed for potential diagnostic value. RESULTS Robot-assisted MRI-guided needle placements were performed to target a total of 30 locations in six dogs, achieving a targeting accuracy of 2.58 mm (mean) and precision of 1.31 mm (SD). All needle placements were successfully completed on the first attempt. The mean time required to select a desired target location in the prostate, align the needle guide to that point, insert the needle and perform the biopsy was ∼ 3 min. For this targeting accuracy study, the inserted needle was also imaged after its placement in the prostate, which took an additional 6-8 min. Signal-to-noise ratio analysis indicated that the presence of the robot within the scanner bore had minimal impact on the quality of the images acquired. Analysis of intact biopsy core samples indicated that the samples contained prostatic tissues, appropriate for making a potential diagnosis. Dogs used in the study did not experience device- or procedure-related complications. CONCLUSIONS Results from this preclinical pilot animal study suggest that MRI-targeted transrectal biopsies are feasible to perform and this procedure may be safely assisted by an MRI-safe robotic device.
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Jung AJ, Westphalen AC, Kurhanewicz J, Wang ZJ, Carroll PR, Simko JP, Coakley FV. Clinical utility of endorectal MRI-guided prostate biopsy: preliminary experience. J Magn Reson Imaging 2013; 40:314-23. [PMID: 24924999 DOI: 10.1002/jmri.24383] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/29/2013] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To investigate the potential clinical utility of endorectal MRI-guided biopsy in patients with known or suspected prostate cancer. MATERIALS AND METHODS We prospectively recruited 24 men with known or suspected prostate cancer in whom MRI-guided biopsy was clinically requested after multiparametric endorectal MRI showed one or more appropriate targets. One to six 18-gauge biopsy cores were obtained from each patient. Transrectal ultrasound guided biopsy results and post MRI-guided biopsy complications were also recorded. RESULTS MRI-guided biopsy was positive in 5 of 7 patients with suspected prostate cancer (including 2 of 4 with prior negative ultrasound-guided biopsies), in 8 of 12 with known untreated prostate cancer (including 5 where MRI-guided biopsy demonstrated a higher Gleason score than ultrasound guided biopsy results), and in 3 of 5 with treated cancer. MRI-guided biopsies had a significantly higher maximum percentage of cancer in positive cores when compared with ultrasound guided biopsy (mean of 37 ± 8% versus 13 ± 4%; P = 0.01). No serious postbiopsy complications occurred. CONCLUSION Our preliminary experience suggests endorectal MRI-guided biopsy may safely contribute to the management of patients with known or suspected prostate cancer by making a new diagnosis of malignancy, upgrading previously diagnosed disease, or diagnosing local recurrence.
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Affiliation(s)
- Adam J Jung
- Departments of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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