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Spadarotto N, Sauck A, Hainc N, Keller I, John H, Hohmann J. Quantitative Evaluation of Apparent Diffusion Coefficient Values, ISUP Grades and Prostate-Specific Antigen Density Values of Potentially Malignant PI-RADS Lesions. Cancers (Basel) 2023; 15:5183. [PMID: 37958357 PMCID: PMC10648562 DOI: 10.3390/cancers15215183] [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: 09/17/2023] [Revised: 10/08/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
The aim of this study was to demonstrate the correlation between ADC values and the ADC/PSAD ratio for potentially malignant prostate lesions classified into ISUP grades and to determine threshold values to differentiate benign lesions (noPCa), clinically insignificant (nsPCa) and clinically significant prostate cancer (csPCa). We enrolled a total of 403 patients with 468 prostate lesions, of which 46 patients with 50 lesions were excluded for different reasons. Therefore, 357 patients with a total of 418 prostate lesions remained for the final evaluation. For all lesions, ADC values were measured; they demonstrated a negative correlation with ISUP grades (p < 0.001), with a significant difference between csPCa and a combined group of nsPCa and noPCa (ns-noPCa, p < 0.001). The same was true for the ADC/PSAD ratio, but only the ADC/PSAD ratio proved to be a significant discriminator between nsPCa and noPCa (p = 0.0051). Using the calculated threshold values, up to 31.6% of biopsies could have been avoided. Furthermore, the ADC/PSAD ratio, with the ability to distinguish between nsPCa and noPCa, offers possible active surveillance without prior biopsy.
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Affiliation(s)
- Nadine Spadarotto
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland;
| | - Anja Sauck
- Clinic of Urology, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland; (A.S.); (I.K.); (H.J.)
| | - Nicolin Hainc
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Isabelle Keller
- Clinic of Urology, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland; (A.S.); (I.K.); (H.J.)
| | - Hubert John
- Clinic of Urology, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland; (A.S.); (I.K.); (H.J.)
- Medical Faculty, University of Zurich, 8032 Zurich, Switzerland
| | - Joachim Hohmann
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland;
- Medical Faculty, University of Basel, 4056 Basel, Switzerland
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Ono A, Hashimoto T, Shishido T, Hirasawa Y, Satake N, Namiki K, Saito K, Ohno Y. Clinical value of minimum apparent diffusion coefficient for prediction of clinically significant prostate cancer in the transition zone. Int J Clin Oncol 2023; 28:716-723. [PMID: 36961616 PMCID: PMC10119207 DOI: 10.1007/s10147-023-02324-y] [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: 08/25/2022] [Accepted: 03/01/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND This study investigated the association between apparent diffusion coefficients in Prostate Imaging Reporting and Data System 4/5 lesions and clinically significant prostate cancer in the transition zone. METHODS We included 102 patients who underwent transperineal cognitive fusion targeted biopsy for Prostate Imaging Reporting and Data System 4/5 lesions in the transition zone between 2016 and 2020. The association between apparent diffusion coefficients and prostate cancers in the transition zone was analyzed. RESULTS The detection rate of prostate cancer was 49% (50/102), including clinically significant prostate cancer in 37.3% (38/102) of patients. The minimum apparent diffusion coefficients in patients with clinically significant prostate cancer were 494.5 ± 133.6 µm2/s, which was significantly lower than 653.8 ± 172.5 µm2/s in patients with benign histology or clinically insignificant prostate cancer. Age, prostate volume, transition zone volume, and mean and minimum apparent diffusion coefficients were associated with clinically significant prostate cancer. Multivariate analysis demonstrated that only the minimum apparent diffusion coefficient value (odds ratio: 0.994; p < 0.001) was an independent predictor of clinically significant prostate cancer. When the cutoff value of the minimum apparent diffusion coefficient was less than 595 µm2/s, indicating the presence of prostate cancer in the transition zone, the detection rate increased to 59.2% (29/49) in this cohort. CONCLUSION The minimum apparent diffusion coefficient provided additional value to indicate the presence of clinically significant prostate cancer in the transition zone. It may help consider the need for subsequent biopsies in patients with Prostate Imaging Reporting and Data System 4/5 lesions and an initial negative targeted biopsy.
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Affiliation(s)
- Ashita Ono
- Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
| | - Takeshi Hashimoto
- Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
| | - Toshihide Shishido
- Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
| | - Yosuke Hirasawa
- Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
| | - Naoya Satake
- Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
| | - Kazunori Namiki
- Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
| | - Yoshio Ohno
- Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
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Prostate cancer in PI-RADS scores 1 and 2 version 2.1: a comparison to previous PI-RADS versions. Abdom Radiol (NY) 2022; 47:2187-2196. [PMID: 35312821 DOI: 10.1007/s00261-022-03444-1] [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: 10/28/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the validity of PI-RADS categories 1 and 2 version 2.1 (V2.1) as predictors of the absence of carcinoma and to reevaluate lesions that were analysed as suspicious prior to PI-RADS or according to PI-RADS versions 1 and 2 and classified as PI-RADS 1 or 2 in V2.1. METHODS Retrospective evaluation of 1170 multiparametric MRIs performed at one academic teaching hospital (2012-2019). Study cohort comprised 188 men that achieved PI-RADS scores 1 or 2 (V2.1) and underwent systematic and targeted biopsy, split into one group with suspect findings in the original reports that were created prior to PI-RADS or with version 1 and 2, and another group with unremarkable reports. Differences in presence of prostate cancer and PSA density were assessed by Chi-square and Fisher's exact test, and the negative predictive value (NPV) for both groups was conducted. RESULTS The NPV for clinically significant carcinoma (csCa) was 89.1% for 55 men with suspect findings in the original report and 93.2% for 133 men with negative MRI. There was no difference between the groups regarding the detection of csCa (p = 0.103). PSA density was significantly higher in the group with suspect original reports (p = 0.015). CONCLUSION A PI-RADS score 1 or 2 appears less likely to miss existing prostate cancer, although a small amount of csCa can be overlooked. In case of clinical suspicion or elevated PSA density and PI-RADS score 1 or 2, an individual decision has to be taken if biopsy is necessary or if monitoring is sufficient.
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Kuhlmann PK, Chen M, Luu M, Naser-Tavakolian A, Kim HL, Saouaf R, Daskivich TJ. Predictors of disparity between targeted and in-zone systematic cores during transrectal MR/US-fusion prostate biopsy. Urol Oncol 2022; 40:162.e1-162.e7. [DOI: 10.1016/j.urolonc.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/16/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
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Velarde N, Westphalen AC, Nguyen HG, Neuhaus J, Shinohara K, Simko JP, Larson PE, Magudia K. US lesion visibility predicts clinically significant upgrade of prostate cancer by systematic biopsy. Abdom Radiol (NY) 2022; 47:1133-1141. [PMID: 34997299 PMCID: PMC8863714 DOI: 10.1007/s00261-021-03389-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Abstract
Purpose To identify predictors of when systematic biopsy leads to a higher overall prostate cancer grade compared to targeted biopsy. Methods and materials 918 consecutive patients who underwent prostate MRI followed by MRI/US fusion biopsy and systematic biopsies from January 2015 to November 2019 at a single academic medical center were retrospectively identified. The outcome was upgrade of PCa by systematic biopsy, defined as cases when systematic biopsy led to a Gleason Grade (GG) ≥ 2 and greater than the maximum GG detected by targeted biopsy. Generalized linear regression and conditional logistic regression were used to analyze predictors of upgrade. Results At the gland level, the presence of an US-visible lesion was associated with decreased upgrade (OR 0.64, 95% CI 0.44–0.93, p = 0.02). At the sextant level, upgrade was more likely to occur through the biopsy of sextants with MRI-visible lesions (OR 2.58, 95% CI 1.87–3.63, p < 0.001), US-visible lesions (OR 1.83, 95% CI 1.14–2.93, p = 0.01), and ipsilateral lesions (OR 3.89, 95% CI 2.36–6.42, p < 0.001). Conclusion Systematic biopsy is less valuable in patients with an US-visible lesion, and more likely to detect upgrades in sextants with imaging abnormalities. An approach that takes additional samples from regions with imaging abnormalities may provide analogous information to systematic biopsy.
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Ghafoor S, Becker AS, Woo S, Causa Andrieu PI, Stocker D, Gangai N, Hricak H, Vargas HA. Comparison of PI-RADS Versions 2.0 and 2.1 for MRI-based Calculation of the Prostate Volume. Acad Radiol 2021; 28:1548-1556. [PMID: 32814644 DOI: 10.1016/j.acra.2020.07.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 01/25/2023]
Abstract
RATIONALE AND OBJECTIVES Prostate gland volume (PGV) should be routinely included in MRI reports of the prostate. The recently updated Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 includes a change in the recommended measurement method for PGV compared to version 2.0. The purpose of this study was to evaluate the agreement of MRI-based PGV calculations with the volumetric manual slice-by-slice prostate segmentation as a reference standard using the linear measurements per PI-RADS versions 2.0 and 2.1. Furthermore, to assess inter-reader agreement for the different measurement approaches, determine the influence of an enlarged transition zone on measurement accuracy and to assess the value of the bullet formula for PGV calculation. MATERIALS AND METHODS Ninety-five consecutive treatment-naive patients undergoing prostate MRI were retrospectively analyzed. Prostates were manually contoured and segmented on axial T2-weighted images. Four different radiologists independently measured the prostate in three dimensions according to PI-RADS v2.0 and v2.1, respectively. MRI-based PGV was calculated using the ellipsoid and bullet formulas. Calculated volumes were compared to the reference manual segmentations using Wilcoxon signed-rank test. Inter-reader agreement was calculated using intraclass correlation coefficient (ICC). RESULTS Inter-reader agreement was excellent for the ellipsoid and bullet formulas using PI-RADS v2.0 (ICC 0.985 and 0.987) and v2.1 (ICC 0.990 and 0.994), respectively. The median difference from the reference standard using the ellipsoid formula derived PGV was 0.4 mL (interquartile range, -3.9 to 5.1 mL) for PI-RADS v2.0 (p = 0.393) and 2.6 mL (interquartile range, -1.6 to 7.3 mL) for v2.1 (p < 0.001) with a median difference of 2.2 mL. The bullet formula overestimated PGV by a median of 13.3 mL using PI-RADS v2.0 (p < 0.001) and 16.0 mL using v2.1 (p < 0.001). In the presence of an enlarged transition zone the PGV tended to be higher than the reference standard for PI-RADS v2.0 (median difference of 4.7 mL; p = 0.018) and for v2.1 (median difference of 5.7 mL, p < 0.001) using the ellipsoid formula. CONCLUSION Inter-reader agreement was excellent for the calculated PGV for both methods. PI-RADS v2.0 measurements with the ellipsoid formula yielded the most accurate volume estimates. The differences between PI-RADS v2.0 and v2.1 were statistically significant although small in absolute numbers but may be of relevance in specific clinical scenarios like prostate-specific antigen density calculation. These findings validate the use of the ellipsoid formula and highlight that the bullet formula should not be used for prostate volume estimation due to systematic overestimation.
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Affiliation(s)
- Soleen Ghafoor
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Anton S Becker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Pamela I Causa Andrieu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Daniel Stocker
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Patient- and tumor-level risk factors for MRI-invisible prostate cancer. Prostate Cancer Prostatic Dis 2021; 24:794-801. [PMID: 33568751 DOI: 10.1038/s41391-021-00330-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/21/2020] [Accepted: 01/20/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Multiparametric MRI is highly sensitive for detection of clinically significant prostate cancer, but has a 10-20% false negative rate. It is unknown if there are clinical factors that predict MRI invisibility. We sought to identify predictors of MRI-invisible (MRI(-)) disease. METHODS Men undergoing MRI/US-fusion targeted + systematic biopsy by two surgeons at our institution from 2015 to 2018 were reviewed. Patient demographics, clinical data, MRI metrics, and biopsy pathology results were obtained by chart review. An MRI(-) tumor was defined as a positive systematic biopsy in a zone without an MRI lesion. Factors associated with presence of MRI(-) tumors were identified using stepwise multivariable logistic regression. RESULTS Of 194 men included in the analysis, 79 (41%) and 25 (13%) men had GG1+ and GG2+ MRI(-) tumors, respectively. On multivariable analysis, only Black race was associated with presence of GG1+ MRI(-) tumors (OR 2.2, 95% CI 1.02-4.96). Black race (OR 3.5, 95% CI 1.24-9.87) and higher PSA density (OR 2.0, 95% CI 1.34-3.20) were associated with presence of GG2+ MRI(-) tumors. In non-Black and Black men, detection of MRI(-) tumors on systematic biopsy upgraded patients from no disease to GG2+ disease 1% and 11% of the time, respectively, and from GG1 to GG2+ disease 42% and 60% of the time, respectively. CONCLUSIONS Black race and PSA density were associated with presence of MRI(-) prostate cancer. Further study on racial differences is warranted based on these results. Surgeons should consider pre-biopsy risk factors before deciding to omit systematic prostate biopsy regardless of mpMRI results.
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Carbunaru S, Stinson J, Babajide R, Hollowell CMP, Yang X, Sekosan M, Ferrer K, Kajdacsy‐Balla A, Abelleira J, Ruden M, King‐Lee P, Dalton DP, Casalino DD, Kittles RA, Gann PH, Schaeffer EM, Murphy AB. Performance of prostate health index and PSA density in a diverse biopsy‐naïve cohort with mpMRI for detecting significant prostate cancer. BJUI COMPASS 2021; 2:370-376. [PMID: 35474697 PMCID: PMC8988695 DOI: 10.1002/bco2.91] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/12/2021] [Accepted: 04/21/2021] [Indexed: 01/11/2023] Open
Abstract
Objective To compare Prostate Health Index (PHI) and prostate‐specific antigen (PSA) density as secondary tests after multiparametric magnetic resonance imaging (mpMRI) in improving the detection accuracy of Gleason grade group (GG) 2‐5 prostate cancer (PCa) and in decreasing unnecessary biopsies in a multiethnic biopsy‐naïve population. Methods From February 2017 to February 2020, we recruited consecutive biopsy‐naïve men in participating urology clinics for elevated PSA levels. They all had a PHI score, mpMRI, and prostate biopsy. Experienced genitourinary radiologists read all mpMRI studies based on PIRADS version 2.0. Logistic regression models were used to generate receiver operating characteristic curves. Models were tested for effect modification between Race (Black vs White) and both PHI and PSA density, and Race and PIRADS to determine if race impacted their prediction accuracy. Sensitivity, specificity, and predictive values of PHI and PSA density thresholds were calculated by PIRADS scores. The primary outcome was GG2‐5 PCa, that is, Gleason score ≥3 + 4. Results The study included 143 men, of which 65 (45.5%) were self‐reported Black. Median age was 62.0 years and 55 men (38.4%) had GG2‐5 PCa. Overall, 18.1% had PIRADS 1‐2, 32.9% had PIRADS 3, and 49.0% had PIRADS 4‐5. For the binary logistic regressions, the interactions between PIRADS and Race (P = .08), Log (PHI) and Race (P = .17), and Log (PSA density) and Race (P = .42) were not statistically significant. Within PIRADS 3 lesions, a PHI ≥49 prevented unnecessary biopsies in 55% of men and missed no GG2‐5 PCa, yielding a negative predictive value of 100%. There was no reliable PHI or PSA density threshold to avoid PCa biopsies in PIRADS 1‐2 or 4‐5. Conclusions PHI and PSA density can be used after mpMRI to improve the detection of GG2‐5 PCa in a biopsy‐naïve cohort. PHI may be superior to PSA density in PIRADS 3 lesions by avoiding 55% of unnecessary biopsies. Using both PHI and PSA density in series may further increase specificity and lead to fewer unnecessary biopsies, but further larger studies are warranted to determine the optimal threshold of each biomarker.
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Affiliation(s)
- Samuel Carbunaru
- Department of Urology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - James Stinson
- Division of Urology Cook County Health and Hospitals System Chicago IL USA
| | - Rilwan Babajide
- Pritzker School of Medicine University of Chicago Chicago IL USA
| | | | - Ximing Yang
- Department of Pathology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Marin Sekosan
- Department of Pathology & Laboratory Medicine Cook County Health and Hospitals System Chicago IL USA
| | - Karen Ferrer
- Department of Pathology & Laboratory Medicine Cook County Health and Hospitals System Chicago IL USA
| | | | - Josephine Abelleira
- Department of Urology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Maria Ruden
- Division of Urology Cook County Health and Hospitals System Chicago IL USA
| | - Patrice King‐Lee
- Department of Pathology University of Illinois at Chicago Chicago IL USA
| | - Daniel P. Dalton
- Department of Urology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - David D. Casalino
- Department of Pathology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Rick A. Kittles
- Department of Population Sciences City of Hope Duarte CA USA
| | - Peter H. Gann
- Department of Pathology University of Illinois at Chicago Chicago IL USA
| | - Edward M. Schaeffer
- Department of Urology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Adam B. Murphy
- Department of Urology Northwestern University Feinberg School of Medicine Chicago IL USA
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Bertokova A, Bertok T, Jane E, Hires M, Ďubjaková P, Novotná O, Belan V, Fillo J, Tkac J. Detection of N,N-diacetyllactosamine (LacdiNAc) containing free prostate-specific antigen for early stage prostate cancer diagnostics and for identification of castration-resistant prostate cancer patients. Bioorg Med Chem 2021; 39:116156. [PMID: 33894508 DOI: 10.1016/j.bmc.2021.116156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
Prostate cancer (PCa) is one of the most common cancer types among men and also acommon cause of death globally. With an increasing incidence, there is aneed for low-cost, reliable biomarkers present in samples, which could be provided non-invasively (without a need to perform prostate biopsy). Glycosylation changes of free-PSA (fPSA) are considered cancer-specific, while the level of different PSA forms can increase under other than cancerous conditions. In the present study, we investigated the role ofN,N-diacetyllactosamine (LacdiNAc) epitope of fPSA (i.e. glycoprofile of fPSA or gPSA) in combination with total-PSA (tPSA), prostate volume, and tPSA density (tPSA level divided by prostate volume i.e. PSAd) as biomarkers for monitoring of PCa development and progression in 105 men. Furthermore, we applied an genetic (evolutionary) algorithm to identify any suspicious individuals in abenign cohort having benign prostatic hyperplasia (BPH). We identified 3 suspicious men originally diagnosed with BPH using gPSA analysis. In thefollow-up we found out that two men should not be considered as BPH patients since multiparametric magnetic resonance imaging (mpMRI) identified one man with clinically significant PCa via Prostate Imaging - Reporting and Data System (PI RADS v2 = 4) and the second man was with High-gradeprostatic intraepithelial neoplasia (HG PIN), commonly described as apre-cancerous stage. Moreover, in the study we described for the first time that changed LacdiNAc on PSA can be applied to identify prostatitis patients and most importantly this is the first study suggesting that changed glycosylation on PSA can be applied to identify castration-resistant prostate cancer (CRPCa) patients.
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Affiliation(s)
- Aniko Bertokova
- Institute of Chemistry, Slovak Academy of Sciences, Dubravska cesta 9, Bratislava 845 38, Slovakia; Glycanostics, Ltd., Dubravska cesta 9, Bratislava 845 38, Slovakia
| | - Tomas Bertok
- Institute of Chemistry, Slovak Academy of Sciences, Dubravska cesta 9, Bratislava 845 38, Slovakia; Glycanostics, Ltd., Dubravska cesta 9, Bratislava 845 38, Slovakia
| | - Eduard Jane
- Institute of Chemistry, Slovak Academy of Sciences, Dubravska cesta 9, Bratislava 845 38, Slovakia
| | - Michal Hires
- Institute of Chemistry, Slovak Academy of Sciences, Dubravska cesta 9, Bratislava 845 38, Slovakia
| | - Petra Ďubjaková
- University Hospital Bratislava, Mickiewiczova 13, 811 07 Bratislava, Slovakia
| | - Oľga Novotná
- University Hospital Bratislava, Mickiewiczova 13, 811 07 Bratislava, Slovakia
| | | | - Juraj Fillo
- University Hospital Bratislava, Mickiewiczova 13, 811 07 Bratislava, Slovakia
| | - Jan Tkac
- Institute of Chemistry, Slovak Academy of Sciences, Dubravska cesta 9, Bratislava 845 38, Slovakia; Glycanostics, Ltd., Dubravska cesta 9, Bratislava 845 38, Slovakia.
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Lee CM, Park KJ, Kim MH, Kim JK. Ancillary imaging and clinical features for the characterization of prostate lesions: A proposed approach to reduce false positives. J Magn Reson Imaging 2020; 53:1887-1897. [PMID: 33377264 DOI: 10.1002/jmri.27491] [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: 10/05/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/07/2022] Open
Abstract
The relatively low specificity and positive predictive value of the Prostate Imaging-Reporting and Data System (PI-RADS) can lead to considerable false-positive results and unnecessary biopsies. The aim of this study was to propose ancillary features (AFs) indicating clinically significant prostate cancer (csPCa) or benign tissues in PI-RADS category ≥3 lesions and determine the usefulness of these AFs in reducing false-positive assessments of suspicious lesions in men at csPCa risk. This was a retrospective study, which included 199 men. A 3T, including turbo spin echo T2 -weighted, echo-planar diffusion-weighted, and spoiled gradient echo dynamic contrast-enhanced (DCE) images, was used. Five AFs (prostate-specific antigen density ≥0.15 ng/mL2 ; size ≥10 mm; heterogeneous T2 signal intensity; circumscribed nodule in the junction of peripheral and transition zone; and DCE time curves) indicating csPCa or non-csPCa were evaluated by three independent readers. The sensitivity and specificity of each AF were calculated. Inter-reader agreement was evaluated using κ statistics. Univariate and multivariate logistic regression analyses were conducted to determine significant AFs. The reduction in positive call rates and csPCa detection rates with combined AF use were calculated and compared with the findings obtained with PI-RADS use alone. The sensitivities and specificities of the AFs indicating csPCa were 72.1%-96.5% and 27.4%-75.2% for reader 1, 66.3%-96.5% and 23.9%-62.0% for reader 2, and 67.4%-96.5% and 34.5%-78.8% for reader 3, with moderate to substantial inter-reader agreement (Fleiss κ, 0.551-0.643). The combined use of two or more AFs for assessing PI-RADS ≥3 lesions resulted in a 19.6%-30.7% reduction in positive calls (p < .05) compared to PI-RADS use alone while preserving the csPCa detection rates (p ≥ .06) for three readers. The use of AFs in combination with PI-RADS can reduce positive calls and false positives without csPCa under-detection.
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Affiliation(s)
- Chul-Min Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kye Jin Park
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mi-Hyun Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jeong Kon Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Mazzone E, Stabile A, Pellegrino F, Basile G, Cignoli D, Cirulli GO, Sorce G, Barletta F, Scuderi S, Bravi CA, Cucchiara V, Fossati N, Gandaglia G, Montorsi F, Briganti A. Positive Predictive Value of Prostate Imaging Reporting and Data System Version 2 for the Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Oncol 2020; 4:697-713. [PMID: 33358543 DOI: 10.1016/j.euo.2020.12.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/26/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT The variability of the positive predictive value (PPV) represents a significant factor affecting the diagnostic performance of multiparametric magnetic resonance imaging (mpMRI). OBJECTIVE To analyze published studies reporting mpMRI PPV and the reasons behind the variability of clinically significant prostate cancer (csPCa) detection rates on targeted biopsies (TBx) according to Prostate Imaging Reporting and Data System (PI-RADS) version 2 categories. EVIDENCE ACQUISITION A search of PubMed, Cochrane library's Central, EMBASE, MEDLINE, and Scopus databases, from January 2015 to June 2020, was conducted. The primary and secondary outcomes were to evaluate the PPV of PI-RADS version 2 in detecting csPCa and any prostate cancer (PCa), respectively. Individual authors' definitions for csPCa and PI-RADS thresholds for positive mpMRI were accepted. Detection rates, used as a surrogate of PPV, were pooled using random-effect models. Preplanned subgroup analyses tested PPV after stratification for PI-RADS scores, previous biopsy status, TBx technique, and number of sampled cores. PPV variation over cancer prevalence was evaluated. EVIDENCE SYNTHESIS Fifty-six studies, with a total of 16 537 participants, were included in the quantitative synthesis. The PPV of suspicious mpMRI for csPCa was 40% (95% confidence interval 36-43%), with large heterogeneity between studies (I2 94%, p < 0.01). PPV increased according to PCa prevalence. In subgroup analyses, PPVs for csPCa were 13%, 40%, and 69% for, respectively, PI-RADS 3, 4, and 5 (p < 0.001). TBx missed 6%, 6%, and 5% of csPCa in PI-RADS 3, 4, and 5 lesions, respectively. In biopsy-naïve and prior negative biopsy groups, PPVs for csPCa were 42% and 32%, respectively (p = 0.005). Study design, TBx technique, and number of sampled cores did not affect PPV. CONCLUSIONS Our meta-analysis underlines that the PPV of mpMRI is strongly dependent on the disease prevalence, and that the main factors affecting PPV are PI-RADS version 2 scores and prior biopsy status. A substantially low PPV for PI-RADS 3 lesions was reported, while it was still suboptimal in PI-RADS 4 and 5 lesions. Lastly, even if the added value of a systematic biopsy for csPCa is relatively low, this rate can improve patient risk assessment and staging. PATIENT SUMMARY Targeted biopsy of Prostate Imaging Reporting and Data System 3 lesions should be considered carefully in light of additional individual risk assessment corroborating the presence of clinically significant prostate cancer. On the contrary, the positive predictive value of highly suspicious lesions is not high enough to omit systematic prostate sampling.
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Affiliation(s)
- Elio Mazzone
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Armando Stabile
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Pellegrino
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Basile
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Cignoli
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Ottone Cirulli
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriele Sorce
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Barletta
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Simone Scuderi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Carlo Andrea Bravi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Vito Cucchiara
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Fossati
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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McAllister BJ, Jarvis AK, Smith SM, Walton TJ. Benefits of pre‐biopsy multi‐parametric magnetic resonance imaging scanning in the initial assessment of prostate cancer. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2020. [DOI: 10.1111/ijun.12250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Bría J. McAllister
- The Urology Centre, Nottingham City Hospital, Hucknall Road, NG5 1PG Nottingham UK
| | - Andrew K. Jarvis
- The Urology Centre, Nottingham City Hospital, Hucknall Road, NG5 1PG Nottingham UK
| | - Stephen M. Smith
- The Urology Centre, Nottingham City Hospital, Hucknall Road, NG5 1PG Nottingham UK
| | - Thomas J. Walton
- The Urology Centre, Nottingham City Hospital, Hucknall Road, NG5 1PG Nottingham UK
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13
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Pepe P, Pennisi M. Negative Biopsy Histology in Men With PI-RADS Score 5 in Daily Clinical Practice: Incidence of Granulomatous Prostatitis. Clin Genitourin Cancer 2020; 18:e684-e687. [PMID: 32389459 DOI: 10.1016/j.clgc.2020.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the biopsy histology of men who underwent transperineal multi-parametric magnetic resonance imaging (mpMRI)/transrectal ultrasound fusion biopsy for Prostate Imaging Reporting and Data System (PI-RADS) score 5 lesions. PATIENTS AND METHODS From January 2016 to June 2019, 105 men with PI-RADS score 5 underwent mpMRI/transrectal ultrasound fusion biopsy combined with systematic prostate biopsy. All the patients underwent a 3.0 Tesla pelvic mpMRI for the first time before prostate biopsy. In detail, the detection rate for clinically significant prostate cancer (PCa) and the follow-up of the patients without proven diagnosis of PCa has been reported. RESULTS In 91 (86.7%) of 105 patients, a stage T1c PCa was diagnosed, and 89 (84.5%) of 105 of them were classified as clinically significant PCa. Among the 16 (15.5%) of 105 patients with absence of cancer, 5 (31.5%) of 16 had an aspecific granulomatous prostatitis, 1 (6.2%) of 16 had a specific granulomatous prostatitis secondary to prostatic Mycobacterium Tubercolosis, and 10 (62.3%) of 16 had a diagnosis of normal parenchyma. The 6 patients with granulomatous prostatitis underwent specific antibiotic therapy followed by laboratory (ie, semen and urine cultures) and clinical evaluation. Six months from prostate biopsy, none of the 16 patients underwent repeat prostate biopsy because prostate-specific antigen (PSA) (15/16 cases) plus PSA density significantly decreased; in addition, in all the cases the initial PI-RADS score 5 was downgraded at mpMRI revaluation to PI-RADS score ≤ 3. CONCLUSION The reduction of PSA plus PSA density values and the downgrading of PI-RADS score to ≤ 3 allow avoiding a repeated prostate biopsy in men with initial mpMRI PI-RADS score 5 lesion and negative biopsy histology.
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Affiliation(s)
- Pietro Pepe
- Urology Unit, Cannizzaro Hospital, Catania, Italy.
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14
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Wang B, Gao J, Zhang Q, Zhang C, Liu G, Wei W, Huang H, Fu Y, Li D, Zhang B, Guo H. Investigating the equivalent performance of biparametric compared to multiparametric MRI in detection of clinically significant prostate cancer. Abdom Radiol (NY) 2020; 45:547-555. [PMID: 31907568 DOI: 10.1007/s00261-019-02281-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE PIRADS v2 stipulates that dynamic contrast-enhanced (DCE) imaging be used to categorize diffusion-weighted-imaging (DWI) score 3 (DWI 3) peripheral zone (PZ) lesions as PIRADS score 3 (PIRADS 3; DCE -) or PIRADS 4 (DCE +). It's controversial for the value of DCE in improving clinically significant prostate cancer (csPCa) detection. We aimed to figure out whether DCE improves csPCa detection and explore new available measures to improve csPCa detection. PATIENTS AND METHODS We retrospectively enrolled 375 patients who underwent mp MRI before MRI/ultrasound (US) fusion-targeted biopsy (TB) with transperineal systematic biopsy (SB). All lesions were classified as DWI 3/DCE -, DWI 3/DCE +, DWI 4/PIRADS 4 lesions. Detection rates of csPCa for each lesion group were analyzed. The diagnostic performance of each approach was analyzed by receiver operating characteristics (ROC) analysis and decision curve analysis. RESULTS Totally, 109 DWI 3 or DWI 4 single lesions in PZ were analyzed (n = 109). The rates of csPCa detection for Group A, Group B, Group C is 10.3%, 13.9%, 55.9%, respectively (A vs. B, p = 0.625; B vs. C, p < 0.001). ROC analysis and decision curve analysis showed the method of combining Age, PSA Density (PSAD) and the mean apparent diffusion coefficient value (ADCmean) outperforms individual approaches for csPCa detection. CONCLUSION For DWI 3 lesions in PZ, DCE sequence has not additional value for improving detection of csPCa. The integration of clinical characteristics and bpMRI parameter improves the detection of csPCa.
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