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El-Helaly HAA, Mahmoud AAA, Magdy AM, Hasehem A, Ibrahim HM, Mohamed KM, Ismail MH. Impact of changing PI-RADS cutoff on prostate cancer detection by MRI cognitive fusion biopsy in biopsy-naïve patients. J Egypt Natl Canc Inst 2023; 35:5. [PMID: 36872409 DOI: 10.1186/s43046-023-00165-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/18/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Multi-parametric magnetic resonance imaging may improve the detection of prostate cancer. The aim of this work is to compare between PI-RADS 3-5 and PI-RADS 4-5 as a threshold for targeted prostatic biopsy. METHODS This is a prospective clinical study that included 40 biopsy-naïve patients referred for prostate biopsy. Patients underwent prebiopsy multi-parametric (mp-MRI), followed by 12-core transrectal ultrasound-guided systematic biopsy and cognitive MRI/TRUS fusion targeted biopsy from each detected lesion. The primary endpoint was to assess the diagnostic accuracy of the PI-RAD 3-4 versus PI-RADS 4-5 lesion by mpMRI for prostate cancer detection in biopsy-naive men. RESULTS The overall prostate cancer detection rate and the clinically significant cancer detection rate were 42.5% and 35%, respectively. Targeted biopsies from PI-RADS 3-5 lesions showed a sensitivity of 100%, specificity of 44%, positive predictive value of 51.7%, and negative predictive value of 100%. Restricting targeted biopsies to PI-RADS 4-5 lesions resulted in a decrease in sensitivity and negative predictive value to 73.3% and 86.2%, respectively, while specificity and positive predictive value were increased to 100% for both parameters which was statistically significant (P value < 0.0001 and P value = 0.004, respectively). CONCLUSIONS Limiting the TBs to PI-RADS 4-5 lesions improves the performance of mp-MRI in the detection of prostate cancer especially aggressive tumors.
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Affiliation(s)
| | | | | | - Abdelwahab Hasehem
- Urology Department, Urology and Nephrology Center, Mansoura, Egypt. .,Urology Department, 30th June Urology and Nephrology Center, Ismailia, Egypt. .,Urology Department, Shebin Elkom Teaching Hospital, Shebin Elkom, Egypt.
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Calatayud DG, Neophytou S, Nicodemou E, Giuffrida SG, Ge H, Pascu SI. Nano-Theranostics for the Sensing, Imaging and Therapy of Prostate Cancers. Front Chem 2022; 10:830133. [PMID: 35494646 PMCID: PMC9039169 DOI: 10.3389/fchem.2022.830133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/16/2022] [Indexed: 01/28/2023] Open
Abstract
We highlight hereby recent developments in the emerging field of theranostics, which encompasses the combination of therapeutics and diagnostics in a single entity aimed for an early-stage diagnosis, image-guided therapy as well as evaluation of therapeutic outcomes of relevance to prostate cancer (PCa). Prostate cancer is one of the most common malignancies in men and a frequent cause of male cancer death. As such, this overview is concerned with recent developments in imaging and sensing of relevance to prostate cancer diagnosis and therapeutic monitoring. A major advantage for the effective treatment of PCa is an early diagnosis that would provide information for an appropriate treatment. Several imaging techniques are being developed to diagnose and monitor different stages of cancer in general, and patient stratification is particularly relevant for PCa. Hybrid imaging techniques applicable for diagnosis combine complementary structural and morphological information to enhance resolution and sensitivity of imaging. The focus of this review is to sum up some of the most recent advances in the nanotechnological approaches to the sensing and treatment of prostate cancer (PCa). Targeted imaging using nanoparticles, radiotracers and biomarkers could result to a more specialised and personalised diagnosis and treatment of PCa. A myriad of reports has been published literature proposing methods to detect and treat PCa using nanoparticles but the number of techniques approved for clinical use is relatively small. Another facet of this report is on reviewing aspects of the role of functional nanoparticles in multimodality imaging therapy considering recent developments in simultaneous PET-MRI (Positron Emission Tomography-Magnetic Resonance Imaging) coupled with optical imaging in vitro and in vivo, whilst highlighting feasible case studies that hold promise for the next generation of dual modality medical imaging of PCa. It is envisaged that progress in the field of imaging and sensing domains, taken together, could benefit from the biomedical implementation of new synthetic platforms such as metal complexes and functional materials supported on organic molecular species, which can be conjugated to targeting biomolecules and encompass adaptable and versatile molecular architectures. Furthermore, we include hereby an overview of aspects of biosensing methods aimed to tackle PCa: prostate biomarkers such as Prostate Specific Antigen (PSA) have been incorporated into synthetic platforms and explored in the context of sensing and imaging applications in preclinical investigations for the early detection of PCa. Finally, some of the societal concerns around nanotechnology being used for the detection of PCa are considered and addressed together with the concerns about the toxicity of nanoparticles–these were aspects of recent lively debates that currently hamper the clinical advancements of nano-theranostics. The publications survey conducted for this review includes, to the best of our knowledge, some of the most recent relevant literature examples from the state-of-the-art. Highlighting these advances would be of interest to the biomedical research community aiming to advance the application of theranostics particularly in PCa diagnosis and treatment, but also to those interested in the development of new probes and methodologies for the simultaneous imaging and therapy monitoring employed for PCa targeting.
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Affiliation(s)
- David G. Calatayud
- Department of Chemistry, University of Bath, Bath, United Kingdom
- Department of Electroceramics, Instituto de Ceramica y Vidrio - CSIC, Madrid, Spain
- *Correspondence: Sofia I. Pascu, ; David G. Calatayud,
| | - Sotia Neophytou
- Department of Chemistry, University of Bath, Bath, United Kingdom
| | - Eleni Nicodemou
- Department of Chemistry, University of Bath, Bath, United Kingdom
| | | | - Haobo Ge
- Department of Chemistry, University of Bath, Bath, United Kingdom
| | - Sofia I. Pascu
- Department of Chemistry, University of Bath, Bath, United Kingdom
- Centre of Therapeutic Innovations, University of Bath, Bath, United Kingdom
- *Correspondence: Sofia I. Pascu, ; David G. Calatayud,
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Califano A, Caputo A, D'Antonio A, Ciccone V, Fabiano M, Maiorino F, Simeone D, Pace L, Rega A, Zeppa P, Altieri V. The best prostate biopsy sampling system-fusion and systematic biopsy: A single center experience. Urologia 2021; 89:529-534. [PMID: 34965795 DOI: 10.1177/03915603211037136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prostate cancer is the second most commonly diagnosed cancer in men. The diagnostic accuracy in prostate cancer can be increased by employing a preliminary multiparametric MRI followed by a fusion-targeted biopsy. METHODS To compare the diagnostic accuracy of fusion-targeted biopsy with the standard systematic biopsy in prostate cancer patients, we enrolled 139 patients on which we performed 139 prostate biopsies consisting of three targeted samples followed by 12 regular systematic samples. Based on histology, we analyzed the diagnostic performance of the two methods. RESULTS Both methods were equally good at detecting clinically significant cancer (83.3%, 50/60), while systematic biopsy detected more clinically insignificant cancers. However, the best diagnostic performance is obtained by combining the two methods. CONCLUSION The two methods are best seen as synergistic, and the addition of fusion biopsy can be used to detect more clinically significant prostate cancers than systematic biopsy alone.
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Affiliation(s)
- Alfonso Califano
- Department of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Alessandro Caputo
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Antonio D'Antonio
- University Hospital "San Giovanni di Dio e Ruggi D'Aragona," Salerno, Campania, Italy
| | - Vincenzo Ciccone
- University Hospital "San Giovanni di Dio e Ruggi D'Aragona," Salerno, Campania, Italy
| | - Marco Fabiano
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Francesco Maiorino
- Department of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Davide Simeone
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Leonardo Pace
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
- University Hospital "San Giovanni di Dio e Ruggi D'Aragona," Salerno, Campania, Italy
| | - Anna Rega
- University Hospital "San Giovanni di Dio e Ruggi D'Aragona," Salerno, Campania, Italy
| | - Pio Zeppa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
- University Hospital "San Giovanni di Dio e Ruggi D'Aragona," Salerno, Campania, Italy
| | - Vincenzo Altieri
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
- University Hospital "San Giovanni di Dio e Ruggi D'Aragona," Salerno, Campania, Italy
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Hubbard S, Wells SA, Olson K, Jarrard DF, Huang W. Combined mpMRI/US fusion targeted and concurrent standard biopsies in the detection of prostate cancer: a retrospective study. Am J Transl Res 2021; 13:12107-12113. [PMID: 34786148 PMCID: PMC8581879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/10/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED In this retrospective study we compared the PCa detection rates between combined (combined MRI/US fusion targeted biopsy with concurrent standard biopsy) and standard systemic, combined and targeted (component), and targeted (component) and concurrent standard (component) biopsies. DESIGN Two cohorts, totaling 735 cases, were selected from the University of Wisconsin Pathology archive. 390 cases (cohort 1) were combined biopsies from 2017-2020 and 345 cases (cohort 2) were part of the standard US-guided systematic biopsies from the same period. PCa was stratified into three categories: low, intermediate, and high risks. RESULTS We found that combined biopsy was significantly better than the standard biopsy in detection of PCa (65.4% vs. 51.6%, P<0.01) and intermediate-risk PCa (18.7% vs. 10.4%, P=0.05) but only slightly better at detecting high-risk PCa (26.7% vs. 23.5%, P=0.32). Further examining the biopsy results in cohort 1, we found that combined biopsy was superior to targeted biopsy (65.4% vs. 56.9%, P=0.02) or concurrent standard biopsy (65.4% vs. 52.1%, P=0.0002) in PCa detection. Combined biopsy detected significantly more high-risk PCa than concurrent standard biopsy (26.7% vs. 17.4, P=0.002), but the difference in detecting high-risk PCa between combined and targeted biopsies was not significant (26.7% vs. 22.1%, P=0.133). Similarly, the differences in detecting PCa and high-risk PCa between targeted and concurrent standard biopsies were not significant (56.9% vs. 52.1%, P=0.172 and 22.1% vs. 17.4, P=0.133, respectively). Both targeted and concurrent standard biopsies missed PCa of each risk level. CONCLUSION Combined MRI/US fusion targeted plus standard prostate biopsy is a superior technique for the detection of PCa and clinically significant PCa.
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Affiliation(s)
- Samuel Hubbard
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
| | - Shane A Wells
- Department of Radiology, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
| | - Kelly Olson
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
| | - David F Jarrard
- Department of Urology, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
| | - Wei Huang
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
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Samtani S, Burotto M, Roman JC, Cortes-Herrera D, Walton-Diaz A. MRI and Targeted Biopsy Essential Tools for an Accurate Diagnosis and Treatment Decision Making in Prostate Cancer. Diagnostics (Basel) 2021; 11:diagnostics11091551. [PMID: 34573893 PMCID: PMC8466276 DOI: 10.3390/diagnostics11091551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/11/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer (PCa) is one of the most frequent causes of cancer death worldwide. Historically, diagnosis was based on physical examination, transrectal (TRUS) images, and TRUS biopsy resulting in overdiagnosis and overtreatment. Recently magnetic resonance imaging (MRI) has been identified as an evolving tool in terms of diagnosis, staging, treatment decision, and follow-up. In this review we provide the key studies and concepts of MRI as a promising tool in the diagnosis and management of prostate cancer in the general population and in challenging scenarios, such as anteriorly located lesions, enlarged prostates determining extracapsular extension and seminal vesicle invasion, and prior negative biopsy and the future role of MRI in association with artificial intelligence (AI).
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Affiliation(s)
- Suraj Samtani
- Clinical Research Center, Bradford Hill, Santiago 8420383, Chile; (S.S.); (M.B.)
- Fundacion Chilena de Inmuno Oncologia, Santiago 8420383, Chile
| | - Mauricio Burotto
- Clinical Research Center, Bradford Hill, Santiago 8420383, Chile; (S.S.); (M.B.)
- Oncología Médica, Clinica Universidad de los Andes, Santiago 7620157, Chile
| | - Juan Carlos Roman
- Urofusion Chile, Santiago 7500010, Chile; (J.C.R.); (D.C.-H.)
- Servicio de Urologia, Instituto Nacional del Cancer, Santiago 8380455, Chile
| | | | - Annerleim Walton-Diaz
- Urofusion Chile, Santiago 7500010, Chile; (J.C.R.); (D.C.-H.)
- Servicio de Urologia, Instituto Nacional del Cancer, Santiago 8380455, Chile
- Departamento de Oncologia Básico-Clinico Universidad de Chile, Santiago 8380455, Chile
- Correspondence:
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Williams C, Ahdoot M, Daneshvar MA, Hague C, Wilbur AR, Gomella PT, Shih J, Khondakar N, Yerram N, Mehralivand S, Gurram S, Siddiqui M, Pinsky P, Parnes H, Merino M, Wood B, Turkbey B, Pinto PA. Why Does Magnetic Resonance Imaging-Targeted Biopsy Miss Clinically Significant Cancer? J Urol 2022; 207:95-107. [PMID: 34433302 DOI: 10.1097/JU.0000000000002182] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Multiple studies demonstrate magnetic resonance imaging (MRI)-targeted biopsy detects more clinically significant cancer than systematic biopsy; however, some clinically significant cancers are detected by systematic biopsy only. While these events are rare, we sought to perform a retrospective analysis of these cases to ascertain the reasons that MRI-targeted biopsy missed clinically significant cancer which was subsequently detected on systematic prostate biopsy. MATERIALS AND METHODS Patients were enrolled in a prospective study comparing cancer detection rates by transrectal MRI-targeted fusion biopsy and systematic 12-core biopsy. Patients with an elevated prostate specific antigen (PSA), abnormal digital rectal examination, or imaging findings concerning for prostate cancer underwent prostate MRI and subsequent MRI-targeted and systematic biopsy in the same setting. The subset of patients with grade group (GG) ≥3 cancer found on systematic biopsy and GG ≤2 cancer (or no cancer) on MRI-targeted biopsy was classified as MRI-targeted biopsy misses. A retrospective analysis of the MRI and MRI-targeted biopsy real-time screen captures determined the cause of MRI-targeted biopsy miss. Multivariable logistic regression analysis compared baseline characteristics of patients with MRI-targeted biopsy misses to GG-matched patients whose clinically significant cancer was detected by MRI-targeted biopsy. RESULTS Over the study period of 2007 to 2019, 2,103 patients met study inclusion criteria and underwent combined MRI-targeted and systematic prostate biopsies. A total of 41 (1.9%) men were classified as MRI-targeted biopsy misses. Most MRI-targeted biopsy misses were due to errors in lesion targeting (21, 51.2%), followed by MRI-invisible lesions (17, 40.5%) and MRI lesions missed by the radiologist (3, 7.1%). On logistic regression analysis, lower Prostate Imaging-Reporting and Data System (PI-RADSTM) score was associated with having clinically significant cancer missed on MRI-targeted biopsy. CONCLUSIONS While uncommon, most MRI-targeted biopsy misses are due to errors in lesion targeting, which highlights the importance of accurate co-registration and targeting when using software-based fusion platforms. Additionally, some patients will harbor MRI-invisible lesions which are untargetable by MRI-targeted platforms. The presence of a low PI-RADS score despite a high PSA is suggestive of harboring an MRI-invisible lesion.
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Wang NN, Zhou SR, Chen L, Tibshirani R, Fan RE, Ghanouni P, Thong AE, To'o KJ, Amirkhiz K, Nix JW, Gordetsky JB, Sprenkle P, Rais-Bahrami S, Sonn GA. The stanford prostate cancer calculator: Development and external validation of online nomograms incorporating PIRADS scores to predict clinically significant prostate cancer. Urol Oncol 2021; 39:831.e19-831.e27. [PMID: 34247909 DOI: 10.1016/j.urolonc.2021.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/01/2021] [Accepted: 06/07/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND While multiparametric MRI (mpMRI) has high sensitivity for detection of clinically significant prostate cancer (CSC), false positives and negatives remain common. Calculators that combine mpMRI with clinical variables can improve cancer risk assessment, while providing more accurate predictions for individual patients. We sought to create and externally validate nomograms incorporating Prostate Imaging Reporting and Data System (PIRADS) scores and clinical data to predict the presence of CSC in men of all biopsy backgrounds. METHODS Data from 2125 men undergoing mpMRI and MR fusion biopsy from 2014 to 2018 at Stanford, Yale, and UAB were prospectively collected. Clinical data included age, race, PSA, biopsy status, PIRADS scores, and prostate volume. A nomogram predicting detection of CSC on targeted or systematic biopsy was created. RESULTS Biopsy history, Prostate Specific Antigen (PSA) density, PIRADS score of 4 or 5, Caucasian race, and age were significant independent predictors. Our nomogram-the Stanford Prostate Cancer Calculator (SPCC)-combined these factors in a logistic regression to provide stronger predictive accuracy than PSA density or PIRADS alone. Validation of the SPCC using data from Yale and UAB yielded robust AUC values. CONCLUSIONS The SPCC combines pre-biopsy mpMRI with clinical data to more accurately predict the probability of CSC in men of all biopsy backgrounds. The SPCC demonstrates strong external generalizability with successful validation in two separate institutions. The calculator is available as a free web-based tool that can direct real-time clinical decision-making.
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Affiliation(s)
- Nancy N Wang
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Steve R Zhou
- Department of Urology, Stanford University School of Medicine, Stanford, CA.
| | - Leo Chen
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Robert Tibshirani
- Departments of Biomedical Data Science and Statistics, Stanford University, Stanford, CA
| | - Richard E Fan
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Pejman Ghanouni
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Alan E Thong
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Katherine J To'o
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Kamyar Amirkhiz
- Department of Urology, Yale School of Medicine, New Haven, CT
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL; Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Geoffrey A Sonn
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Department of Radiology, Stanford University School of Medicine, Stanford, CA
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Liu Y, Dong L, Xiang L, Zhou B, Wang H, Zhang Y, Xu G, Wu J, Wang S, Zhang Y, Xu H. Does PSA level affect the choice of prostate puncture methods among MRI-ultrasound fusion targeted biopsy, transrectal ultrasound systematic biopsy or the combination of both? Br J Radiol 2021; 94:20210312. [PMID: 34133228 PMCID: PMC8248205 DOI: 10.1259/bjr.20210312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To explore whether prostate-specific antigen (PSA) affects the choice of prostate puncture methods by comparing MRI-ultrasound fusion targeted biopsy (MRI-TBx) with transrectal ultrasound systematic biopsy (TRUS-SBx) in the detection of prostate cancer (PCa), clinically significant prostate cancer (csPCa) and non-clinically significant prostate cancer (nsPCa) in different PSA groups (<10.0,10.0-20.0 and>20.0 ng ml-1). METHODS A total of 190 patients with 215 lesions who underwent both MRI-TBx and TRUS-SBx were included in this retrospective study. PSA was measured pre-operatively and stratified to three levels. The detection rates of PCa, csPCa and nsPCa through different methods (MRI-TBx, TRUS-SBx, or MRI-TBx +TRUS SBx) were compared with stratification by PSA. RESULTS Among the 190 patients, the histopathological results revealed PCa in 126 cases, including 119 csPCa. In PSA <10.0 ng ml-1 group, although the detection rates of PCa and csPCa by MRI-TBx were higher than those of TRUS-SBx, no significant differences were observed (p = 0.741; p = 0.400). In PSA 10.0-20.0 ng ml-1 group, difference between the detection rate of csPCa with TRUS-SBx and the combined method was statistically significant (p = 0.044). As for PSA >20.0 ng ml-1, MRI-TBx had a higher csPCa rate than TRUS-SBx with no statistical significance noted (p = 0.600). CONCLUSION MRI-TBx combined with TRUS-SBx could be suitable as a standard detection approach for csPCa in patients with PSA 10.0-20.0 ng ml-1. As for PSA >20.0 and <10.0 ng ml-1, both MRI-TBx and TRUS-SBx might provide effective solutions for tumor detection. ADVANCES IN KNOWLEDGE This study gives an account of choosing appropriate prostate puncture methods through PSA level.
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Affiliation(s)
- Yunyun Liu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Tongji University School of Medicine; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Lin Dong
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Tongji University School of Medicine; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Lihua Xiang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Tongji University School of Medicine; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Boyang Zhou
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Tongji University School of Medicine; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Hanxiang Wang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Tongji University School of Medicine; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Ying Zhang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Tongji University School of Medicine; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Guang Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Tongji University School of Medicine; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Jian Wu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Tongji University School of Medicine; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Shuai Wang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Tongji University School of Medicine; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Yifeng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Tongji University School of Medicine; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Huixiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Tongji University School of Medicine; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
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Zhou Z, Zhou Y, Yan W, Sun H, Li Q, Li H, Ji Z. Unilateral lesion detected on preoperative multiparametric magnetic resonance imaging and MRI/US fusion-guided prostate biopsy is not an appropriate indication for focal therapy in prostate cancer. Urol Oncol 2021; 39:730.e17-730.e22. [PMID: 34175215 DOI: 10.1016/j.urolonc.2021.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/03/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to investigate if preoperative assessments of multiparametric magnetic resonance imaging (mpMRI) and Magnetic resonance imaging /ultrasound (MRI/US) fusion-guided prostate biopsy could be used to guide focal therapy for prostate cancer. MATERIALS AND METHODS A total of 101 prostate cancer patients undergoing radical prostatectomy were included. Preoperative findings included mpMRI and MRI/US fusion-guided prostate biopsy, while postoperative whole mount pathology was based on surgical specimen. RESULTS Of the 101 patients preoperatively diagnosed with a unilateral tumor, postoperative whole mount pathology showed 73.27% were bilateral tumors, and 71.62% of bilateral lesions were clinically significant. Comparison between preoperative and postoperative findings, the correct rate of preoperative mpMRI on the lesion side (left or right) was only 20.79%. As for the Gleason score, the correct rate of preoperative MRI/US fusion-guided prostate pathology was 67.33%. Judging from postoperative whole mount pathology, 47.52% of patients had a unilateral clinically significant tumor, which is an indication for focal therapy. CONCLUSION Preoperative examinations of mpMRI and MRI/US fusion-guided prostate biopsy cannot be used to guide focal therapy for prostate cancer.
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Affiliation(s)
- Zhien Zhou
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Zhou
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Weigang Yan
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
| | - Hao Sun
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qianyue Li
- Department of Urology, General Hospital of Xinjiang Production and Construction Corps, Xinjiang, China
| | - Hanzhong Li
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Knull E, Bax JS, Park CKS, Tessier D, Fenster A. Design and validation of an MRI-compatible mechatronic system for needle delivery to localized prostate cancer. Med Phys 2021; 48:5283-5299. [PMID: 34131933 DOI: 10.1002/mp.15050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/18/2021] [Accepted: 06/03/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Prostate cancer is the most common non-cutaneous cancer among men in the United States and is the second leading cause of cancer death in American men. (Siegel et al. [2019] CA: A Cancer J Clin.69(1):7-34.) Focal laser ablation (FLA) has the potential to control small tumors while preserving urinary and erectile function by leaving the neurovascular bundles and urethral sphincters intact. Accurate needle guidance is critical to the success of FLA. Multiparametric magnetic resonance images (mpMRI) can be used to identify targets, guide needles, and assess treatment outcomes. The purpose of this work was to design and evaluate the accuracy of an MR-compatible mechatronic system for in-bore transperineal guidance of FLA ablation needles to localized lesions in the prostate. METHODS The mechatronic system was constructed entirely of non-ferromagnetic materials, with actuation controlled by piezoelectric motors and optical encoders. The needle guide hangs between independent front and rear two-link arms, which allows for horizontal and vertical translation as well as pitch and yaw rotation of the guide with a 6.0 cm range of motion in each direction. Needles are inserted manually through a chosen hole in the guide, which has been aligned with the target in the prostate. Open-air positioning error was evaluated using an optical tracking system (0.25 mm RMS accuracy) to measure 125 trajectories in free space. Correction of systematic bias in the system was performed using 85 of the trajectories, and the remaining 40 were used to estimate the residual error. The error was calculated as the horizontal and vertical displacement between the axis of the desired and measured trajectories at a typical needle insertion depth of 10 cm. MR-compatibility was evaluated using a grid phantom to assess image degradation due to the presence of the system, and induced force, heating, and electrical interference in the system were assessed qualitatively. In-bore positioning error was evaluated on 25 trajectories. RESULTS Open-air mean positioning error at the needle tip was 0.80 ± 0.36 mm with a one-sided 95% confidence interval of 1.40 mm. The mean deviation of needle trajectories from the planned direction was 0.14 ± 0.06∘ . In the MR bore, the mean positioning error at the needle tip was 2.11 ± 1.05 mm with a one-sided 95% prediction interval of 3.84 mm. The mean angular error was 0.49 ± 0.26∘ . The system was found to be compatible with the MR environment under the specified gradient-echo sequence parameters used in this study. CONCLUSION A complete system for delivering needles to localized prostate tumors was developed and described in this work, and its compatibility with the MR environment was demonstrated. In-bore MRI positioning error was sufficiently small for targeting small localized prostate tumors.
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Affiliation(s)
- Eric Knull
- School of Biomedical Engineering, Faculty of Engineering, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada
| | - Jeffrey Scott Bax
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Claire Keun Sun Park
- Robarts Research Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David Tessier
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Aaron Fenster
- School of Biomedical Engineering, Faculty of Engineering, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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11
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Rahman IA, Nusaly IF, Syahrir S, Nusaly H, Kasim F. Optimizing biopsy strategy for prostate cancer: Bayesian framework of network meta-analysis and hierarchical summary receiver operating characteristic model for diagnostic accuracy. Indian J Urol 2021; 37:20-31. [PMID: 33850352 PMCID: PMC8033239 DOI: 10.4103/iju.iju_187_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/24/2020] [Accepted: 10/12/2020] [Indexed: 12/09/2022]
Abstract
Overdiagnosis and overtreatment are well known problems in prostate cancer (PCa). The transrectal ultrasound (TRUS) Guided biopsy (GB) as a current gold standard investigation has a low positive detection rate resulting in unnecessary biopsies. The choice of optimal biopsy strategy needs to be defined. Therefore, we undertook a Bayesian network meta analysis (NMA) and Bayesian prediction in the hierarchical summary receiver operating characteristic (HSROC) model to present a method for optimizing biopsy strategy in PCa. Twenty eight relevant studies were retrieved through online databases of EMBASE, MEDLINE, and CENTRAL up to February 2020. Markov chain Monte Carlo simulation and Surface Under the Cumulative RAnking curve were used to calculate the rank probability using odds ratio with 95% credible interval. HSROC model was used to formulate the predicted true sensitivity and specificity of each biopsy strategy. Six different PCa biopsy strategies including transrectal ultrasound GB (TRUS GB), fusion GB (FUS GB), fusion + transrectal ultrasound GB (FUS + TRUS GB), magnetic resonance imaging GB (MRI GB), transperineal ultrasound GB (TPUS GB), and contrast enhanced ultrasound GB were analyzed in this study with a total of 7584 patients. These strategies were analyzed on five outcomes including detection rate of overall PCa, clinically significant PCa, insignificant PCa, complication rate, and HSROC. The rank probability showed that the overall PCa detection rate was higher in FUS + TRUS GB, MRI GB, and FUS GB. In terms of clinically significant PCa detection, FUS + TRUS GB and FUS GB had a relatively higher clinically significant PCa detection rate, whereas TRUS GB had a relatively lower rate for clinically significant PCa detection rate. MRI GB (91% and 81%) and FUS GB (82% and 83%) had the highest predicted true sensitivity and specificity, respectively, whereas TRUS GB (62% and 83%) had a lower predicted true sensitivity and specificity. MRI GB, FUS GB, and FUS + TRUS GB were associated with lower complication rate, whereas TPUS GB and TRUS GB were more associated with higher complication rate. This NMA and HSROC model highlight the important finding that FUS + TRUS GB, FUS GB, and MRI GB were superior compared with other strategies to avoid the overdiagnosis and overtreatment of PCa. FUS GB, MRI GB, and FUS + TRUS GB had lower complication rates. These results may assist in shared decision making between patients, carers, and their surgeons.
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Affiliation(s)
- Ilham Akbar Rahman
- Department of Urology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Ilham Fauzan Nusaly
- Department of Urology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Syakri Syahrir
- Department of Urology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Harry Nusaly
- Department of Urology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Firdaus Kasim
- Department of Public Health, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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12
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Fennessy FM, Fedorov A, Vangel MG, Mulkern RV, Tretiakova M, Lis RT, Tempany C, Taplin ME. Multiparametric MRI as a Biomarker of Response to Neoadjuvant Therapy for Localized Prostate Cancer-A Pilot Study. Acad Radiol 2020; 27:1432-9. [PMID: 31862185 DOI: 10.1016/j.acra.2019.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/18/2019] [Accepted: 10/25/2019] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES To explore a role for multiparametric MRI (mpMRI) as a biomarker of response to neoadjuvant androgen deprivation therapy (ADT) for prostate cancer (PCa). MATERIALS AND METHODS This prospective study was approved by the institutional review board and was HIPAA compliant. Eight patients with localized PCa had a baseline mpMRI, repeated after 6-months of ADT, followed by prostatectomy. mpMRI indices were extracted from tumor and normal regions of interest (TROI/NROI). Residual cancer burden (RCB) was measured on mpMRI and on the prostatectomy specimen. Paired t-tests compared TROI/NROI mpMRI indices and pre/post-treatment TROI mpMRI indices. Spearman's rank tested for correlations between MRI/pathology-based RCB, and between pathological RCB and mpMRI indices. RESULTS At baseline, TROI apparent diffusion coefficient (ADC) was lower and dynamic contrast enhanced (DCE) metrics were higher, compared to NROI (ADC: 806 ± 137 × 10-6 vs. 1277 ± 213 × 10-6 mm2/sec, p = 0.0005; Ktrans: 0.346 ± 0.16 vs. 0.144 ± 0.06 min-1, p = 0.002; AUC90: 0.213 ± 0.08 vs. 0.11 ± 0.03, p = 0.002). Post-treatment, there was no change in TROI ADC, but a decrease in TROI Ktrans (0.346 ± 0.16 to 0.188 ± 0.08 min-1; p = 0.02) and AUC90 (0.213 ± 0.08 to 0.13 ± 0.06; p = 0.02). Tumor volume decreased with ADT. There was no difference between mpMRI-based and pathology-based RCB, which positively correlated (⍴ = 0.74-0.81, p < 0.05). Pathology-based RCB positively correlated with post-treatment DCE metrics (⍴ = 0.76-0.70, p < 0.05) and negatively with ADC (⍴ = -0.79, p = 0.03). CONCLUSION Given the heterogeneity of PCa, an individualized approach to ADT may maximize potential benefit. This pilot study suggests that mpMRI may serve as a biomarker of ADT response and as a surrogate for RCB at prostatectomy.
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13
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Colvin SD, Cason DE, Galgano SJ, Triche BL, Gordetsky J, Rais-Bahrami S, Porter KK. Fusion of high B-value diffusion-weighted and T2-weighted MR images increases sensitivity for identification of extraprostatic disease in prostate cancer. Clin Imaging 2020; 68:202-209. [PMID: 32892105 DOI: 10.1016/j.clinimag.2020.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate whether fusion of high b-value diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI) increases radiologists' ability to detect pathologic features responsible for upstaging in prostate cancer patients prior to radical prostatectomy (RP). BASIC PROCEDURES This was a retrospective study including 103 patients who underwent RP and a prostate MRI performed at 3T. High b-value DWI and T2WI were fused and interpreted by three radiologists with different degrees of experience. Prior to and after fusion, readers answered questionnaires about cancer presence, extraprostatic extension (EPE), seminal vesicle (SV) invasion, lymph node (LN) involvement, and reader confidence. Pathology reports served as the reference standard. MAIN FINDINGS High b-value DWI-T2WI fusion increased sensitivity for detection of EPE from 65.6% to 77.4% (p < 0.05), SV invasion from 40.5% to 48.8% (p < 0.05), and LN metastasis by 23.8% to 44.4% (p < 0.05). Readers' confidence significantly improved with the use of fusion imaging. Across all readers, confidence of cancer detection increased by 12.5% (p < 0.05), EPE by 14.7% (p < 0.05), SV invasion by 8.1% (p < 0.05), and LN metastasis by 2.5% (p < 0.05) using Wilcoxon signed rank test. PRINCIPAL CONCLUSIONS Fusion overlay of high b-value DWI and T2WI increases sensitivity for detection of extraprostatic disease resulting in upstaging at the time of RP.
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Affiliation(s)
- Stephanie D Colvin
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Daniel E Cason
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Benjamin L Triche
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Jennifer Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Soroush Rais-Bahrami
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States of America; Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
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14
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Chen MY, Woodruff MA, Dasgupta P, Rukin NJ. Variability in accuracy of prostate cancer segmentation among radiologists, urologists, and scientists. Cancer Med 2020; 9:7172-7182. [PMID: 32810385 PMCID: PMC7541146 DOI: 10.1002/cam4.3386] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/19/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022] Open
Abstract
Background There is increasing research in using segmentation of prostate cancer to create a digital 3D model from magnetic resonance imaging (MRI) scans for purposes of education or surgical planning. However, the variation in segmentation of prostate cancer among users and potential inaccuracy has not been studied. Methods Four consultant radiologists, four consultant urologists, four urology trainees, and four nonclinician segmentation scientists were asked to segment a single slice of a lateral T3 prostate tumor on MRI (“Prostate 1”), an anterior zone prostate tumor MRI (“Prostate 2”), and a kidney tumor computed tomography (CT) scan (“Kidney”). Time taken and self‐rated subjective accuracy out of a maximum score of 10 were recorded. Root mean square error, Dice coefficient, Matthews correlation coefficient, Jaccard index, specificity, and sensitivity were calculated using the radiologists as the ground truth. Results There was high variance among the radiologists in segmentation of Prostate 1 and 2 tumors with mean Dice coefficients of 0.81 and 0.58, respectively, compared to 0.96 for the kidney tumor. Urologists and urology trainees had similar accuracy, while nonclinicians had the lowest accuracy scores for Prostate 1 and 2 tumors (0.60 and 0.47) but similar for kidney tumor (0.95). Mean sensitivity in Prostate 1 (0.63) and Prostate 2 (0.61) was lower than specificity (0.92 and 0.93) suggesting under‐segmentation of tumors in the non‐radiologist groups. Participants spent less time on the kidney tumor segmentation and self‐rated accuracy was higher than both prostate tumors. Conclusion Segmentation of prostate cancers is more difficult than other anatomy such as kidney tumors. Less experienced participants appear to under‐segment models and underestimate the size of prostate tumors. Segmentation of prostate cancer is highly variable even among radiologists, and 3D modeling for clinical use must be performed with caution. Further work to develop a methodology to maximize segmentation accuracy is needed.
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Affiliation(s)
- Michael Y Chen
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia.,Redcliffe Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia
| | - Maria A Woodruff
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Prokar Dasgupta
- King's College London, Guy's Hospital, London, United Kingdom
| | - Nicholas J Rukin
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia.,Redcliffe Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia
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15
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Savin Z, Dekalo S, Marom R, Barnes S, Gitstein G, Mabjeesh NJ, Matzkin H, Yossepowitch O, Keren-Paz G, Mano R. The effect of delaying transperineal fusion biopsy of the prostate for patients with suspicious MRI findings-Implications for the COVID-19 era. Urol Oncol 2020; 39:73.e1-73.e8. [PMID: 32778478 PMCID: PMC7413128 DOI: 10.1016/j.urolonc.2020.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/10/2020] [Accepted: 07/08/2020] [Indexed: 12/02/2022]
Abstract
Objective Image guided biopsies are an integral part of prostate cancer evaluation. The effect of delaying biopsies of suspicious prostate mpMRI lesions is uncertain and clinically relevant during the COVID-19 crisis. We evaluated the association between biopsy delay time and pathologic findings on subsequent prostate biopsy. Materials and methods After obtaining IRB approval we reviewed the medical records of 214 patients who underwent image-guided transperineal fusion biopsy of the prostate biopsy between 2017 and 2019. Study outcomes included clinically significant (ISUP grade group ≥2) and any prostate cancer on biopsy. Logistic regression was used to evaluate the association between biopsy delay time and outcomes while adjusting for known predictors of cancer on biopsy. Results The study cohort included 195 men with a median age of 68. Median delay between mpMRI and biopsy was 5 months, and 90% of patients had a ≤8 months delay. A significant association was found between PI-RADS 5 lesions and no previous biopsies and shorter delay time. Delay time was not associated with clinically significant or any cancer on biopsy. A higher risk of significant cancer was associated with older age (P = 0.008), higher PSA (0.003), smaller prostate volume (<0.001), no previous biopsy (0.012) and PI-RADS 5 lesions (0.015). Conclusions Our findings suggest that under current practice, where men with PI-RADS 5 lesions and no previous biopsies undergo earlier evaluation, a delay of up to 8 months between imaging and biopsy does not affect biopsy findings. In the current COVID-19 crisis, selectively delaying image-guided prostate biopsies is unlikely to result in a higher rate of significant cancer.
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Affiliation(s)
- Ziv Savin
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Snir Dekalo
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Ron Marom
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Sophie Barnes
- Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Gilad Gitstein
- Department of Pathology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Nicola J Mabjeesh
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel; Department of Urology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Haim Matzkin
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Ofer Yossepowitch
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Gal Keren-Paz
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Roy Mano
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
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Gaur S, Mena E, Harmon SA, Lindenberg ML, Adler S, Ton AT, Shih JH, Mehralivand S, Merino MJ, Wood BJ, Pinto PA, Mease RC, Pomper MG, Choyke PL, Turkbey B. Prospective Evaluation of 18F-DCFPyL PET/CT in Detection of High-Risk Localized Prostate Cancer: Comparison With mpMRI. AJR Am J Roentgenol 2020; 215:652-9. [PMID: 32755168 DOI: 10.2214/AJR.19.22042] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to assess the utility of PET with (2S)-2-[[(1S)-1-carboxy-5-[(6-(18F)fluoranylpyridine-3-carbonyl)amino]pentyl]carbamoylamino]pentanedioic acid (18F-DCFPyL), a prostate-specific membrane antigen (PSMA)-targeted radiotracer, in the detection of high-risk localized prostate cancer as compared with multiparametric MRI (mpMRI). SUBJECTS AND METHODS. This HIPAA-compliant prospective study included 26 consecutive patients with localized high-risk prostate cancer (median age, 69.5 years [range, 53-81 years]; median prostate-specific antigen [PSA] level, 18.88 ng/mL [range, 1.03-20.00 ng/mL]) imaged with 18F-DCFPyL PET/CT and mpMRI. Images from PET/CT and mpMRI were evaluated separately, and suspicious areas underwent targeted biopsy. Lesion-based sensitivity and tumor detection rate were compared for PSMA PET and mpMRI. Standardized uptake value (SUV) and PSMA PET parameters were correlated with histopathology score, and uptake in tumor was compared with that in nonmalignant tissue. On a patient level, SUV and PSMA tumor volume were correlated with PSA density. RESULTS. Forty-four tumors (one in Gleason grade [GG] group 1, 12 in GG group 2, seven in GG group 3, nine in GG group 4, and 15 in GG group 5) were identified at histopathology. Sensitivity and tumor detection rate of 18F-DCFPyL PET/CT and mpMRI were similar (PET/CT, 90.9% and 80%; mpMRI, 86.4% and 88.4%; p = 0.58/0.17). Total lesion PSMA and PSMA tumor volume showed a relationship with GG (τ = 0.27 and p = 0.08, τ = 0.30 and p = 0.06, respectively). Maximum SUV in tumor was significantly higher than that in nonmalignant tissue (p < 0.05). Tumor burden density moderately correlated with PSA density (r = 0.47, p = 0.01). Five true-positive tumors identified on 18F-DCFPyL PET/CT were not identified on mpMRI. CONCLUSION. In patients with high-risk prostate cancer, 18F-DCFPyL PET/CT is highly sensitive in detecting intraprostatic tumors and can detect tumors missed on mpMRI. Measured uptake is significantly higher in tumor tissue, and PSMA-derived tumor burden is associated with severity of disease.
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17
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Shin TJ, Jung W, Ha JY, Kim BH, Kim YH. The significance of the visible tumor on preoperative magnetic resonance imaging in localized prostate cancer. Prostate Int 2020; 9:6-11. [PMID: 33912508 PMCID: PMC8053693 DOI: 10.1016/j.prnil.2020.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/02/2020] [Accepted: 06/14/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives We investigated the relationship between tumor characteristics and visible tumors on magnetic resonance imaging (MRI) and examined the prognosis of tumor detection on MRI compared with no tumor detection in localized prostate cancer. Materials and methods We reviewed 214 patients with pT2N0M0 prostate cancer who underwent radical prostatectomy between January 2009 and December 2016. All the patients underwent MRI preoperatively. The patients were divided into 2 groups postoperatively: no visible tumor on the MRI group (n = 96, 44.9%) and visible tumor on the MRI group (n = 118, 55.1%). The visible tumor was defined as Prostate Imaging Reporting and Data System, version 2 Grade ≥ 3 on MRI. Age, prostate-specific antigen, prostate volume, positive surgical margin (PSM), lymphovascular invasion, and biochemical recurrence (BCR) were compared between the 2 groups. We also assessed the relationship between visible tumors on MRI and oncologic characteristics. Results The visible tumor on the MRI group showed a higher Gleason score ≥4 + 3 [45.8% versus (vs.) 17.7%], high frequency of postoperative PSMs (28.8% vs. 16.7%), and higher BCR rate (17.8% vs. 7.3%) than the no visible tumor on the MRI group. The Kaplan–Meier analysis for BCR-free survival also showed a significant difference (P = 0.006). In multivariate Cox regression analysis, the detection of tumors on MRI was associated with a higher BCR risk [hazard ratio: 3.35; 95% confidence interval (CI): 1.36-8.27; P = 0.009]. We found a positive association between visible tumors on MRI and primary Gleason pattern of ≥4 (odds ratio: 4.31; 95% CI: 2.21–8.40; P < 0.001). Conclusions In localized prostate cancer, BCR was significantly more frequent when the tumor was detected on MRI, and a visible tumor on MRI was associated with the Gleason score. Therefore, attention should be paid to the possibility of high-grade prostate cancer when a tumor is detected on MRI before radical prostatectomy, and active follow-up may be needed postoperatively.
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Affiliation(s)
- Teak Jun Shin
- Department of Urology, Keimyung University School of Medicine, Dongsan Hospital, Daegu, Korea
| | - Wonho Jung
- Department of Urology, Keimyung University School of Medicine, Dongsan Hospital, Daegu, Korea
| | - Ji Yong Ha
- Department of Urology, Keimyung University School of Medicine, Dongsan Hospital, Daegu, Korea
| | - Byung Hoon Kim
- Department of Urology, Keimyung University School of Medicine, Dongsan Hospital, Daegu, Korea
| | - Young Hwan Kim
- Department of Radiology, Keimyung University School of Medicine, Dongsan Hospital, Daegu, Korea
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19
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Ahdoot M, Wilbur AR, Reese SE, Lebastchi AH, Mehralivand S, Gomella PT, Bloom J, Gurram S, Siddiqui M, Pinsky P, Parnes H, Linehan WM, Merino M, Choyke PL, Shih JH, Turkbey B, Wood BJ, Pinto PA. MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis. N Engl J Med 2020; 382:917-928. [PMID: 32130814 PMCID: PMC7323919 DOI: 10.1056/nejmoa1910038] [Citation(s) in RCA: 470] [Impact Index Per Article: 117.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The use of 12-core systematic prostate biopsy is associated with diagnostic inaccuracy that contributes to both overdiagnosis and underdiagnosis of prostate cancer. Biopsies performed with magnetic resonance imaging (MRI) targeting may reduce the misclassification of prostate cancer in men with MRI-visible lesions. METHODS Men with MRI-visible prostate lesions underwent both MRI-targeted and systematic biopsy. The primary outcome was cancer detection according to grade group (i.e., a clustering of Gleason grades). Grade group 1 refers to clinically insignificant disease; grade group 2 or higher, cancer with favorable intermediate risk or worse; and grade group 3 or higher, cancer with unfavorable intermediate risk or worse. Among the men who underwent subsequent radical prostatectomy, upgrading and downgrading of grade group from biopsy to whole-mount histopathological analysis of surgical specimens were recorded. Secondary outcomes were the detection of cancers of grade group 2 or higher and grade group 3 or higher, cancer detection stratified by previous biopsy status, and grade reclassification between biopsy and radical prostatectomy. RESULTS A total of 2103 men underwent both biopsy methods; cancer was diagnosed in 1312 (62.4%) by a combination of the two methods (combined biopsy), and 404 (19.2%) underwent radical prostatectomy. Cancer detection rates on MRI-targeted biopsy were significantly lower than on systematic biopsy for grade group 1 cancers and significantly higher for grade groups 3 through 5 (P<0.01 for all comparisons). Combined biopsy led to cancer diagnoses in 208 more men (9.9%) than with either method alone and to upgrading to a higher grade group in 458 men (21.8%). However, if only MRI-target biopsies had been performed, 8.8% of clinically significant cancers (grade group ≥3) would have been misclassified. Among the 404 men who underwent subsequent radical prostatectomy, combined biopsy was associated with the fewest upgrades to grade group 3 or higher on histopathological analysis of surgical specimens (3.5%), as compared with MRI-targeted biopsy (8.7%) and systematic biopsy (16.8%). CONCLUSIONS Among patients with MRI-visible lesions, combined biopsy led to more detection of all prostate cancers. However, MRI-targeted biopsy alone underestimated the histologic grade of some tumors. After radical prostatectomy, upgrades to grade group 3 or higher on histopathological analysis were substantially lower after combined biopsy. (Funded by the National Institutes of Health and others; Trio Study ClinicalTrials.gov number, NCT00102544.).
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Affiliation(s)
- Michael Ahdoot
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
| | - Andrew R Wilbur
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
| | - Sarah E Reese
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
| | - Amir H Lebastchi
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
| | - Sherif Mehralivand
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
| | - Patrick T Gomella
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
| | - Jonathan Bloom
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
| | - Sandeep Gurram
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
| | - Minhaj Siddiqui
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
| | - Paul Pinsky
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
| | - Howard Parnes
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
| | - W Marston Linehan
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
| | - Maria Merino
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
| | - Peter L Choyke
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
| | - Joanna H Shih
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
| | - Baris Turkbey
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
| | - Bradford J Wood
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
| | - Peter A Pinto
- From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) - all in Maryland
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20
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Sugano D, Sidana A, Jain AL, Calio B, Gaur S, Maruf M, Merino M, Choyke P, Turkbey B, Wood BJ, Pinto PA. Hypogonadism and prostate cancer detection on multiparametric MRI and mpMRI-TRUS fusion biopsy. Int Urol Nephrol 2019; 52:633-638. [PMID: 31807974 DOI: 10.1007/s11255-019-02354-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Currently, there is a dearth of data concerning the impact of hypogonadism on prostate cancer detection by imaging. In this study, we evaluated the performance of multiparametric MRI (mpMRI) and mpMRI-TRUS fusion biopsy in hypogonadal patients. MATERIALS AND METHODS Clinical and pathologic data from a prospectively maintained, single-institution database of patients who underwent 3T mpMRI and fusion biopsy between 2007 and 2016 were analyzed. Hypogonadism was defined by an institutional cutoff of serum testosterone ≤ 180 ng/dL; T2, DWI, and DCE scores were calculated from mpMRI. Cancer detection rates were compared by Chi-square tests. Multivariate logistic regression was undertaken to evaluate the impact of hypogonadism on clinically significant cancer detection by systematic and fusion biopsy. RESULTS We included 522 patients in our study who had total testosterone levels measured within 90 days of mpMRI. Of these, 49 (9.4%) were hypogonadal. Median total testosterone was 148 ng/dL (IQR 41) in the hypogonadal group, and 304 ng/dL (IQR 132) in the normogonadal group (p < 0.001). Imaging results were comparable between the hypo and normogonadal groups. In the hypogonadal group, systematic biopsy detected clinically significant cancer in 28.6% of patients compared to 40.8% with fusion biopsy. In the normogonadal cohort, systematic and fusion biopsy detected 37.3% and 43.2% CS cancer, respectively. In the hypogonadal cohort, fusion biopsy detected 12.2% more CS cancers compared to systematic biopsy, while it detected only 5.9% more in the normogonadal cohort. On multivariate analysis, hypogonadism was found to be an independent predictor of decreased CS cancer detection on systematic (p = 0.048), but not on fusion biopsy (p = 0.170). CONCLUSIONS Hypogonadism is an independent predictor of lower CS cancer detection on systematic biopsy. However, it fails to significantly impact CS detection on fusion biopsy with comparable cancer detection rates in both groups. Patients with hypogonadism may benefit more from fusion biopsy than normogonadal patients.
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Affiliation(s)
- Dordaneh Sugano
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Abhinav Sidana
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amit L Jain
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Brian Calio
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sonia Gaur
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mahir Maruf
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Maria Merino
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Bae JH, Kim SH. Transrectal ultrasound-guided prostate biopsy versus combined magnetic resonance imaging-ultrasound fusion and systematic biopsy for prostate cancer detection in routine clinical practice. Ultrasonography 2019; 39:137-143. [PMID: 31995858 PMCID: PMC7065986 DOI: 10.14366/usg.19036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 11/26/2019] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The goal of this study was to retrospectively compare systematic ultrasound-guided prostate biopsy (US-PB) and multiparametric magnetic resonance imaging-ultrasound fusion prostate biopsy (MRI-PB) in men undergoing primary or repeated biopsies. METHODS A population of 2,200 patients with a prostate-specific antigen (PSA) level >4.0 ng/ dL and/or an abnormal rectal examination was divided into two groups. All patients underwent US-PB (n=1,021) or MRI-PB (n=1,179) between April 2015 and April 2019. Population demographics, including age, PSA level, digital rectal examination results, prostate volume, number of previous negative biopsies, Prostate Imaging Reporting and Data System (PI-RADS) version 2 (V2) score, and biopsy results, were acquired and compared with respect to these variables. Univariate regression analysis of the risk factors for a higher Gleason score (GS) was performed. RESULTS The cancer detection rate (CDR) was 23.8% (243 of 1,021) in the US-PB group and 31.3% (399 of 1,179) in the MRI-PB group. Of those, 225 patients (22.0%) in the US-PB group and 374 patients (31.7%) in the MRI-PB group had clinically significant prostate cancer (csPCa). The patients with csPCa in the MRI-PB group included 10 (40%), 50 (62.5%), 184 (94.8%), and 32 (94.1%) patients with PI-RADS V2 scores of 2, 3, 4, and 5, respectively. Of the patients with csPCa, 155 (91.7%) in the US-PB group were diagnosed on the basis of the primary biopsy, compared to 308 (94.4%) in the MRI-PB group. We found the PI-RADS V2 score to be the best predictor of a higher GS. CONCLUSION MRI-PB showed a high CDR for csPCa. MRI-PB could be a reasonable approach in patients with high PI-RADS V2 scores at primary biopsy.
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Affiliation(s)
- Jae Heung Bae
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - See Hyung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
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Szewczyk-Bieda M, Wei C, Coll K, Gandy S, Donnan P, Ragupathy SKA, Singh P, Wilson J, Nabi G. A multicentre parallel-group randomised trial assessing multiparametric MRI characterisation and image-guided biopsy of prostate in men suspected of having prostate cancer: MULTIPROS study protocol. Trials 2019; 20:638. [PMID: 31752954 PMCID: PMC6868804 DOI: 10.1186/s13063-019-3746-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is growing evidence suggesting that multiparametric magnetic resonance imaging (mpMRI) is a marker for prostate cancer (PCa) aggressiveness and could be used to plan treatment. Improving early detection of clinically significant PCa with pre-biopsy mpMRI would very likely have advantages including optimising the diagnosis and treatment of diseases and diminishing patient anxiety. METHODS AND MATERIALS This is a prospective multicentre study of pre-biopsy mpMRI diagnostic test accuracy with subgroup randomisation at a 1:1 ratio with respect to transrectal ultrasound (TRUS) and MRI/US fusion-guided biopsy or TRUS-only biopsy. It is designed as a single-gate study with a single set of inclusion criteria. The total duration of the recruitment phase was 48 months; however, this has now been extended to 66 months. A sample size of 600 participants is required. DISCUSSION The primary objective is to determine whether mpMRI can improve PCa detection and characterisation. The key secondary objective is to determine whether MRI/US fusion-guided biopsy can reduce the number of false-negative biopsies. Ethical approval was obtained from the East of Scotland Research Ethics Committee 1 (14/ES/1070) on 20 November 2014. The results of this study will be used for publication and presentation in national and international journals and at scientific conferences. TRIAL REGISTRATION ClinicalTrials.gov, NCT02745496. Retrospectively registered on 20 April 2016.
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Affiliation(s)
| | - Cheng Wei
- Division of Imaging Science and Technology, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Katherine Coll
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Stephen Gandy
- Department of Medical Physics, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Peter Donnan
- Division of Population Health Genomics, University of Dundee, Dundee, DD2 4BF, UK
| | | | - Paras Singh
- Royal Free London NHS Foundation Trust, Royal Free Hospital, London, NW3 2QG, UK
| | - Jennifer Wilson
- Department of Clinical Pathology, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Ghulam Nabi
- Division of Imaging Science and Technology, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
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23
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Patel P, Wang S, Siddiqui MM. The Use of Multiparametric Magnetic Resonance Imaging (mpMRI) in the Detection, Evaluation, and Surveillance of Clinically Significant Prostate Cancer (csPCa). Curr Urol Rep 2019; 20:60. [PMID: 31478113 DOI: 10.1007/s11934-019-0926-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW With the long-standing controversy surrounding the use of prostate-specific antigen (PSA) for the detection, evaluation, and surveillance of prostate cancer, there is a need for a minimally invasive technique to identify and risk-stratify these patients. Additionally, in an effort to reduce the number of unnecessary biopsies and identify clinically significant prostate cancer (csPCa), there has been a shift in practice towards the use of multiparametric magnetic resonance imaging (mpMRI) in conjunction with decision-making regarding prostate cancer diagnosis and management. In the current review, we summarize the data regarding the use of mpMRI in the detection, evaluation, and surveillance of csPCa. RECENT FINDINGS Recent prospective clinical trials have determined that a pre-biopsy mpMRI may rule out insignificant prostate cancers, thereby reducing the number of patients who require a biopsy. The anatomic information gathered from these pre-biopsy mpMRI performed during MRI fusion biopsy in csPCa increases the accuracy of pathologic staging in terms of Gleason scores. In regard to active surveillance, prospective trials suggest little to no clinical utility for mpMRI and fusion biopsy in the surveillance of prostate cancer despite conflicting findings from retrospective studies. Recent trials suggest that mpMRI can play an important role in the detection and evaluation of csPCa. The ideal role for mpMRI in active surveillance remains limited.
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Affiliation(s)
- Parth Patel
- Division of Urology, Department of Surgery, University of Maryland Medical Center, 29 S Greene St Suite 500, Baltimore, MD, 21201, USA
| | - Shu Wang
- Division of Urology, Department of Surgery, University of Maryland Medical Center, 29 S Greene St Suite 500, Baltimore, MD, 21201, USA
| | - Mohummad Minhaj Siddiqui
- Division of Urology, Department of Surgery, University of Maryland Medical Center, 29 S Greene St Suite 500, Baltimore, MD, 21201, USA.
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Capogrosso P, Vertosick EA, Benfante NE, Sjoberg DD, Vickers AJ, Eastham JA. Can We Improve the Preoperative Prediction of Prostate Cancer Recurrence With Multiparametric MRI? Clin Genitourin Cancer 2019; 17:e745-50. [PMID: 31201051 DOI: 10.1016/j.clgc.2019.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/18/2019] [Accepted: 03/21/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The use of multiparametric magnetic resonance imaging (mpMRI) to assess prostate cancer (PCa) has increased over the past decade. We aimed to assess if preoperative mpMRI lesion score, a variable routinely available for men undergoing pre-biopsy MRI, improves the performance of commonly used preoperative predictive models for PCa recurrence. PATIENTS AND METHODS We analyzed data from 372 patients with PCa treated with radical prostatectomy in 2012 to 2017 and assessed with pre-biopsy mpMRI within 6 months prior to surgery. Suspicious areas for cancer were scored on a standardized 5-point scale. Cox regression was used to assess the association between mpMRI score and the risk of postoperative biochemical recurrence. Two different models were tested accounting for factors included in the Kattan nomogram and in the D'Amico risk-classification. RESULTS Overall, 53% and 30% of patients were found with a lesion scored 4 or 5 at pre-biopsy mpMRI, respectively. Risk varied widely by mpMRI (29% 2-year risk of biochemical recurrence for a score of 5 vs. 5% for a score of 1-2), and mpMRI score was associated with large hazard ratios after adjusting for stage, grade, and prostate-specific antigen: 1.66, 1.96, and 2.71 for scores 3, 4, and 5, respectively. However, 95% confidence intervals were very wide (0.19-14.20, 0.26-14.65, and 0.36-20.55, respectively) and included 1. CONCLUSIONS Our data did not show that preoperative models, commonly used to assess PCa risk, were improved after including the pre-biopsy mpMRI score. However, the value of pre-biopsy mpMRI to improve preoperative risk models should be investigated in larger data sets.
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25
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Gold SA, VanderWeele DJ, Harmon S, Bloom JB, Karzai F, Hale GR, Marhamati S, Rayn KN, Mehralivand S, Merino MJ, Gulley JL, Bilusic M, Madan RA, Choyke PL, Turkbey B, Dahut W, Pinto PA. mpMRI preoperative staging in men treated with antiandrogen and androgen deprivation therapy before robotic prostatectomy. Urol Oncol 2019; 37:352.e25-352.e30. [PMID: 31000430 DOI: 10.1016/j.urolonc.2019.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/28/2018] [Accepted: 01/13/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Using multiparametric magnetic resonance imaging (mpMRI), we sought to preoperatively characterize prostate cancer (PCa) in the setting of antiandrogen plus androgen deprivation therapy (AA-ADT) prior to robotic-assisted radical prostatectomy (RARP). We present our preliminary findings regarding mpMRI depiction of changes of disease staging features and lesion appearance in treated prostate. METHODS Prior to RARP, men received 6 months of enzalutamide and goserelin. mpMRI consisting of T2 weighted, b = 2,000 diffusion weighted imaging, apparent diffusion coefficient mapping, and dynamic contrast enhancement sequences was acquired before and after neoadjuvant therapy. Custom MRI-based prostate molds were printed to directly compare mpMRI findings to H&E whole-mount pathology as part of a phase II clinical trial (NCT02430480). RESULTS Twenty men underwent imaging and RARP after a regimen of AA-ADT. Positive predictive values for post-AA-ADT mpMRI diagnosis of extraprostatic extension, seminal vesicle invasion, organ-confined disease, and biopsy-confirmed PCa lesions were 71%, 80%, 80%, and 85%, respectively. Post-treatment mpMRI correctly staged disease in 15/20 (75%) cases with 17/20 (85%) correctly identified as organ-confined or not. Of those incorrectly staged, 2 were falsely positive for higher stage features and 1 was falsely negative. Post-AA-ADT T2 weighted sequences best depicted presence of PCa lesions as compared to diffusion weighted imaging and dynamic contrast enhancement sequences. CONCLUSION mpMRI proved reliable in detecting lesion changes after antiandrogen therapy corresponding to PCa pathology. Therefore, mpMRI of treated prostates may be helpful for assessing men for surgical planning and staging.
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Affiliation(s)
- Samuel A Gold
- Laboratory for Genitourinary Cancer Pathogenesis, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - David J VanderWeele
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Stephanie Harmon
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD
| | - Jonathan B Bloom
- Laboratory for Genitourinary Cancer Pathogenesis, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Fatima Karzai
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Graham R Hale
- Laboratory for Genitourinary Cancer Pathogenesis, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Shawn Marhamati
- Laboratory for Genitourinary Cancer Pathogenesis, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Urology, Georgetown University Hospital, Washington, DC
| | - Kareem N Rayn
- Laboratory for Genitourinary Cancer Pathogenesis, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Sherif Mehralivand
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - James L Gulley
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Marijo Bilusic
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Ravi A Madan
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - William Dahut
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter A Pinto
- Laboratory for Genitourinary Cancer Pathogenesis, National Cancer Institute, National Institutes of Health, Bethesda, MD.
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Tooker GM, Truong H, Pinto PA, Siddiqui MM. National Survey of Patterns Employing Targeted MRI/US Guided Prostate Biopsy in the Diagnosis and Staging of Prostate Cancer. Curr Urol 2019; 12:97-103. [PMID: 31114467 DOI: 10.1159/000489426] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/29/2018] [Indexed: 12/15/2022] Open
Abstract
Background/aims Targeted magnetic resonance imaging/ ultrasound (MRI/US) guided biopsy is an emerging technology that has the potential to change standard of care for the diagnosis and management of prostate cancer. This technology is rapidly proliferating, however quantitative analysis of these trends are unavailable. The objective of this study was to assess urologist opinions regarding implementing MRI/ US imaging into their practices. Methods A questionnaire was distributed using research electronic data capture and completed by 291 practicing urologists within the United States registered through the American Urological Association. The survey gathered information regarding demographics, changes in MRI use, opinions on targeted MRI/US guided biopsy, and barriers to implementation. The survey results were analyzed using ANOVA. Results Practice setting and geographic region were signifIcantly associated with implementation of MRI/US guided biopsy. Total 72% of urologists in academic centers report using MRI/US targeted biopsy, compared to 38% in solo private practice. In the northeast 68% of urologists report using MRI/US biopsy, compared to 44% in the western United States. Conclusion While there are some reservations about employing MRI/US guided biopsy as standard of care in all prostate biopsies, the data suggests urologists support its use, and are making efforts to introduce targeted MRI/US guided biopsy into their practice. Regional and practice setting variations exist in implementation.
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Affiliation(s)
| | - Hong Truong
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Barth BK, Rupp NJ, Cornelius A, Nanz D, Grobholz R, Schmidtpeter M, Wild PJ, Eberli D, Donati OF. Diagnostic Accuracy of a MR Protocol Acquired with and without Endorectal Coil for Detection of Prostate Cancer: A Multicenter Study. Curr Urol 2019; 12:88-96. [PMID: 31114466 DOI: 10.1159/000489425] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/29/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction The purpose of this study was to compare diagnostic accuracy of a prostate multiparametric magnetic resonance imaging (mpMRI) protocol for detection of prostate cancer between images acquired with and without en-dorectal coil (ERC). Materials This study was approved by the regional ethics committee. Between 2014 and 2015, 33 patients (median age 51.3 years; range 42.1-77.3 years) who underwent prostate-MRI at 3T scanners at 2 different institutions, acquired with (mpMRIERC) and without (mpMRIPPA) ERC and who received radical prostatectomy, were included in this retrospective study. Two expert readers (R1, R2) attributed a PI-RADS version 2 score for the most suspect (i. e. index) lesion for mpMRIPPA and mpMRIERC. Sensitivity and positive predictive value for detection of index lesions were assessed using 2 × 2 contingency tables. Differences between groups were tested using the McNemar test. Whole-mount histopathology served as reference standard. Results On a quadrant-basis cumulative sensitivity ranged between 0.61-0.67 and 0.76-0.88 for mpMRIPPA and mpMRIERC protocols, respectively (p > 0.05). Cumulative positive predictive value ranged between 0.80-0.81 and 0.89-0.91 for mpMRIPPA and mpMRIERC protocols, respectively. The differences were not statistically significant for R1 (p = 0.267) or R2 (p = 0.508). Conclusion Our results suggest that there may be no significant differences for detection of prostate cancer between images acquired with and without an ERC.
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Affiliation(s)
- Borna K Barth
- Institute of Diagnostic and Interventional Radiology, Zurich
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, Zurich
| | - Alexander Cornelius
- Department of Urology, University Hospital Zurich and University of Zurich, Zurich
| | - Daniel Nanz
- Institute of Diagnostic and Interventional Radiology, Zurich.,Department of Radiology, Zurich
| | | | - Martin Schmidtpeter
- Swiss Center for Musculoskeletal Imaging, Balgrist Campus AG, Zurich.,Department of Urology, Cantonal Hospital Aarau, Aarau
| | - Peter J Wild
- Department of Pathology and Molecular Pathology, Zurich.,Urologiepraxis Lenzburg, Lenzburg, Switzerland
| | - Daniel Eberli
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Olivio F Donati
- Institute of Diagnostic and Interventional Radiology, Zurich
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Mehralivand S, Shih JH, Harmon S, Smith C, Bloom J, Czarniecki M, Gold S, Hale G, Rayn K, Merino MJ, Wood BJ, Pinto PA, Choyke PL, Turkbey B. A Grading System for the Assessment of Risk of Extraprostatic Extension of Prostate Cancer at Multiparametric MRI. Radiology 2019; 290:709-719. [PMID: 30667329 DOI: 10.1148/radiol.2018181278] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate MRI features associated with pathologically defined extraprostatic extension (EPE) of prostate cancer and to propose an MRI grading system for pathologic EPE. Materials and Methods In this prospective study, consecutive male study participants underwent preoperative 3.0-T MRI from June 2007 to March 2017 followed by robotic-assisted laparoscopic radical prostatectomy. An MRI-based EPE grading system was defined as follows: curvilinear contact length of 1.5 cm or capsular bulge and irregularity were grade 1, both features were grade 2, and frank capsular breach were grade 3. Multivariable logistic regression and decision curve analyses were performed to compare the MRI grade model and clinical parameters (prostate-specific antigen, Gleason score) for pathologic EPE prediction by using the area under the receiver operating characteristic curve (AUC) value. Results Among 553 study participants, the mean age was 60 years ± 8 (standard deviation); the median prostate-specific antigen value was 6.3 ng/mL. A total of 125 of 553 (22%) participants had pathologic EPE at radical prostatectomy. Detection of pathologic EPE, defined as number of pathologic EPEs divided by number of participants with individual MRI features, was as follows: curvilinear contact length, 88 of 208 (42%); capsular bulge and irregularity, 78 of 175 (45%); and EPE visible at MRI, 37 of 56 (66%). For MRI, grades 1, 2, and 3 for detection of pathologic EPE were 18 of 74 (24%), 39 of 102 (38%), and 37 of 56 (66%), respectively. Clinical features plus the MRI-based EPE grading system (prostate-specific antigen, International Society of Urological Pathology stage, MRI grade) predicted pathologic EPE better than did MRI grade alone (AUC, 0.81 vs 0.77, respectively; P < .001). Conclusion Higher MRI-based extraprostatic extension (EPE) grading categories were associated with a greater risk of pathologic EPE. Clinical features plus MRI grading had the highest diagnostic performance for prediction of pathologic EPE. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Eberhardt in this issue.
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Affiliation(s)
- Sherif Mehralivand
- From the Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany (S.M.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (S.M., J.B., S.G., G.H., K.R., P.A.P.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892-1088 (S.M., C.S., M.C., P.L.C., B.T.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Md (J.H.S.); Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, NCI Campus at Frederick, Frederick, Md (S.H.); Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md (M.J.M.); and Center for Interventional Oncology, National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Joanna H Shih
- From the Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany (S.M.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (S.M., J.B., S.G., G.H., K.R., P.A.P.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892-1088 (S.M., C.S., M.C., P.L.C., B.T.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Md (J.H.S.); Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, NCI Campus at Frederick, Frederick, Md (S.H.); Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md (M.J.M.); and Center for Interventional Oncology, National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Stephanie Harmon
- From the Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany (S.M.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (S.M., J.B., S.G., G.H., K.R., P.A.P.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892-1088 (S.M., C.S., M.C., P.L.C., B.T.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Md (J.H.S.); Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, NCI Campus at Frederick, Frederick, Md (S.H.); Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md (M.J.M.); and Center for Interventional Oncology, National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Clayton Smith
- From the Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany (S.M.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (S.M., J.B., S.G., G.H., K.R., P.A.P.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892-1088 (S.M., C.S., M.C., P.L.C., B.T.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Md (J.H.S.); Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, NCI Campus at Frederick, Frederick, Md (S.H.); Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md (M.J.M.); and Center for Interventional Oncology, National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Jonathan Bloom
- From the Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany (S.M.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (S.M., J.B., S.G., G.H., K.R., P.A.P.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892-1088 (S.M., C.S., M.C., P.L.C., B.T.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Md (J.H.S.); Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, NCI Campus at Frederick, Frederick, Md (S.H.); Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md (M.J.M.); and Center for Interventional Oncology, National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Marcin Czarniecki
- From the Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany (S.M.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (S.M., J.B., S.G., G.H., K.R., P.A.P.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892-1088 (S.M., C.S., M.C., P.L.C., B.T.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Md (J.H.S.); Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, NCI Campus at Frederick, Frederick, Md (S.H.); Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md (M.J.M.); and Center for Interventional Oncology, National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Samuel Gold
- From the Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany (S.M.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (S.M., J.B., S.G., G.H., K.R., P.A.P.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892-1088 (S.M., C.S., M.C., P.L.C., B.T.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Md (J.H.S.); Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, NCI Campus at Frederick, Frederick, Md (S.H.); Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md (M.J.M.); and Center for Interventional Oncology, National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Graham Hale
- From the Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany (S.M.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (S.M., J.B., S.G., G.H., K.R., P.A.P.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892-1088 (S.M., C.S., M.C., P.L.C., B.T.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Md (J.H.S.); Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, NCI Campus at Frederick, Frederick, Md (S.H.); Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md (M.J.M.); and Center for Interventional Oncology, National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Kareem Rayn
- From the Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany (S.M.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (S.M., J.B., S.G., G.H., K.R., P.A.P.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892-1088 (S.M., C.S., M.C., P.L.C., B.T.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Md (J.H.S.); Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, NCI Campus at Frederick, Frederick, Md (S.H.); Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md (M.J.M.); and Center for Interventional Oncology, National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Maria J Merino
- From the Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany (S.M.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (S.M., J.B., S.G., G.H., K.R., P.A.P.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892-1088 (S.M., C.S., M.C., P.L.C., B.T.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Md (J.H.S.); Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, NCI Campus at Frederick, Frederick, Md (S.H.); Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md (M.J.M.); and Center for Interventional Oncology, National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Bradford J Wood
- From the Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany (S.M.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (S.M., J.B., S.G., G.H., K.R., P.A.P.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892-1088 (S.M., C.S., M.C., P.L.C., B.T.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Md (J.H.S.); Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, NCI Campus at Frederick, Frederick, Md (S.H.); Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md (M.J.M.); and Center for Interventional Oncology, National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Peter A Pinto
- From the Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany (S.M.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (S.M., J.B., S.G., G.H., K.R., P.A.P.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892-1088 (S.M., C.S., M.C., P.L.C., B.T.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Md (J.H.S.); Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, NCI Campus at Frederick, Frederick, Md (S.H.); Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md (M.J.M.); and Center for Interventional Oncology, National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Peter L Choyke
- From the Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany (S.M.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (S.M., J.B., S.G., G.H., K.R., P.A.P.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892-1088 (S.M., C.S., M.C., P.L.C., B.T.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Md (J.H.S.); Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, NCI Campus at Frederick, Frederick, Md (S.H.); Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md (M.J.M.); and Center for Interventional Oncology, National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Baris Turkbey
- From the Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany (S.M.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (S.M., J.B., S.G., G.H., K.R., P.A.P.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892-1088 (S.M., C.S., M.C., P.L.C., B.T.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Md (J.H.S.); Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, NCI Campus at Frederick, Frederick, Md (S.H.); Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md (M.J.M.); and Center for Interventional Oncology, National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
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Regis L, Celma A, Planas J, Lopez R, Roche S, Lorente D, Placer J, Trilla E, Morote J. The role of negative magnetic resonance imaging: can we safely avoid biopsy in P.I.-R.A.D.S. 2 as in P.I.-R.A.D.S. 1? Scand J Urol 2019; 53:21-25. [DOI: 10.1080/21681805.2018.1551243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lucas Regis
- Department of Urology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Ana Celma
- Department of Urology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Jacques Planas
- Department of Urology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Ricardo Lopez
- Department of Urology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Sarai Roche
- Institute of Imaging Diagnosis, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - David Lorente
- Department of Urology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Jose Placer
- Department of Urology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Enrique Trilla
- Department of Urology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Juan Morote
- Department of Urology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
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Cantiello F, Russo GI, Kaufmann S, Cacciamani G, Crocerossa F, Ferro M, De Cobelli O, Artibani W, Cimino S, Morgia G, Damiano R, Nikolaou K, Kröger N, Stenzl A, Bedke J, Kruck S. Role of multiparametric magnetic resonance imaging for patients under active surveillance for prostate cancer: a systematic review with diagnostic meta-analysis. Prostate Cancer Prostatic Dis 2018; 22:206-220. [PMID: 30487646 DOI: 10.1038/s41391-018-0113-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/23/2018] [Accepted: 11/04/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The use of multiparametric magnetic resonance imaging (mpMRI) in the setting of patients under active surveillance (AS) is promising. In this systematic-review we aimed to analyse the role of mpMRI in patients under AS. METHODS A comprehensive literature research for English-language original and review articles, recently published, was carried out using Medline, Scopus and Web of sciences databases until 30 October 2017. The following MeSH terms were used: 'active surveillance', 'prostate cancer', 'multiparametric magnetic resonance imaging'. A diagnostic meta-analysis was performed for 3.0 T mpMRI in predicting disease re-classification. RESULTS In total, 226 studies were selected after research and after removal of duplicates. After analysis on inclusion criteria, 43 studies were identified as eligible for this systematic review with a total of 6,605 patients. The timing of MRI during follow-up of AS differed from all studies like criteria for inclusion in the AS protocol. Overall, there was a low risk of bias across all studies. The diagnostic meta-analysis for 1.5 tesla showed a sensitivity of 0.60, negative predictive value (NPV) of 0.75 and a hierarchical summary receiving operating curve (HSROC) of 0.74 while for 3.0 tesla mpMRI a sensitivity of 0.81, a NPV of 0.78 and a HSROC of 0.83. CONCLUSIONS Overall, the available evidence suggests that both 1.5 or 3.0 Tesla mpMRI are a valid tool to monitor progression during AS follow-up, showing good accuracy capabilities in detecting PCa re-classification. However, the modality to better define what means 'disease progression' on mpMRI must be further evaluated.
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Affiliation(s)
- Francesco Cantiello
- Department of Urology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giorgio Ivan Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy.
| | - Sascha Kaufmann
- Department of Urology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | | | - Fabio Crocerossa
- Department of Urology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology, Milan, Italy
| | | | - Walter Artibani
- Department of Urology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Sebastiano Cimino
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Giuseppe Morgia
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Rocco Damiano
- Department of Urology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Konstantin Nikolaou
- Department of Urology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Nils Kröger
- Department of Urology, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
| | - Arnulf Stenzl
- Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Jens Bedke
- Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Stephan Kruck
- Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
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Salvaggio G, Calamia M, Purpura P, Bartolotta TV, Picone D, Dispensa N, Lunetta C, Bruno A, Raso L, Salvaggio L, Lo Re G, Galia M, Simonato A, Midiri M, Lagalla R. Role of apparent diffusion coefficient values in prostate diseases characterization on diffusion-weighted magnetic resonance imaging. MINERVA UROL NEFROL 2018; 71:154-160. [PMID: 30421590 DOI: 10.23736/s0393-2249.18.03065-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND To evaluate if normal and pathological prostate tissue can be distinguished by using apparent diffusion coefficient (ADC) values on magnetic resonance imaging (MRI) and to understand if it is possible to differentiate among pathological prostate tissues using ADC values. METHODS Our population consisted in 81 patients (mean age 65.4 years) in which 84 suspicious areas were identified. Regions of interest were placed over suspicious areas, detected on MRI, and over areas with normal appearance, and ADC values were recorded. Statistical differences between ADC values of suspicious and normal areas were evaluated. Histopathological diagnosis, obtained from targeted biopsy using MRI-US fusion biopsies in 39 patients and from prostatectomy in 42 patients, were correlated to ADC values. RESULTS Histopathological diagnosis revealed 58 cases of prostate cancer (PCa), 19 patients with indolent PCa (Gleason Score ≤6) and 39 patients with clinically significant PCa (Gleason Score ≥7), 16 of high-grade prostatic intraepithelial neoplasia (HG-PIN) and 10 of atypical small acinar proliferation (ASAP). Significant statistical differences between mean ADC values of normal prostate tissue versus PCa (P<0.00001), HG-PIN (P<0.00001) and ASAP (P<0.00001) were found. Significant differences were observed between mean ADC values of PCa versus HG-PIN (P<0.00001) and ASAP (P<0.00001) with many overlapping values. Differences between mean ADC values of HG-PIN versus ASAP (P=0.015) were not significant. Significant differences of ADC values were also observed between patients with indolent and clinically significant PCa (P<0.00001). CONCLUSIONS ADC values allow differentiation between normal and pathological prostate tissue and between indolent and clinically significant PCa but do not allow a definite differentiation between PCa, HG-PIN, and ASAP.
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Affiliation(s)
- Giuseppe Salvaggio
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy -
| | - Mauro Calamia
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
| | - Pierpaolo Purpura
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
| | - Tommaso V Bartolotta
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
| | - Dario Picone
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
| | - Nino Dispensa
- Unit of Urology, Department of Surgery, Oncology, and Stomatology, University of Palermo, Palermo, Italy
| | - Claudio Lunetta
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
| | - Alberto Bruno
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
| | - Ludovica Raso
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
| | | | - Giuseppe Lo Re
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
| | - Massimo Galia
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
| | - Alchiede Simonato
- Unit of Urology, Department of Surgery, Oncology, and Stomatology, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
| | - Roberto Lagalla
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
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Yarlagadda VK, Lai WS, Gordetsky JB, Porter KK, Nix JW, Thomas JV, Rais-Bahrami S. MRI/US fusion-guided prostate biopsy allows for equivalent cancer detection with significantly fewer needle cores in biopsy-naive men. ACTA ACUST UNITED AC 2018; 24:115-120. [PMID: 29770762 DOI: 10.5152/dir.2018.17422] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to investigate the efficiency and cancer detection of magnetic resonance imaging (MRI) / ultrasonography (US) fusion-guided prostate biopsy in a cohort of biopsy-naive men compared with standard-of-care systematic extended sextant transrectal ultrasonography (TRUS)-guided biopsy. METHODS From 2014 to 2016, 72 biopsy-naive men referred for initial prostate cancer evaluation who underwent MRI of the prostate were prospectively evaluated. Retrospective review was performed on 69 patients with lesions suspicious for malignancy who underwent MRI/US fusion-guided biopsy in addition to systematic extended sextant biopsy. Biometric, imaging, and pathology data from both the MRI-targeted biopsies and systematic biopsies were analyzed and compared. RESULTS There were no significant differences in overall prostate cancer detection when comparing MRI-targeted biopsies to standard systematic biopsies (P = 0.39). Furthermore, there were no significant differences in the distribution of severity of cancers based on grade groups in cases with cancer detection (P = 0.68). However, significantly fewer needle cores were taken during the MRI/US fusion-guided biopsy compared with systematic biopsy (63% less cores sampled, P < 0.001) CONCLUSION: In biopsy-naive men, MRI/US fusion-guided prostate biopsy offers equal prostate cancer detection compared with systematic TRUS-guided biopsy with significantly fewer tissue cores using the targeted technique. This approach can potentially reduce morbidity in the future if used instead of systematic biopsy without sacrificing the ability to detect prostate cancer, particularly in cases with higher grade disease.
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Affiliation(s)
- Vidhush K Yarlagadda
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Win Shun Lai
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Department of Pathology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - John V Thomas
- Department of Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Department of Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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Goldman H, Singh N, Harding C, McGirr J, Seal A, Duncan I, Sowter S. Accuracy of multiparametric magnetic resonance imaging to detect significant prostate cancer and index lesion location. ANZ J Surg 2018; 89:106-110. [DOI: 10.1111/ans.14754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 05/02/2018] [Accepted: 06/01/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Hariette Goldman
- School of Medicine; The University of Notre Dame Australia; Sydney New South Wales Australia
- Rural Clinical School; The University of New South Wales; Wagga Wagga New South Wales Australia
| | - Neha Singh
- Rural Clinical School; The University of New South Wales; Wagga Wagga New South Wales Australia
- Wagga Wagga Base Hospital; Wagga Wagga New South Wales Australia
- Calvary Healthcare Regional Imaging; Wagga Wagga New South Wales Australia
| | - Catherine Harding
- School of Medicine; The University of Notre Dame Australia; Sydney New South Wales Australia
| | - Joe McGirr
- School of Medicine; The University of Notre Dame Australia; Sydney New South Wales Australia
| | - Alexa Seal
- School of Medicine; The University of Notre Dame Australia; Sydney New South Wales Australia
| | - Ian Duncan
- Calvary Healthcare Regional Imaging; Wagga Wagga New South Wales Australia
| | - Steven Sowter
- Rural Clinical School; The University of New South Wales; Wagga Wagga New South Wales Australia
- Wagga Wagga Base Hospital; Wagga Wagga New South Wales Australia
- Riverina Urology; Wagga Wagga New South Wales Australia
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McDonald AM, Dobelbower MC, Yang ES, Clark GM, Jacob R, Kim RY, Cardan RA, Popple R, Nix JW, Rais-Bahrami S, Fiveash JB. Prostate Stereotactic Body Radiation Therapy With a Focal Simultaneous Integrated Boost: Acute Toxicity and Dosimetry Results From a Prospective Trial. Adv Radiat Oncol 2019; 4:90-5. [PMID: 30706015 DOI: 10.1016/j.adro.2018.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/23/2018] [Accepted: 09/10/2018] [Indexed: 12/15/2022] Open
Abstract
Purpose This study aimed to report the early toxicity results of a prospective clinical trial of prostate stereotactic body radiation therapy (SBRT) to the entire prostate with a simultaneous integrated boost (SIB) to magnetic resonance imaging (MRI)-defined focal lesions. Methods and materials Eligible patients included men with biopsy-proven prostate stage T1c to T2c adenocarcinoma, a Gleason score ≤7, and prostate-specific antigen values of ≤20 ng/mL, who had at least 1 focal lesion visible on MRI and a total prostate volume no greater than 120 cm3. SBRT consisted of a dose of 36.25 Gy to the entire prostate with an SIB of 40 Gy to the MRI-defined lesions, delivered in 5 fractions. The primary purpose of the study was to confirm the feasibility of treatment planning/delivery and to estimate the rate of urinary retention requiring placement of a Foley catheter within 90 days of treatment. This study was to be considered successful if urinary retention occurred in no more than 15% of cases, with a planned enrollment of at least 25 patients. Results A total of 26 men were enrolled, and all underwent SBRT as planned. Twenty patients (77%) had intermediate-risk features, and the remainder were low risk. A treatment plan that met the protocol-defined goals for all cases was developed. Two patients (7.7%) developed acute urinary symptoms that required the temporary placement of a Foley catheter. No grade 3+ toxicity events were observed. Conclusions Planning and delivery of prostate SBRT with a whole prostate dose of 36.25 Gy and a focal 40 Gy SIB is feasible. Early follow-up suggests that this treatment is not associated with undue morbidity.
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Gaur S, Lay N, Harmon SA, Doddakashi S, Mehralivand S, Argun B, Barrett T, Bednarova S, Girometti R, Karaarslan E, Kural AR, Oto A, Purysko AS, Antic T, Magi-Galluzzi C, Saglican Y, Sioletic S, Warren AY, Bittencourt L, Fütterer JJ, Gupta RT, Kabakus I, Law YM, Margolis DJ, Shebel H, Westphalen AC, Wood BJ, Pinto PA, Shih JH, Choyke PL, Summers RM, Turkbey B. Can computer-aided diagnosis assist in the identification of prostate cancer on prostate MRI? a multi-center, multi-reader investigation. Oncotarget 2018; 9:33804-33817. [PMID: 30333911 PMCID: PMC6173466 DOI: 10.18632/oncotarget.26100] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/23/2018] [Indexed: 12/31/2022] Open
Abstract
For prostate cancer detection on prostate multiparametric MRI (mpMRI), the Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2) and computer-aided diagnosis (CAD) systems aim to widely improve standardization across radiologists and centers. Our goal was to evaluate CAD assistance in prostate cancer detection compared with conventional mpMRI interpretation in a diverse dataset acquired from five institutions tested by nine readers of varying experience levels, in total representing 14 globally spread institutions. Index lesion sensitivities of mpMRI-alone were 79% (whole prostate (WP)), 84% (peripheral zone (PZ)), 71% (transition zone (TZ)), similar to CAD at 76% (WP, p=0.39), 77% (PZ, p=0.07), 79% (TZ, p=0.15). Greatest CAD benefit was in TZ for moderately-experienced readers at PI-RADSv2 <3 (84% vs mpMRI-alone 67%, p=0.055). Detection agreement was unchanged but CAD-assisted read times improved (4.6 vs 3.4 minutes, p<0.001). At PI-RADSv2 ≥ 3, CAD improved patient-level specificity (72%) compared to mpMRI-alone (45%, p<0.001). PI-RADSv2 and CAD-assisted mpMRI interpretations have similar sensitivities across multiple sites and readers while CAD has potential to improve specificity and moderately-experienced radiologists' detection of more difficult tumors in the center of the gland. The multi-institutional evidence provided is essential to future prostate MRI and CAD development.
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Affiliation(s)
- Sonia Gaur
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nathan Lay
- Imaging Biomarkers and Computer-aided Diagnosis Lab, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Stephanie A. Harmon
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Clinical Research Directorate/ Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Sreya Doddakashi
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sherif Mehralivand
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Burak Argun
- Department of Urology, Acibadem University, Istanbul, Turkey
| | - Tristan Barrett
- Department of Radiology, University of Cambridge, Cambridge, UK
| | | | | | | | - Ali Riza Kural
- Department of Urology, Acibadem University, Istanbul, Turkey
| | - Aytekin Oto
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | | | - Tatjana Antic
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | | | - Yesim Saglican
- Department of Pathology, Acibadem University, Istanbul, Turkey
| | | | - Anne Y. Warren
- Department of Pathology, University of Cambridge, Cambridge, UK
| | | | | | - Rajan T. Gupta
- Department of Radiology, Duke University, Durham, NC, USA
| | - Ismail Kabakus
- Department of Radiology, Hacettepe University, Ankara, Turkey
| | - Yan Mee Law
- Department of Radiology, Singapore General Hospital, Singapore
| | | | - Haytham Shebel
- Department of Radiology, Mansoura University, Mansoura, Egypt
| | - Antonio C. Westphalen
- UCSF Department of Radiology, University of California-San Francisco, San Francisco, CA, USA
| | - Bradford J. Wood
- Center for Interventional Oncology, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joanna H. Shih
- Biometric Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter L. Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ronald M. Summers
- Imaging Biomarkers and Computer-aided Diagnosis Lab, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Glaser ZA, Porter KK, Thomas JV, Gordetsky JB, Rais-Bahrami S. MRI findings guiding selection of active surveillance for prostate cancer: a review of emerging evidence. Transl Androl Urol 2018; 7:S411-S419. [PMID: 30363494 PMCID: PMC6178314 DOI: 10.21037/tau.2018.03.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Active surveillance (AS) for prostate cancer (PCa) is generally considered to be a safe strategy for men with low-risk, localized disease. However, as many as 1 in 4 patients may be incorrectly classified as AS-eligible using traditional inclusion criteria. The use of multiparametric magnetic resonance imaging (mpMRI) may offer improved risk stratification in both the initial diagnostic and disease monitoring setting. We performed a review of recently published studies to evaluate the utility of this imaging modality for this clinical setting. An English literature search was conducted on PubMed for original investigations on localized PCa, AS, and magnetic resonance imaging. Our Boolean criteria included the following terms: PCa, AS, imaging, MRI, mpMRI, prospective, retrospective, and comparative. Our search excluded publication types such as comments, editorials, guidelines, reviews, or interviews. Our literature review identified 71 original investigations. Among these, 52 met our inclusion criteria. Evidence suggests mpMRI improves characterization of clinically significant prostate cancer (csPCa) foci, and the enhanced detection and risk-stratification afforded by this modality may keep men from being inappropriately placed on AS. Use of serial mpMRI may also permit longer intervals between confirmatory biopsies. Multiple studies demonstrate the benefit of MRI-targeted biopsies. The use of mpMRI of the prostate offers improved confidence in risk-stratification for men with clinically low-risk PCa considering AS. While on AS, serial mpMRI and MRI-targeted biopsy aid in the detection of aggressive disease transformation or foci of clinically-significant cancer undetected on prior biopsy sessions.
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Affiliation(s)
- Zachary A Glaser
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John V Thomas
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Patel N, Halpern JA, Kasabwala K, Cricco-Lizza E, Herman M, Margolis D, Xu C, Robinson BD, Wang Y, McClure T, Hu JC. Multiple Regions of Interest on Multiparametric Magnetic Resonance Imaging are Not Associated with Increased Detection of Clinically Significant Prostate Cancer on Fusion Biopsy. J Urol 2018. [DOI: 10.1016/j.juro.2018.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Neal Patel
- Department of Urology, Weill Cornell Medicine, New York, New York
| | | | | | | | - Michael Herman
- Division of Urology, South Nassau Communities Hospital, Oceanside, New York
| | - Daniel Margolis
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Chris Xu
- School of Applied and Engineering Physics, Cornell University, Ithaca, New York
| | - Brian D. Robinson
- Department of Urology, Weill Cornell Medicine, New York, New York
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Yi Wang
- Department of Radiology, Weill Cornell Medicine, Cornell University, New York, New York
| | - Timothy McClure
- Department of Urology, Weill Cornell Medicine, New York, New York
| | - Jim C. Hu
- Department of Urology, Weill Cornell Medicine, New York, New York
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Dix DB, McDonald AM, Gordetsky JB, Nix JW, Thomas JV, Rais-Bahrami S. How Would MRI-targeted Prostate Biopsy Alter Radiation Therapy Approaches in Treating Prostate Cancer? Urology 2018; 122:139-146. [PMID: 30172834 DOI: 10.1016/j.urology.2018.08.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine if magnetic resonance imaging (MRI)/ultrasound fusion-targeted prostate biopsy (TB) would lead to increased recommendations of aggressive radiotherapy treatments for higher risk prostate cancer compared to systematic biopsy (SB) results. METHODS Clinicopathologic data of 533 men who underwent both TB and SB from 2014 to 2017 was analyzed. TB was performed in addition to SB in patients with detection of MRI suspicious lesions. Three patient cohorts were established: (1) biopsy naïve (80/533, 15.0%), (2) active surveillance (185/533, 34.7%), and (3) prior negative biopsy (268/533, 50.3%). Cancer risk categorical criteria were established with recommended radiotherapy treatment for each. Variation of risk classification due to biopsy method for all patients and within each cohort was analyzed using either a chi-squared statistic or Fisher's exact test. McNemar's pairwise analyses were performed for all risk categories between TB and SB to assess the effects of TB on high-risk cancer identification and subsequent radiotherapy recommendations. RESULTS Number of patients within cancer risk categories (1. "No Cancer or Low-Risk"; 2. "More Favorable Intermediate-Risk"; 3. "Less Favorable Intermediate-Risk"; 4. "High-Risk") varied significantly based on TB and SB pathology among all patients combined (P <.0001), in cohort 2 (P = .0005), and in cohort 3 (P <0.0001). Further, among all patients, TB increased cancer risk classification and correspondingly would result in more aggressive radiotherapy recommendations: "No Cancer or Low-Risk" to "Less Favorable Intermediate-Risk" (30/343, P <0.0001) and "No Cancer or Low-Risk" to "High-Risk" (31/353, P <.0001). CONCLUSION Among men with prostate cancer, TB commonly led to reclassification to a higher risk group, which is accompanied by more aggressive radiotherapy treatment recommendations when compared with SB findings alone.
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Affiliation(s)
- Daniel B Dix
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | - Andrew M McDonald
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL; Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | - John V Thomas
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL.
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Pal RP, Ahmad R, Trecartan S, Voss J, Ahmed S, Bazo A, Lloyd J, Walton TJ. A Single Center Evaluation of the Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging against Transperineal Prostate Mapping Biopsy: An Analysis of Men with Benign Histology and Insignificant Cancer following Transrectal Ultrasound Biopsy. J Urol 2018; 200:302-8. [DOI: 10.1016/j.juro.2018.02.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 11/23/2022]
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40
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Thai JN, Narayanan HA, George AK, Siddiqui MM, Shah P, Mertan FV, Merino MJ, Pinto PA, Choyke PL, Wood BJ, Turkbey B. Validation of PI-RADS Version 2 in Transition Zone Lesions for the Detection of Prostate Cancer. Radiology 2018; 288:485-491. [PMID: 29786491 PMCID: PMC6071681 DOI: 10.1148/radiol.2018170425] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose To determine the association between Prostate Imaging Reporting and Data System (PI-RADS) version 2 scores and prostate cancer (PCa) in a cohort of patients undergoing biopsy of transition zone (TZ) lesions. Materials and Methods A total of 634 TZ lesions in 457 patients were identified from a prospectively maintained database of consecutive patients undergoing prostate magnetic resonance imaging. Prostate lesions were retrospectively categorized with the PI-RADS version 2 system by two readers in consensus who were blinded to histopathologic findings. The proportion of cancer detection for all PCa and for clinically important PCa (Gleason score ≥3+4) for each PI-RADS version 2 category was determined. The performance of PI-RADS version 2 in cancer detection was evaluated. Results For PI-RADS category 2 lesions, the overall proportion of cancers was 4% (one of 25), without any clinically important cancer. For PI-RADS category 3, 4, and 5 lesions, the overall proportion of cancers was 22.2% (78 of 352), 39.1% (43 of 110), and 87.8% (129 of 147), respectively, and the proportion of clinically important cancers was 11.1% (39 of 352), 29.1% (32 of 110), and 77.6% (114 of 147), respectively. Higher PI-RADS version 2 scores were associated with increasing likelihood of the presence of clinically important PCa (P < .001). Differences were found in the percentage of cancers in the PI-RADS category between PI-RADS 3 and those upgraded to PI-RADS 4 based on diffusion-weighted imaging for clinically important cancers (proportion for clinically important cancers for PI-RADS 3 and PI-RADS 3+1 were 11.1% [39 of 352] and 30.8% [28 of 91], respectively; P < .001). Conclusion Higher PI-RADS version 2 scores are associated with a higher proportion of clinically important cancers in the TZ. PI-RADS category 2 lesions rarely yield PCa, and their presence does not justify targeted biopsy.
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Affiliation(s)
- Janice N. Thai
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Harish A. Narayanan
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Arvin K. George
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - M. Minhaj Siddiqui
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Parita Shah
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Francesca V. Mertan
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Maria J. Merino
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Peter A. Pinto
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Peter L. Choyke
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Bradford J. Wood
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
| | - Baris Turkbey
- From the Center for Interventional Oncology (J.N.T., H.A.N., P.S.,
B.J.W.), Molecular Imaging Program (F.V.M., P.L.C., B.T.), Laboratory of
Pathology (M.J.M.), and Urologic Oncology Branch (P.A.P.), National Cancer
Institute and Clinical Center, National Institutes of Health, 10 Center Dr,
Building 10, MSC 1182, Room B3B85, Bethesda, MD 20892; Department of Urology,
University of Michigan Health System, Ann Arbor, Mich (A.K.G.); and Department
of Surgery, Division of Urology, University of Maryland Medical Center,
Baltimore, Md (M.M.S.)
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Coker MA, Glaser ZA, Gordetsky JB, Thomas JV, Rais-Bahrami S. Targets missed: predictors of MRI-targeted biopsy failing to accurately localize prostate cancer found on systematic biopsy. Prostate Cancer Prostatic Dis 2018; 21:549-55. [PMID: 29988101 DOI: 10.1038/s41391-018-0062-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/15/2018] [Accepted: 04/21/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided biopsy has improved the ability to localize and detect prostate cancer (PCa) with efficiency surpassing systematic biopsy. Nevertheless, some patients have PCa missed using the MRI-targeted biopsy sampling alone. We aim to identify clinical and imaging parameters associated with cases where targeted biopsy did not detect PCa compared to systematic biopsy. METHODS We conducted a retrospective review of patients who underwent MRI/US fusion-guided biopsy in addition to concurrent systematic, extended-sextant biopsy between 2014 and 2017. For patients with PCa detected on systematic biopsy not properly localized by MRI/US fusion-guided biopsy, the sextant distance from MRI-targeted lesion to the cancer-positive sextant was calculated and parameters potentially predicting this targeting miss were evaluated. RESULTS In all, 35/127 (27.6%) patients with single-session MRI/US fusion-guided biopsy plus standard biopsy finding PCa had lesions incorrectly localized. Of these, 15/35 (42.9%) were identified as possible fusion-software misregistrations. The remainder, 12/35 (34.3%), represented targeted biopsies one sextant away from the cancer focus and 8/35 (22.9%) targeted biopsies two sextants away from the cancer focus. Only 7/35 (20.0%) patients were determined to have clinically significant PCa, which represents 7/127 (5.5%) of the overall population. Lower MRI lesion volumes (p = 0.022), lesion density (p < 0.001), and PI-RADS scores (p < 0.001) were significantly associated with targeted biopsy missing PCa detected on systematic biopsy. CONCLUSION Clinically significant PCa is rarely missed utilizing MRI/US fusion-guided biopsy. With the majority of missed tumors representing targeting misregistrations or cases of low-grade cancer in sextants immediately adjacent to MRI suspicious lesions. Lower MRI lesion volumes, lesion density, and PI-RADS are predictors of cases with targeted biopsies missing cancer, for which systematic sampling of the sextants containing MRI targets and adjacent sextants would most optimize PCa detection.
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Gordetsky JB, Schultz L, Porter KK, Nix JW, Thomas JV, del Carmen Rodriguez Pena M, Rais-bahrami S. Defining the optimal method for reporting prostate cancer grade and tumor extent on magnetic resonance/ultrasound fusion–targeted biopsies. Hum Pathol 2018; 76:68-75. [DOI: 10.1016/j.humpath.2018.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/20/2018] [Accepted: 03/07/2018] [Indexed: 11/20/2022]
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Rayn KN, Bloom JB, Gold SA, Hale GR, Baiocco JA, Mehralivand S, Czarniecki M, Sabarwal VK, Valera V, Wood BJ, Merino MJ, Choyke P, Turkbey B, Pinto PA. Added Value of Multiparametric Magnetic Resonance Imaging to Clinical Nomograms for Predicting Adverse Pathology in Prostate Cancer. J Urol 2018; 200:1041-1047. [PMID: 29852182 DOI: 10.1016/j.juro.2018.05.094] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE We examined the additional value of preoperative prostate multiparametric magnetic resonance imaging and transrectal ultrasound/multiparametric magnetic resonance imaging fusion guided targeted biopsy when performed in combination with clinical nomograms to predict adverse pathology at radical prostatectomy. MATERIALS AND METHODS We identified all patients who underwent 3 Tesla multiparametric magnetic resonance imaging prior to fusion biopsy and radical prostatectomy. The Partin and the MSKCC (Memorial Sloan Kettering Cancer Center) preradical prostatectomy nomograms were applied to estimate the probability of organ confined disease, extraprostatic extension, seminal vesicle invasion and lymph node involvement using transrectal ultrasound guided systematic biopsy and transrectal ultrasound/multiparametric magnetic resonance imaging fusion guided targeted biopsy Gleason scores. With radical prostatectomy pathology as the gold standard we developed multivariable logistic regression models based on these nomograms before and after adding multiparametric magnetic resonance imaging to assess any additional predictive ability. RESULTS A total of 532 patients were included in study. When multiparametric magnetic resonance imaging findings were added to the systematic biopsy based MSKCC nomogram, the AUC increased by 0.10 for organ confined disease (p <0.001), 0.10 for extraprostatic extension (p = 0.003), 0.09 for seminal vesicle invasion (p = 0.011) and 0.06 for lymph node involvement (p = 0.120). Using Gleason scores derived from targeted biopsy compared to systematic biopsy provided an additional predictive value of organ confined disease (Δ AUC 0.07, p = 0.003) and extraprostatic extension (Δ AUC 0.07, p = 0.048) at radical prostatectomy with the MSKCC nomogram. Similar results were obtained using the Partin nomogram. CONCLUSIONS Magnetic resonance imaging alone or in addition to standard clinical nomograms provides significant additional predictive ability of adverse pathology at the time of radical prostatectomy. This information can be greatly beneficial to urologists for preoperative planning and for counseling patients regarding the risks of future therapy.
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Affiliation(s)
- Kareem N Rayn
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jonathan B Bloom
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Samuel A Gold
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Graham R Hale
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Joseph A Baiocco
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sherif Mehralivand
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Department of Urology and Pediatric Urology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marcin Czarniecki
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Vikram K Sabarwal
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Vladimir Valera
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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Sidana A, Watson MJ, George AK, Rastinehad AR, Vourganti S, Rais-Bahrami S, Muthigi A, Maruf M, Gordetsky JB, Nix JW, Merino MJ, Turkbey B, Choyke PL, Wood BJ, Pinto PA. Fusion prostate biopsy outperforms 12-core systematic prostate biopsy in patients with prior negative systematic biopsy: A multi-institutional analysis. Urol Oncol 2018; 36:341.e1-341.e7. [PMID: 29753548 DOI: 10.1016/j.urolonc.2018.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/23/2018] [Accepted: 04/05/2018] [Indexed: 10/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES Patients with persistently elevated prostate specific antigen (PSA) and prior negative 12-core TRUS prostate biopsy (or biopsies) (systematic biopsy-SBx) are a diagnostic challenge. Repeat SBx or saturation biopsy in this cohort has been shown to have an even lower yield. The aim of our study is to compare the prostate cancer yield of magnetic resonance imaging (MRI) fusion biopsy (FBx) to SBx in a multi-institutional cohort comprised of patients with prior negative biopsies. METHODS A multi-institutional review was performed on patients with a history of one or more prior negative SBx who underwent multiparametric MRI (mpMRI), followed by FBx and SBx in the same session. Imaging protocol was standardized across institutions and institutional genitourinary radiologists and pathologists reviewed mpMRI and pathology, respectively. Gleason score (GS) distribution and risk classifications were recorded. Prostate cancer with GS ≥3 + 4 was defined as clinically significant (CS). Univariate and multivariable logistic regression was done to identify predictors of cancer detection on SBx and FBx. RESULTS Seven-hundred seventy-nine patients from four institutions were included in the study. Median age and prostate specific antigen (IQR) were 63.1 (58.5-68.0) years and 8.5 (5.9-13.1)ng/dl, respectively. Median number of prior negative biopsies (range) was 2.0 (1-16). The cancer detection rate (CDR) in the cohort was 346/779 patients (44.4%). Total CS CDR was 30.7% (239/779 patients), with FBx detecting 26.3% (205/779) of patients with CS disease and SBx diagnosing an additional 4.4% (34/779) of patients (P<0.001). Furthermore, of all cancers detected by each modality, FBx detected a higher proportion of CS cancer compared to SBx (one negative biopsy: 75 vs. 50%, P<0.001, 2-3 negative biopsy: 76 vs. 61%, P = 0.006, 4 or more negative biopsies: 84 vs. 52%, P = 0.006). As such, SBx added a relatively small diagnostic value to FBx for detecting CS disease (one negative biopsy 3.5%, 2-3 negative biopsies 5%, 4 or more negative biopsies: 1%). FBx also outperformed SBx for upgrading patients to an intermediate or high-risk cancer category (GS>6) (one negative biopsy 11.5% vs. 3.6%, 2-3 negative biopsy 10.3% vs. 5.3%, 4 or more negative biopsies 19.1% vs. 1.1%). On multivariable analysis, the number of prior negative biopsies was a significant negative predictor of CS CDR on SBx (P = 0.006), but not on FBx (P = 0.151). CONCLUSIONS Using a large multi-institutional cohort, we were able to demonstrate that FBx outperformed SBx in patients with prior negative systematic biopsy. This was due, in part, to the decreasing CS CDR by SBx with increased number of prior biopsies. The yield of FBx stayed constant and did not decrease with increased number of prior negative biopsies. Therefore, repeat SBx alone in patients with multiple prior negative biopsies will be hindered by lower yield and FBx should be utilized concurrently in these patients.
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Affiliation(s)
- Abhinav Sidana
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Division of Urology, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Matthew J Watson
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Urology, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN
| | - Arvin K George
- Department of Urology, University of Michigan, Ann Arbor, MI
| | | | - Srinivas Vourganti
- Department of Urology, State University of New York (SUNY) Upstate Medical University, Syracuse, NY; Department of Urology, Rush University Medical Center, Chicago, IL
| | | | - Akhil Muthigi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Urology, Georgetown University Hospital, Washington, DC
| | - Mahir Maruf
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | - Maria J Merino
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, MD
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Gordetsky JB, Saylor B, Bae S, Nix JW, Rais-Bahrami S. Prostate cancer management choices in patients undergoing multiparametric magnetic resonance imaging/ultrasound fusion biopsy compared to systematic biopsy. Urol Oncol 2018. [DOI: 10.1016/j.urolonc.2018.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Coker MA, Dulaney C, McDonald A, Nix JW, Gordetsky JB, Yang ES, Dobelbower MC, Rais-Bahrami S. Stereotactic Radiosurgery for Prostate Cancer Following Magnetic Resonance Imaging Directed Biopsy: A Multidisciplinary Approach with Case Examples. Cureus 2018; 10:e2524. [PMID: 29942727 PMCID: PMC6015993 DOI: 10.7759/cureus.2524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Classically, prostate cancer has been diagnosed via systematic, transrectal ultrasound-guided biopsy prompted by an abnormal digital rectal exam or elevated serum prostate-specific antigen (PSA) level. The development of multi-parametric magnetic resonance imaging (MRI) has led to improved detection of prostate cancer foci. For patients with clinically localized prostate cancer seeking definitive therapy through radiation therapy, external beam radiation has been a mainstay with a movement toward hypofractionation, notably prostate stereotactic body radiotherapy (SBRT). We aim to describe the practical aspects of establishing a multidisciplinary, MRI-based prostate SBRT program by means of case examples. The prostate SBRT team at the University of Alabama at Birmingham has been performing prostate SBRT for over four years using a multidisciplinary workflow. We have additionally completed a phase II trial of prostate SBRT with additional targeting of intraprostatic lesions with higher doses of radiation using a simultaneous integrated boost technique. While there have been no reported randomized trials of prostate SBRT, this treatment has been proven safe and effective for properly selected patients with low and intermediate-risk prostate cancer. We present our multidisciplinary approach to prostate SBRT with two clinical cases targeting high-risk [MAM1] lesions in different anatomic zones of the prostate highlighting pertinent clinical challenges in successfully delivering prostate SBRT and managing potential side effects. In conclusion, we report a multidisciplinary, MRI-based approach to treating patients with ultra hyperfractionated stereotactic radiosurgery as primary definitive treatment for prostate cancer.
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Affiliation(s)
| | - Caleb Dulaney
- Department of Radiation Oncology, University of Alabama at Birmingham
| | - Andrew McDonald
- Department of Radiation Oncology, University of Alabama at Birmingham
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham
| | | | - Eddy S Yang
- Department of Radiation Oncology, University of Alabama at Birmingham
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Gaur S, Harmon S, Mehralivand S, Bednarova S, Calio BP, Sugano D, Sidana A, Merino MJ, Pinto PA, Wood BJ, Shih JH, Choyke PL, Turkbey B. Prospective comparison of PI-RADS version 2 and qualitative in-house categorization system in detection of prostate cancer. J Magn Reson Imaging 2018; 48:1326-1335. [PMID: 29603833 DOI: 10.1002/jmri.26025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 03/12/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Prostate Imaging-Reporting and Data System v. 2 (PI-RADSv2) provides standardized nomenclature for interpretation of prostate multiparametric MRI (mpMRI). Inclusion of additional features for categorization may provide benefit to stratification of disease. PURPOSE To prospectively compare PI-RADSv2 to a qualitative in-house system for detecting prostate cancer on mpMRI. STUDY TYPE Prospective. POPULATION In all, 338 patients who underwent mpMRI May 2015-May 2016, with subsequent MRI/transrectal ultrasound fusion-guided biopsy. FIELD STRENGTH 3T mpMRI (T2 W, diffusion-weighted [DW], apparent diffusion coefficient [ADC] map, b-2000 DWI acquisition, and dynamic contrast-enhanced [DCE] MRI). ASSESSMENT One genitourinary radiologist prospectively read mpMRIs using both in-house and PI-RADSv2 5-category systems. STATISTICAL TEST In lesion-based analysis, overall and clinically significant (CS) tumor detection rates (TDR) were calculated for all PI-RADSv2 and in-house categories. The ability of each scoring system to detect cancer was assessed by area under receiver operator characteristic curve (AUC). Within each PI-RADSv2 category, lesions were further stratified by their in-house categories to determine if TDRs can be increased by combining features of both systems. RESULTS In 338 patients (median prostate-specific antigen [PSA] 6.5 [0.6-113.6] ng/mL; age 64 [44-84] years), 733 lesions were identified (47% tumor-positive). Predictive abilities of both systems were comparable for all (AUC 76-78%) and CS cancers (AUCs 79%). The in-house system had higher overall and CS TDRs than PI-RADSv2 for categories 3 and 4 (P < 0.01 for both), with the greatest difference between the scoring systems seen in lesions scored category 4 (CS TDRs: in-house 65%, PI-RADSv2 22.1%). For lesions categorized as PI-RADSv2 = 4, characterization of suspicious/indeterminate extraprostatic extension (EPE) and equivocal findings across all mpMRI sequences contributed to significantly different TDRs for both systems (TDR range 19-75%, P < 0.05). DATA CONCLUSION PI-RADSv2 behaves similarly to an existing validated system that relies on the number of sequences on which a lesion is seen. This prospective evaluation suggests that sequence positivity and suspicion of EPE can enhance PI-RADSv2 category 4 cancer detection. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1326-1335.
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Affiliation(s)
- Sonia Gaur
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Stephanie Harmon
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, Maryland, USA.,Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, 21702
| | - Sherif Mehralivand
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Sandra Bednarova
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Brian P Calio
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Dordaneh Sugano
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Abhinav Sidana
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Maria J Merino
- Department of Pathology, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Bradford J Wood
- Center for Interventional Oncology, Clinical Center, NIH, Bethesda, Maryland, USA
| | - Joanna H Shih
- Biometric Research Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, Maryland, USA
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Abstract
Prostate cancer is characterized by a complex set of heterogeneous disease states. This review aims to describe how imaging has been studied within each specific state. As physicians transition into an era of precision medicine, multiparametric magnetic resonance imaging (mpMRI) is proving to be a powerful tool leading the way for a paradigm shift in the diagnosis and management of localized prostate cancer. With further research and development, molecular imaging modalities will likely change the way we approach recurrent and metastatic disease. Given the range of possible oncological progression patterns, a thorough understanding of the underlying carcinogenesis, as it relates to imaging, is a requisite if we are to appropriately manage prostate cancer in future decades.
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Affiliation(s)
- Eric T Miller
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Amirali Salmasi
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Robert E Reiter
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095.,Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
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Sherrer RL, Lai WS, Thomas JV, Nix JW, Rais-Bahrami S. Incidental findings on multiparametric MRI performed for evaluation of prostate cancer. Abdom Radiol (NY) 2018; 43:696-701. [PMID: 28677001 DOI: 10.1007/s00261-017-1237-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Multiparametric magnetic resonance imaging (mp-MRI) and MRI/Ultrasound (US) fusion-guided biopsy are relatively new techniques for improved detection, staging, and active surveillance of prostate cancer (PCa). As with all imaging modalities, MRI reveals incidental findings (IFs) which carry the risk of increased cost, patient anxiety, and iatrogenic morbidity due to workup of IFs. Herein, we report the IFs from 684 MRIs for evaluation of PCa and consider their characteristics and clinical significance. METHODS Patients underwent mp-MRI prostate protocol incorporating triplanar T2-weighted, diffusion-weighted, and dynamic contrast-enhanced pelvic MRI as well as a post-contrast abdominopelvic MRI with the primary indication of detection or evaluation of PCa. A total of 684 consecutive prostate MRI reports performed in a series of 580 patients were reviewed. All extraprostatic findings reported were logged and then categorized by organ system and potential clinical significance. RESULTS There were 349 true IFs found in 233 (40%) of the 580 patients. One hundred nineteen additional extraprostatic findings were unsuspected but directly related to PCa staging, while the 349 IFs were unrelated and thus truly incidental beyond study indication. While the majority of true IFs were non-urologic, only 6.6% of IFs were considered clinically significant, non-urologic findings, and more than a third of MRI reports had urologic IFs not related to PCa. CONCLUSIONS Rates of incidental findings on prostate indication MRI are similar to other abdominopelvic imaging studies. However, only 6.6% of the IFs were considered to be clinically significant non-urologic findings. Further investigations are needed to assess downstream workup of these IFs and resulting costs.
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50
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Galgano SJ, Glaser ZA, Porter KK, Rais-Bahrami S. Role of Prostate MRI in the Setting of Active Surveillance for Prostate Cancer. Advances in Experimental Medicine and Biology 2018; 1096:49-67. [DOI: 10.1007/978-3-319-99286-0_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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