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Englman C, Barrett T, Moore CM, Giganti F. Active Surveillance for Prostate Cancer: Expanding the Role of MR Imaging and the Use of PRECISE Criteria. Radiol Clin North Am 2024; 62:69-92. [PMID: 37973246 DOI: 10.1016/j.rcl.2023.06.009] [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: 11/19/2023]
Abstract
Multiparametric magnetic resonance (MR) imaging has had an expanding role in active surveillance (AS) for prostate cancer. It can improve the accuracy of prostate biopsies, assist in patient selection, and help monitor cancer progression. The PRECISE recommendations standardize reporting of serial MR imaging scans during AS. We summarize the evidence on MR imaging-led AS and provide a clinical primer to help report using the PRECISE criteria. Some limitations to both serial imaging and the PRECISE recommendations must be considered as we move toward a more individualized risk-stratified approach to AS.
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Affiliation(s)
- Cameron Englman
- Department of Radiology, University College London Hospital NHS Foundation Trust, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK; Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK
| | - Tristan Barrett
- Department of Radiology, University of Cambridge, Box 218, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK; Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Box 218, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK; Department of Urology, University College London Hospital NHS Foundation Trust, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK; Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley Street, London, W1W7TY, UK.
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Aerts J, Hendrickx S, Berquin C, Lumen N, Verbeke S, Villeirs G, Van Praet C, De Visschere P. Clinical Application of the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation Score for Reporting Magnetic Resonance Imaging in Men on Active Surveillance for Prostate Cancer. EUR UROL SUPPL 2023; 56:39-46. [PMID: 37822515 PMCID: PMC10562144 DOI: 10.1016/j.euros.2023.08.006] [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] [Accepted: 08/16/2023] [Indexed: 10/13/2023] Open
Abstract
Background The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) score has been developed to standardise prostate magnetic resonance imaging (MRI) reporting in men on active surveillance (AS) for prostate cancer (PCa). Objective To evaluate the feasibility of PRECISE scoring and assess its diagnostic accuracy. Design setting and participants All PCa patients on AS with a baseline MRI and at least one follow-up MRI scan between January 2008 and September 2022 at a single tertiary referral centre were included in a database. The follow-up protocol of the Prostate Cancer International Active Surveillance (PRIAS) study was used. All scans were retrospectively re-reported by a dedicated uroradiologist and appointed a Prostate Imaging Reporting and Data System (version 2.1) and PRECISE score. Outcome measurements and statistical analysis Clinically significant progression was defined by histopathological upgrading (on biopsy or radical prostatectomy) to grade group ≥3 and/or evolution to T3 stage. A survival analysis was performed to assess differential progression-free survival (PFS) according to the PRECISE score. Results and limitations A total of 188 patients were included for an analysis with a total of 358 repeat MRI scans and 144 repeat biopsies. The median follow-up was 46 mo (interquartile range 21-74). Radiological progression (PRECISE 4-5) had sensitivity, specificity, negative predictive value, and positive predictive value of, respectively, 78%, 70%, 90%, and 49% for clinically significant progression. Four-year PFS was 91% for PRECISE 1-3 versus 66% for PRECISE 4-5 (p < 0.001). In total, 137 patients underwent a confirmation MRI scan within 18 mo after diagnosis. Four-year PFS in this group was 81% for PRECISE 1-3 versus 43% for PRECISE 4-5 (p < 0.001). Limitations include retrospective design and no strict adherence to AS protocol. Conclusions Implementation of PRECISE scoring for PCa patients on AS is feasible and offers a prognostic value. Patients with PRECISE score 4-5 on confirmation MRI within 18 mo after diagnosis have a three-fold higher risk of clinically significant progression after 4 yr. Patient summary Patients with low-risk prostate cancer can be followed up carefully. In this study, we evaluate the standardised reporting of repeat magnetic resonance imaging scans (using the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation [PRECISE] recommendations). PRECISE scoring is feasible and helps identify patients in need of further treatment.
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Affiliation(s)
- Jan Aerts
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Sigi Hendrickx
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Camille Berquin
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Nicolaas Lumen
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Sofie Verbeke
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Geert Villeirs
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Pieter De Visschere
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
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Harder FN, Heming CAM, Haider MA. mpMRI Interpretation in Active Surveillance for Prostate Cancer-An overview of the PRECISE score. Abdom Radiol (NY) 2023; 48:2449-2455. [PMID: 37160473 DOI: 10.1007/s00261-023-03912-2] [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] [Received: 02/28/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 05/11/2023]
Abstract
Active surveillance (AS) is now included in all major guidelines for patients with low-risk PCa and selected patients with intermediate-risk PCa. Several studies have highlighted the potential benefit of multiparametric magnetic resonance imaging (mpMRI) in AS and it has been adopted in some guidelines. However, uncertainty remains about whether serial mpMRI can help to safely reduce the number of required repeat biopsies under AS. In 2017, the European School of Oncology initiated the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) panel which proposed the PRECISE scoring system to assess the likelihood of radiological tumor progression on serial mpMRI. The PRECISE scoring system remains the only major system evaluated in multiple publications. In this review article, we discuss the current body of literature investigating the application of PRECISE as it is not as yet an established standard in mpMRI reporting. We delineate the strengths of PRECISE and its potential added value. Also, we underline potential weaknesses of the PRECISE scoring system, which might be tackled in future versions to further increase its value in AS.
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Affiliation(s)
- Felix N Harder
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, M5G 1X5, Canada
| | - Carolina A M Heming
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, M5G 1X5, Canada
- Radiology Department, Instituto Nacional do Cancer (INCa), Rio de Janeiro, Brazil
| | - Masoom A Haider
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
- Joint Department of Medical Imaging, University Health Network, Sinai Health System and University of Toronto, Toronto, ON, M5G 1X5, Canada.
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Abstract
Prostate MRI plays an important role in the clinical management of localized prostate cancer, mainly assisting in biopsy decisions and guiding biopsy procedures. The Prostate Imaging Reporting and Data System (PI-RADS) has been available to radiologists since 2012, with the most up-to-date and actively used version being PI-RADS version 2.1. This review article discusses the current use of PI-RADS, including its limitations and controversies, and summarizes research that aims to improve future iterations of this system.
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Affiliation(s)
- Baris Turkbey
- From the Molecular Imaging Branch, National Cancer Institute,
National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85,
Bethesda, MD 20892 (B.T.); and Section of Abdominal Imaging, Department of
Nuclear Radiology, Cleveland Clinic Imaging Institute, Cleveland, Ohio
(A.S.P.)
| | - Andrei S. Purysko
- From the Molecular Imaging Branch, National Cancer Institute,
National Institutes of Health, 10 Center Dr, MSC 1182, Building 10, Room B3B85,
Bethesda, MD 20892 (B.T.); and Section of Abdominal Imaging, Department of
Nuclear Radiology, Cleveland Clinic Imaging Institute, Cleveland, Ohio
(A.S.P.)
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Wang R, Pinto D, Liu T, Hamade M, Jubane M, Arif A, Boateng J, Maloney S, Amin A, Sandhu J, Nini S, Manov J, Tordjman L, Villavicencio J, Chamoun M, Leslom S, Aristizabal J, Felix M, Gomez-Rodriguez C, Alessandrino F. Effect of a dedicated PI-QUAL curriculum on the assessment of prostate MRI quality. Eur J Radiol 2023; 164:110865. [PMID: 37167684 DOI: 10.1016/j.ejrad.2023.110865] [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: 03/06/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE The Prostate Imaging Quality (PI-QUAL) score is a metric to evaluate the diagnostic quality of multiparametric magnetic resonance imaging (MRI) of the prostate. This study evaluated the impact of a prostate MRI quality training lecture on the participant's ability to assess prostate MRI image quality. METHODS Eighteen in-training-radiologists of varying experience in reviewing diagnostic prostate MRI assessed the image quality of ten examinations. Then, they attended a dedicated lecture on MRI quality assessment using the PI-QUAL score. After the lecture, the same participants evaluated the image quality of a new set of ten scans applying the PI-QUAL score. Results were assessed using receiver operating characteristic (ROC) analysis. The reference standard was the PI-QUAL score assessed by a fellowship trained abdominal radiologist with experience in reading prostate MRI. RESULTS There was a significant improvement in the average area under the curve (AUC) for assessment of prostate MRI image quality from baseline (0.82; [0.576 - 0.888]) to post teaching (1.0; [0.954-1]), with an improvement of 0.18 (p < 0.03). When ROC curves were computed for different cohorts stratified based on year of training, difference ranged from 0.48 for second year residents to 0.32 for fourth year residents (p < 0.001-0.01). For abdominal imaging fellows, the pre-teaching AUC was 0.9 [0.557-1] and post teaching AUC was 1 [0.957-1], a difference of 0.1 (p = 0.20). CONCLUSIONS A dedicated lecture on PI-QUAL improved the ability of radiologists-in-training to assess prostate MRI image quality, with variable impact depending on year of training.
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Affiliation(s)
- Richard Wang
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Denver Pinto
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - TianHao Liu
- Division of Biostatistics, Department of Public Health Science, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Mohamad Hamade
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Maverick Jubane
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Aazim Arif
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Joseph Boateng
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Sean Maloney
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Ayush Amin
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Jagteshwar Sandhu
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Saad Nini
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - John Manov
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Laura Tordjman
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Joseph Villavicencio
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Michelle Chamoun
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Salman Leslom
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Julieta Aristizabal
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Marcelo Felix
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Carolina Gomez-Rodriguez
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Francesco Alessandrino
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Leonard M. Miller School of Medicine, Miami, FL, USA; Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA.
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Giganti F, Cole AP, Fennessy FM, Clinton T, Moreira PLDF, Bernardes MC, Westin CF, Krishnaswamy D, Fedorov A, Wollin DA, Langbein B, Frego N, Labban M, Badaoui JS, Chang SL, Briggs LG, Tokuda J, Ambrosi A, Kirkham A, Emberton M, Kasivisvanathan V, Moore CM, Allen C, Tempany CM. Promoting the use of the PI-QUAL score for prostate MRI quality: results from the ESOR Nicholas Gourtsoyiannis teaching fellowship. Eur Radiol 2023; 33:461-471. [PMID: 35771247 PMCID: PMC9244244 DOI: 10.1007/s00330-022-08947-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The Prostate Imaging Quality (PI-QUAL) score is a new metric to evaluate the diagnostic quality of multiparametric magnetic resonance imaging (MRI) of the prostate. This study assesses the impact of an intervention, namely a prostate MRI quality training lecture, on the participant's ability to apply PI-QUAL. METHODS Sixteen participants (radiologists, urologists, physicists, and computer scientists) of varying experience in reviewing diagnostic prostate MRI all assessed the image quality of ten examinations from different vendors and machines. Then, they attended a dedicated lecture followed by a hands-on workshop on MRI quality assessment using the PI-QUAL score. Five scans assessed by the participants were evaluated in the workshop using the PI-QUAL score for teaching purposes. After the course, the same participants evaluated the image quality of a new set of ten scans applying the PI-QUAL score. Results were assessed using receiver operating characteristic analysis. The reference standard was the PI-QUAL score assessed by one of the developers of PI-QUAL. RESULTS There was a significant improvement in average area under the curve for the evaluation of image quality from baseline (0.59 [95 % confidence intervals: 0.50-0.66]) to post-teaching (0.96 [0.92-0.98]), an improvement of 0.37 [0.21-0.41] (p < 0.001). CONCLUSIONS A teaching course (dedicated lecture + hands-on workshop) on PI-QUAL significantly improved the application of this scoring system to assess the quality of prostate MRI examinations. KEY POINTS • A significant improvement in the application of PI-QUAL for the assessment of prostate MR image quality was observed after an educational intervention. • Appropriate training on image quality can be delivered to those involved in the acquisition and interpretation of prostate MRI. • Further investigation will be needed to understand the impact on improving the acquisition of high-quality diagnostic prostate MR examinations.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., W1W 7TS, London, UK.
| | - Alexander P Cole
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fiona M Fennessy
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy Clinton
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Mariana Costa Bernardes
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carl-Fredrik Westin
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Deepa Krishnaswamy
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andriy Fedorov
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel A Wollin
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bjoern Langbein
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicola Frego
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Muhieddine Labban
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joy S Badaoui
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven L Chang
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Logan G Briggs
- Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Junichi Tokuda
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Alex Kirkham
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., W1W 7TS, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., W1W 7TS, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., W1W 7TS, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clare M Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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