1
|
Gietelink L, Jansen BHE, Oprea-Lager DE, Nieuwenhuijzen JA, Vis AN. Preoperative multiparametric MRI does not lower positive surgical margin rate in a large series of patients undergoing robot-assisted radical prostatectomy. J Robot Surg 2021; 16:273-278. [PMID: 33811618 DOI: 10.1007/s11701-020-01184-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/20/2020] [Indexed: 11/30/2022]
Abstract
To optimize functional outcomes after robot-assisted radical prostatectomy (RARP), surgical preservation of the neurovascular bundle is desired. However, nerve-sparing surgery (NSS) is only feasible in the absence of extraprostatic tumour extension (T-stage 3) to avoid the risk of positive surgical margins (PSM). Multiparametric magnetic-resonance imaging (MRI) is increasingly performed for primary prostate cancer and provides information on local tumour stage. In this study, we evaluated whether the availability of information from MRI influenced the incidence of PSM. A total of 523 patients undergoing RARP for localized prostate cancer in a single Dutch reference centre for prostate-cancer surgery were retrospectively evaluated (2013-2017). Patient characteristics and postoperative outcomes were retrieved. Patients were stratified according to the presence of a preoperative MRI. The incidence of PSM and proportion of patients receiving NSS was analysed using Chi-square tests and logistic regression analysis. N = 139 of 523 (26.6%) patients had a preoperative MRI scan available. Patients with MRI had identical preoperative characteristics compared to the patients without MRI, except for a higher percentage of patients having a prostate-specific antigen value ≥ 20 ng/mL (20.1% versus 9.4%, p = 0.004). PSM were present in 107/384 (27.9%) patients without MRI compared to 36/139 (25.9%) patients with an MRI scan before surgery (p = 0.66). Unilateral NSS was performed more often in the MRI group (26.6% vs. 11.7%), but NSS on both sides was more frequently performed in patients without MRI (57.6% versus 69.8%) (p < 0.001). MRI was not associated with PSM in multivariate analysis (p = 0.265). Preoperative mpMRI imaging was not associated with lower rates of positive surgical margins in patients undergoing RARP for localized prostate cancer.
Collapse
Affiliation(s)
- L Gietelink
- Department of Urology, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Prostate Cancer Network, Amsterdam, The Netherlands.
| | - B H E Jansen
- Department of Urology, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - D E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - J A Nieuwenhuijzen
- Department of Urology, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - A N Vis
- Department of Urology, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Jansen BHE, Bodar YJL, Zwezerijnen GJC, Meijer D, van der Voorn JP, Nieuwenhuijzen JA, Wondergem M, Roeleveld TA, Boellaard R, Hoekstra OS, van Moorselaar RJA, Oprea-Lager DE, Vis AN. Pelvic lymph-node staging with 18F-DCFPyL PET/CT prior to extended pelvic lymph-node dissection in primary prostate cancer - the SALT trial. Eur J Nucl Med Mol Imaging 2021; 48:509-520. [PMID: 32789599 PMCID: PMC7835187 DOI: 10.1007/s00259-020-04974-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [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: 03/24/2020] [Accepted: 07/23/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE The detection of lymph-node metastases (N1) with conventional imaging such as magnetic resonance imaging (MRI) and computed tomography (CT) is inadequate for primarily diagnosed prostate cancer (PCa). Prostate-specific membrane antigen (PSMA) PET/CT is successfully introduced for the staging of (biochemically) recurrent PCa. Besides the frequently used 68gallium-labelled PSMA tracers, 18fluorine-labelled PSMA tracers are available. This study examined the diagnostic accuracy of 18F-DCFPyL (PSMA) PET/CT for lymph-node staging in primary PCa. METHODS This was a prospective, multicentre cohort study. Patients with primary PCa underwent 18F-DCFPyL PET/CT prior to robot-assisted radical prostatectomy (RARP) with extended pelvic lymph-node dissection (ePLND). Patients were included between October 2017 and January 2020. A Memorial Sloan Kettering Cancer Centre (MSKCC) nomogram risk probability of ≥ 8% of lymph-node metastases was set to perform ePLND. All images were reviewed by two experienced nuclear physicians, and were compared with post-operative histopathologic results. RESULTS A total of 117 patients was analysed. Lymph-node metastases (N1) were histologically diagnosed in 17/117 patients (14.5%). The sensitivity, specificity, positive predictive value and negative predictive value for the 18F-DCFPyL PET/CT detection of pelvic lymph-node metastases on a patient level were 41.2% (confidence interval (CI): 19.4-66.5%), 94.0% (CI 86.9-97.5%), 53.8% (CI 26.1-79.6%) and 90.4% (CI 82.6-95.0%), respectively. CONCLUSION 18F-DCFPyL PET/CT showed a high specificity (94.4%), yet a limited sensitivity (41.2%) for the detection of pelvic lymph-node metastases in primary PCa. This implies that current PSMA PET/CT imaging cannot replace diagnostic ePLND. Further research is necessary to define the exact place of PSMA PET/CT imaging in the primary staging of PCa.
Collapse
Affiliation(s)
- B H E Jansen
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Department of Radiology & Nuclear medicine, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Prostate Cancer Network, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Y J L Bodar
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Department of Radiology & Nuclear medicine, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Prostate Cancer Network, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - G J C Zwezerijnen
- Department of Radiology & Nuclear medicine, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - D Meijer
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Department of Radiology & Nuclear medicine, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Prostate Cancer Network, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - J P van der Voorn
- Department of Pathology, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - J A Nieuwenhuijzen
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Prostate Cancer Network, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - M Wondergem
- Department of Nuclear medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - T A Roeleveld
- Prostate Cancer Network, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Department of Urology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - R Boellaard
- Department of Radiology & Nuclear medicine, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - O S Hoekstra
- Department of Radiology & Nuclear medicine, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - R J A van Moorselaar
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Prostate Cancer Network, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - D E Oprea-Lager
- Department of Radiology & Nuclear medicine, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - A N Vis
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Prostate Cancer Network, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Bodar YJL, Jansen BHE, van der Voorn JP, Zwezerijnen GJC, Meijer D, Nieuwenhuijzen JA, Boellaard R, Hendrikse NH, Hoekstra OS, van Moorselaar RJA, Oprea-Lager DE, Vis AN. Detection of prostate cancer with 18F-DCFPyL PET/CT compared to final histopathology of radical prostatectomy specimens: is PSMA-targeted biopsy feasible? The DeTeCT trial. World J Urol 2020; 39:2439-2446. [PMID: 33079250 PMCID: PMC8332599 DOI: 10.1007/s00345-020-03490-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 06/29/2020] [Accepted: 10/07/2020] [Indexed: 11/01/2022] Open
Abstract
PURPOSE In primary prostate cancer (PCa) patients, accurate staging and histologic grading are crucial to guide treatment decisions. 18F-DCFPyL (PSMA)-PET/CT has been successfully introduced for (re)staging PCa, showing high accuracy to localise PCa in lymph nodes and/or osseous structures. The diagnostic performance of 18F-DCFPyL-PET/CT in localizing primary PCa within the prostate gland was assessed, allowing for PSMA-guided targeted-prostate biopsy. METHODS Thirty patients with intermediate-/high-risk primary PCa were prospectively enrolled between May 2018 and May 2019 and underwent 18F-DCFPyL-PET/CT prior to robot-assisted radical prostatectomy (RARP). Two experienced and blinded nuclear medicine physicians assessed tumour localisation within the prostate gland on PET/CT, using a 12-segment mapping model of the prostate. The same model was used by a uro-pathologist for the RARP specimens. Based on PET/CT imaging, a potential biopsy recommendation was given per patient, based on the size and PET-intensity of the suspected PCa localisations. The biopsy recommendation was correlated to final histopathology in the RARP specimen. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for clinically significant PCa (csPCa, Gleason score ≥ 3 + 4 = 7) were assessed. RESULTS The segments recommended for potential targeted biopsy harboured csPCA in 28/30 patients (93%), and covered the highest Gleason score PCa segment in 26/30 patient (87%). Overall, 122 of 420 segments (29.0%) contained csPCa at final histopathological examination. Sensitivity, specificity, PPV and NPV for csPCa per segment using 18F-DCFPyL-PET/CT were 61.4%, 88.3%, 68.1% and 84.8%, respectively. CONCLUSIONS When comparing the PCa-localisation on 18F-DCFPyL-PET/CT with the RARP specimens, an accurate per-patient detection (93%) and localisation of csPCa was found. Thus, 18F-DCFPyL-PET/CT potentially allows for accurate PSMA-targeted biopsy.
Collapse
Affiliation(s)
- Y J L Bodar
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands. .,Prostate Cancer Network, Amsterdam, The Netherlands.
| | - B H E Jansen
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - J P van der Voorn
- Department of Pathology, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - G J C Zwezerijnen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - D Meijer
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - J A Nieuwenhuijzen
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - R Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - N H Hendrikse
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands.,Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - O S Hoekstra
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - R J A van Moorselaar
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - D E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - A N Vis
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Cysouw MCF, Jansen BHE, Yaqub M, Voortman J, Vis AN, van Moorselaar RJA, Hoekstra OS, Boellaard R, Oprea-Lager DE. Correction to: Letter to the Editor re: Semiquantitative Parameters in PSMA-Targeted PET Imaging with [18F]DCFPyL: Impact of Tumor Burden on Normal Organ Uptake. Mol Imaging Biol 2020; 22:18. [DOI: 10.1007/s11307-019-01448-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
5
|
Wondergem M, Jansen BHE, van der Zant FM, van der Sluis TM, Knol RJJ, van Kalmthout LWM, Hoekstra OS, van Moorselaar RJA, Oprea-Lager DE, Vis AN. Early lesion detection with 18F-DCFPyL PET/CT in 248 patients with biochemically recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2019; 46:1911-1918. [PMID: 31230088 PMCID: PMC6647179 DOI: 10.1007/s00259-019-04385-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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: 03/14/2019] [Accepted: 05/30/2019] [Indexed: 01/14/2023]
Abstract
Purpose Prostate-specific membrane antigen (PSMA) PET/CT is increasingly used in patients with biochemically recurrent prostate cancer (BCR), mostly using gallium-68 (168Ga)-labelled radiotracers. Alternatively, fluorine-18 (18F)-labelled PSMA tracers are available, such as 18F-DCFPyL, which offer enhanced image quality and therefore potentially increased detection of small metastases. In this study we evaluate the lesion detection efficacy of 18F-DCFPyL PET/CT in patients with BCR and determine the detection efficacy as a function of their PSA value. Methods A total of 248 consecutive patients were evaluated and underwent scanning with 18F-DCFPyL PET/CT for BCR between November 2016 and 2018 in two hospitals in the Netherlands. Patients were examined after radical prostatectomy (52%), external-beam radiation therapy (42%) or brachytherapy (6%). Imaging was performed 120 min after injection of a median dose of 311 MBq 18F-DCFPyL. Results In 214 out of 248 PET/CT scans (86.3%), at least one lesion suggestive of cancer recurrence was detected (‘positive scan’). Scan positivity increased with higher PSA values: 17/29 scans (59%) with PSA values <0.5 ng/ml; 20/29 (69%) with PSA 0.5 to <1.0 ng/ml; 35/41 (85%) with PSA 1.0 to <2.0 ng/ml; 69/73 (95%) with PSA 2.0 to <5.0 ng/ml; and 73/76 (96%) with PSA ≥5.0 ng/ml. Interestingly, suspicious lesions outside the prostatic fossa were detected in 39–50% of patients with PSA <1.0 ng/ml after radical prostatectomy (i.e. candidates for salvage radiotherapy). Conclusion 18F-DCFPyL PET/CT offers early detection of lesions in patients with BCR, even at PSA levels <0.5 ng/ml. These results appear to be comparable to those reported for 68Ga-PSMA and 18F-PSMA-1007, with potentially increased detection efficacy compared to 68Ga-PSMA for patients with PSA <2.0. Electronic supplementary material The online version of this article (10.1007/s00259-019-04385-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- M Wondergem
- Noordwest Ziekenhuisgroep, Nuclear Medicine, Wilhelminalaan 12, 1815 JD, Alkmaar, the Netherlands
| | - B H E Jansen
- Amsterdam University Medical Centers, VU University, Urology, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands. .,Amsterdam University Medical Centers, VU University, Radiology & Nuclear Medicine, Amsterdam, the Netherlands.
| | - F M van der Zant
- Noordwest Ziekenhuisgroep, Nuclear Medicine, Wilhelminalaan 12, 1815 JD, Alkmaar, the Netherlands
| | - T M van der Sluis
- Amsterdam University Medical Centers, VU University, Urology, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - R J J Knol
- Noordwest Ziekenhuisgroep, Nuclear Medicine, Wilhelminalaan 12, 1815 JD, Alkmaar, the Netherlands
| | - L W M van Kalmthout
- Radiology & Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - O S Hoekstra
- Amsterdam University Medical Centers, VU University, Radiology & Nuclear Medicine, Amsterdam, the Netherlands
| | - R J A van Moorselaar
- Amsterdam University Medical Centers, VU University, Urology, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - D E Oprea-Lager
- Amsterdam University Medical Centers, VU University, Radiology & Nuclear Medicine, Amsterdam, the Netherlands
| | - A N Vis
- Amsterdam University Medical Centers, VU University, Urology, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| |
Collapse
|
6
|
Jansen BHE, Disselhorst GW, Schutte T, Jansen B, Rissmann R, Richir MC, Keijsers CJPW, Vanmolkot FHM, van den Brink AM, Kramers C, Vondeling AM, Dumont GJH, de Waard-Siebinga I, Van Agtmael MA, Tichelaar J. Essential diseases in prescribing: A national Delphi study towards a core curriculum in pharmacotherapy education. Br J Clin Pharmacol 2018; 84:2645-2650. [PMID: 30076631 DOI: 10.1111/bcp.13730] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/18/2018] [Accepted: 07/29/2018] [Indexed: 11/28/2022] Open
Abstract
AIMS Prescribing is a core skill for junior doctors, yet 8-10% of their prescriptions contain errors. To ensure adequate training in prescribing, it is important to define the diseases for which junior doctors should be competent to prescribe. The aim of the present study was therefore to identify the essential diseases in prescribing for junior doctors. METHODS A two-round Delphi consensus study was conducted among medical specialists, general practitioners, junior doctors, pharmacists and pharmacotherapy teachers from all eight academic hospitals in the Netherlands. Using a five-point Likert scale, the participants indicated for each item on an initial questionnaire whether it should be considered an essential disease for junior doctors. The items for which ≥80% of all respondents agreed or strongly agreed were accepted as essential diseases. RESULTS Sixty-two participants completed the Delphi survey. In total, 63 of 220 items were considered to be essential diseases. CONCLUSION This is the first Delphi consensus study identifying exact conditions that junior doctors must be able to prescribe for. The essential diseases can be used for training in prescribing and assessment of junior doctors' prescribing competence.
Collapse
Affiliation(s)
- B H E Jansen
- Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam.,RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam.,Department of Urology, VU University Medical Center, Amsterdam
| | - G W Disselhorst
- Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam.,RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam
| | - T Schutte
- Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam.,RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam
| | - B Jansen
- Department of General Practice & Elderly Care Medicine, VU University Medical Center, Amsterdam
| | - R Rissmann
- Centre for Human Drug Research, Leiden & Leiden University Medical Center
| | - M C Richir
- Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam.,RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam
| | - C J P W Keijsers
- Department of Geriatrics, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch
| | | | - A Maassen van den Brink
- Department of Internal Medicine, Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus MC, Rotterdam
| | - C Kramers
- Department of Pharmacology-Toxicology, Radboud MC, Nijmegen
| | - A M Vondeling
- Department of Geriatrics, Division of Internal Medicine and Dermatology, UMC, Utrecht
| | | | | | - M A Van Agtmael
- Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam.,RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam
| | - J Tichelaar
- Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam.,RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam
| |
Collapse
|
7
|
Jansen BHE, Oudshoorn FHK, Tijans AM, Yska MJ, Lont AP, Collette ERP, Nieuwenhuijzen JA, Vis AN. Local staging with multiparametric MRI in daily clinical practice: diagnostic accuracy and evaluation of a radiologic learning curve. World J Urol 2018; 36:1409-1415. [PMID: 29680949 PMCID: PMC6105169 DOI: 10.1007/s00345-018-2295-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/05/2018] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To estimate the diagnostic accuracy of multiparametric MRI (mpMRI) for the detection of locally advanced prostate cancer (T-stage 3-4) prior to radical prostatectomy, in a multicenter cohort representing daily clinical practice. In addition, the radiologic learning curve for the detection of locally advanced disease is evaluated. METHODS Preoperative mpMRI findings of 430 patients (2012-2016) were compared to pathology results following radical prostatectomy. The diagnostic accuracy (sensitivity, specificity, PPV, and NPV) for the detection of locally advanced disease was calculated and compared for all years separately, to evaluate the presence of a radiological learning curve. RESULTS Of all 137 patients with locally advanced disease, 62 patients were preoperatively detected with mpMRI [sensitivity 45.3% (95% CI 36.9-53.6%), specificity 75.8% (CI 70.9-80.7%), PPV 46.6% (CI 38.1-55.1%), and NPV 74.7% (CI 69.8-79.7%)]. The diagnostic accuracy did not improve significantly over time (sensitivity p = 0.12; specificity p = 0.57). CONCLUSIONS In daily clinical practice, the diagnostic accuracy of mpMRI for the detection of locally advanced prostate cancer remains limited. It, therefore, seems questionable whether mpMRI is adequate to guide preoperative decision-making. No significant radiologic learning curve for the detection of locally advance disease was observed.
Collapse
Affiliation(s)
- B H E Jansen
- VU University Medical Center, Amsterdam, The Netherlands.
| | | | - A M Tijans
- VU University Medical Center, Amsterdam, The Netherlands
| | - M J Yska
- Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - A P Lont
- Meander Medisch Centrum, Amersfoort, The Netherlands
| | | | | | - A N Vis
- VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|