Preoperative nomograms incorporating magnetic resonance imaging and spectroscopy for prediction of insignificant prostate cancer

Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
BJU International (Impact Factor: 3.53). 09/2011; 109(9):1315-22. DOI: 10.1111/j.1464-410X.2011.10612.x
Source: PubMed


OBJECTIVES To validate previously published nomograms for predicting insignificant prostate cancer (PCa) that incorporate clinical data, percentage of biopsy cores positive (%BC+) and magnetic resonance imaging (MRI) or MRI/MR spectroscopic imaging (MRSI) results. We also designed new nomogram models incorporating magnetic resonance results and clinical data without detailed biopsy data. Nomograms for predicting insignificant PCa can help physicians counsel patients with clinically low-risk disease who are choosing between active surveillance and definitive therapy. PATIENTS AND METHODS In total, 181 low-risk PCa patients (clinical stage T1c-T2a, prostate-specific antigen level <10 ng/mL, biopsy Gleason score of 6) had MRI/MRSI before surgery. For MRI and MRI/MRSI, the probability of insignificant PCa was recorded prospectively and independently by two radiologists on a scale from 0 (definitely insignificant) to 3 (definitely significant PCa). Insignificant PCa was defined on surgical pathology. There were four models incorporating MRI or MRI/MRSI and clinical data with and without %BC+ that were compared with a base clinical model without %BC and a more comprehensive clinical model with %BC+. Prediction accuracy was assessed using areas under receiver operator characteristic curves. RESULTS At pathology, 27% of patients had insignificant PCa, and the Gleason score was upgraded in 56.4% of patients. For both readers, all magnetic resonance models performed significantly better than the base clinical model (P <= 0.05 for all) and similarly to the more comprehensive clinical model. CONCLUSIONS Existing models incorporating magnetic resonance data, clinical data and %BC+ for predicting the probability of insignificant PCa were validated. All MR-inclusive models performed significantly better than the base clinical model.

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Available from: Changhong yu, Oct 13, 2015
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    • "These results suggest that patients with unremarkable findings on mp-MRI could be scheduled for an active surveillance program, because they could at worst harbor a low-risk PCa or a precancerous lesion. In addition, this assumption is validated by our findings of whole-mount radiologic-pathologic correlation, which show that mp-MR images are unable to detect PCas with a Gleason score of 6 (3 þ 3) in up to 96% of cases if the tumor is less than 0.5 cm 3 , as reported in the literature [20]. "
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    ABSTRACT: To assess whether the proportion of men with clinically significant prostate cancer (PCa) is higher among men randomized to multiparametric magnetic resonance imaging (mp-MRI)/biopsy vs. those randomized to transrectal ultrasound (TRUS)-guided biopsy.Methods In total, 1,140 patients with symptoms highly suggestive of PCa were enrolled and divided in 2 groups of 570 patients to follow 2 different diagnostic algorithms. Group A underwent a TRUS-guided random biopsy. Group B underwent an mp-MRI and a TRUS-guided targeted+random biopsy. The accuracy of mp-MRI in the diagnosis of PCa was calculated using prostatectomy as the standard of reference.ResultsIn group A, PCa was detected in 215 patients. The remaining 355 patients underwent an mp-MRI: the findings were positive in 208 and unremarkable in 147 patients. After the second random+targeted biopsy, PCa was detected in 186 of the 208 patients. In group B, 440 patients had positive findings on mp-MRI, and PCa was detected in 417 at first biopsy; 130 group B patients had unremarkable findings on both mp-MRI and biopsy. In the 130 group B patients with unremarkable findings on mp-MRI and biopsy, a PCa Gleason score of 6 or precancerous lesions were detected after saturation biopsy. mp-MRI showed an accuracy of 97% for the diagnosis of PCa.Conclusions The proportion of men with clinically significant PCa is higher among those randomized to mp-MRI/biopsy vs. those randomized to TRUS-guided biopsy; moreover, mp-MRI is a very reliable tool to identify patients to schedule in active surveillance.
    Urologic Oncology 11/2014; 33(1). DOI:10.1016/j.urolonc.2014.09.013 · 2.77 Impact Factor
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    • "Recent studies showed that MRS is more accurate in detecting prostate cancers with high grade of malignancy and in low grade cancers its accuracy is somehow limited (37, 38). "
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    ABSTRACT: Imaging studies play an important role in detection and management of prostate cancer and MRI especially with the use of endorectal coil because of high contrast resolution is recognized as the best imaging modality in evaluation of prostate cancer. Multiparametric MR study including T1 and T2 weighted images, diffusion weighted images, dynamic contrast study and MR spectroscopy is useful for detection and local staging of prostate cancer as well as posts treatment evaluation of patients either after surgery or radiation therapy for detection of local recurrence.
    12/2013; 15(12):e16620. DOI:10.5812/ircmj.16620
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    • "A recent pilot study found that apparent diffusion coefficients accurately identified those who progressed to radical treatment [99]. Another study found that incorporation of MRI and magnetic resonance spectroscopy into a risk nomogram improved accuracy in predicting aggressive disease [100]. The greatest utility of specialized MRI techniques may be as a complement or alternative tool to confirmatory biopsy. "
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    ABSTRACT: Today, the majority of men with newly diagnosed prostate cancer will present with low-risk features of the disease. Because prostate cancer often takes an insidious course, it is debated whether the majority of these men require radical treatment and the accompanying derangement of quality of life domains imposed by surgery, radiation, and hormonal therapy. Investigators have identified various selection criteria for "insignificant disease," or that which can be monitored for disease progression while safely delaying radical treatment. In addition to the ideal definition of low risk, a lack of randomized trials comparing the various options for treatment in this group of men poses a great challenge for urologists. Early outcomes from active surveillance cohorts support its use in carefully selected men with low-risk disease features, but frequent monitoring is required. Patient selection and disease monitoring methods will require refinement that will likely be accomplished through the increased use of biomarkers and specialized imaging techniques.
    Korean journal of urology 07/2013; 54(7):417-25. DOI:10.4111/kju.2013.54.7.417
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