Preoperative nomograms incorporating magnetic resonance imaging and spectroscopy for prediction of insignificant prostate cancer
ABSTRACT 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.
Full-textDOI: · Available from: Changhong yu, Aug 26, 2015
- SourceAvailable from: Valeria Panebianco
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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 . "
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 · 3.36 Impact Factor
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- ".) ou de pouvoir éventuellement proposer un traitement focalisé ; • identifier d'autres foyers de cancer dans la glande, pouvant modifier l'attitude thérapeutique ; • proposer une stadification de la maladie, certes peu sensible , mais très spécifique, notamment pour l'extension séminale. De récentes publications ont ainsi confirmé sa capacité à améliorer l'efficacité des nomogrammes pour prédire l'atteinte séminale , extracapsulaire  ou encore le caractère « non significatif » d'un cancer  "
ABSTRACT: L’IRM multiparamétrique de la prostate est un examen indispensable pour le diagnostic, l’évaluation préopératoire et la planification thérapeutique du cancer de la prostate. Cet examen peut détecter avec précision les foyers de cancer dans la glande afin de proposer la prise en charge la plus adaptée, diminuer les risques de surtraitement, mais aussi ne plus méconnaître certaines lésions agressives ou de topographie inhabituelle mettant en jeu le pronostic. Nous présentons ses principales indications, en mettant l’accent sur les techniques d’interprétation de l’IRM, ses performances et ses limites, ainsi que sur les récentes recommandations européennes qui soulignent la nécessité de les harmoniser au niveau international.04/2012; 93(4):291–301. DOI:10.1016/j.jradio.2012.01.011
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ABSTRACT: Multiparametric MRI of the prostate is an essential examination for the diagnosis, preoperative evaluation and planning of treatment for prostate cancer. This examination can accurately detect cancer foci in the gland so that the most appropriate management can be offered, reduce the risk of over-treatment and also ensure that certain aggressive lesions or unusual locations, which might affect the prognosis, are not ignored. We present here its main indications, focusing on the techniques for interpreting MRI, its performance and its limitations, as well as the recent European recommendations underlining the need for international harmonisation.03/2012; 93(4):268-78. DOI:10.1016/j.diii.2012.01.019