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Batson's venous plexus. Cited from Diseases of the Spine and Spinal Cord (Thomas N Byrne et al. P169, Oxford University Press)
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Whole-body magnetic resonance imaging (WB-MRI) is currently used worldwide for detecting bone metastases from prostate cancer. The 5-year survival rate for prostate cancer is > 95%. However, an increase in survival time may increase the incidence of bone metastasis. Therefore, detecting bone metastases is of great clinical interest. Bone metastases...
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... the circulation, cells and extracellular matrix within this region assist in the formation of bone metastasis [10]. Batson [11] showed that venous blood from the breast and pelvis flowed not only into the vena cava but also into the vertebral venous plexus, which extends from the pelvis to throughout the epidural and peri-vertebral veins [11,12] (Fig. 1). Blood drainage to the skeleton via the vertebral venous plexus may, at least in part, explain the tendency of breast and prostate cancers (as well as those arising in the kidney, thyroid, and lung) to produce metastases in the axial skeleton and limb girdles ...
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Citations
... PCa disseminates by EPE to reach the para-vertebral Batson's plexus --a series of primordial valveless veins (Nathoo et al., 2011) and nerves that account for how tumor originating in the prostate organ can reach the known dissemination sites of the pelvic bones, the vertebral column, and brain (Batson, 1940). Interception of PCa dissemination at its earliest stages is now an actionable goal since EPE can be detected by multiparametric magnetic resonance imaging (mpMRI) and continued improvements for 30-min whole body scan times and AI assistance (Nakanishi et al., 2022) will enable the early detection of this sub-type of aggressive tumor. This advance coupled with our increased ability to target this sub-type of PCa will add significantly to the choices available to combat this chronic and indolent cancer. ...
In 2023, approximately 288,300 new diagnoses of prostate cancer will occur, with 34,700 disease-related deaths. Death from prostate cancer is associated with metastasis, enabled by progression of tumor phenotypes and successful extracapsular extension to reach Batson’s venous plexus, a specific route to the spine and brain. Using a mouse-human tumor xenograft model, we isolated an aggressive muscle invasive cell population of prostate cancer, called DU145 J7 with a distinct biophysical phenotype, elevated histone H3K27, and increased matrix metalloproteinase 14 expression as compared to the non-aggressive parent cell population called DU145 WT . Our goal was to determine the sensitivities to known chemotherapeutic agents of the aggressive cells as compared to the parent population. High-throughput screening was performed with 5,578 compounds, comprising of approved and investigational drugs for oncology. Eleven compounds were selected for additional testing, which revealed that vorinostat, 5-azacitidine, and fimepinostat (epigenetic inhibitors) showed 2.6-to-7.5-fold increases in lethality for the aggressive prostate cancer cell population as compared to the parent, as judged by the concentration of drug to inhibit 50% cell growth (IC 50 ). On the other hand, the DU145 J7 cells were 2.2-to-4.0-fold resistant to mitoxantrone, daunorubicin, and gimatecan (topoisomerase inhibitors) as compared to DU145 WT . No differences in sensitivities between cell populations were found for docetaxel or pirarubicin. The increased sensitivity of DU145 J7 prostate cancer cells to chromatin modifying agents suggests a therapeutic vulnerability occurs after tumor cells invade into and through muscle. Future work will determine which epigenetic modifiers and what combinations will be most effective to eradicate early aggressive tumor populations.
... Although rFOV-DWI also improves spatial resolution and reduces distortion, it has a limited FOV and is primarily used to evaluate the prostate only. As DWI is also useful in evaluating lymph node and bone metastases of PCa, [23][24][25] MUSE-DWI, which can improve spatial resolution while maintaining a wide FOV, would be a promising technique that could adequately replace c-DWI in prostate MRI. Interreader agreement for qualitative analysis was generally fair to moderate. ...
Purpose: To compare objective and subjective image quality, lesion conspicuity, and apparent diffusion coefficient (ADC) of high-resolution multiplexed sensitivity-encoding diffusion-weighted imaging (MUSE-DWI) with conventional DWI (c-DWI) and reduced FOV DWI (rFOV-DWI) in prostate MRI.
Methods: Forty-seven patients who underwent prostate MRI, including c-DWI, rFOV-DWI, and MUSE-DWI, were retrospectively evaluated. SNR and ADC of normal prostate tissue and contrast-to-noise ratio (CNR) and ADC of prostate cancer (PCa) were measured and compared between the three sequences. Image quality and lesion conspicuity were independently graded by two radiologists using a 5-point scale and compared between the three sequences.
Results: The SNR of normal prostate tissue was significantly higher with rFOV-DWI than with the other two DWI techniques (P ≤ 0.01). The CNR of the PCa was significantly higher with rFOV-DWI than with MUSE-DWI (P < 0.05). The ADC of normal prostate tissue measured by rFOV-DWI was lower than that measured by MUSE-DWI and c-DWI (P < 0.01), while there was no difference in the ADC of cancers. In the qualitative analysis, MUSE-DWI showed significantly higher scores than rFOV-DWI and c-DWI for visibility of anatomy and overall image quality in both readers, and significantly higher scores for distortion in one of the two readers (P < 0.001). There was no difference in lesion conspicuity between the three sequences.
Conclusion: High-resolution MUSE-DWI showed higher image quality and reduced distortion compared to c-DWI, while maintaining a wide FOV and similar ADC quantification, although no difference in lesion conspicuity was observed.
... In addition, it may be used to assess the patient as a whole and track improvement as therapy progresses. For instance, diffusion-weighted imaging (DWI) for whole-body scanning is currently part of the standard protocol for whole-body magnetic resonance imaging (WB-MRI) [7]. ...
Background
Metastases to the bones are a frequent location of metastasis in advanced breast cancer and are responsible for substantial morbidity and healthcare expenses. Imaging has been crucial in directing patient therapy for decades, contributing to the staging and response evaluation of the skeleton. This research aimed to assess the diagnostic value of whole-body magnetic resonance imaging with diffusion-weighted imaging added to radionuclide bone scans for early diagnosis of bone metastases in breast cancer patients.
Results
The study was a prospective observational cohort study performed on 20 patients with breast cancer and suspected bone metastases. The patients were evaluated first by obtaining a detailed personal history. Laboratory tests, including CBC, liver, and kidney function tests were assessed. All patients were examined by diffusion-weighted whole-body MRI (DWIBS; diffusion-weighted imaging with background body signal suppression) images and bone scintigraphy after intravenous injection of 20 mci of technetium-99m ( 99m Tc) methylene diphosphonate using a dual head gamma camera. The total number of lesions detected by bone scan was 74, and 75 lesions were seen by DWIBS. Twenty-four lesions were missed by bone scan and detected by DWIBS. Fourteen lesions were detected by bone scan and found free by DWIBS examination in the spine and pelvic bones.
Conclusions
Whole body DWIBS seems to be a promising method of imaging in detecting bone metastases from breast cancer that could be used complementary to the traditional bone scan for more accurate diagnosis and staging of the tumor, helping to determine the most appropriate protocol of management.
... 68 The limitation of WB MRI are the limited field of view, long examination times and limited spatial resolution. 69 Methods such as adding background body suppression to DWI (DWIBS) can increase diagnostic accuracy of WB-MRI. However, there is an ongoing development and new quantitative WB-MRI biomarkers such as ADC histogram descriptors, tumor volume, bone tissue sub-classification, and heterogeneity metrics are emerging. ...
Imaging plays an increasingly important role in the detection and characterization of prostate cancer (PC). This review summarizes the key conventional and advanced imaging modalities including multiparametric magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging and tries to instruct clinicians in finding the best image modality depending on the patient`s PC-stage. We aim to give an overview of the different image modalities and their benefits and weaknesses in imaging PC. Emphasis is put on primary prostate cancer detection and staging as well as on recurrent and castration resistant prostate cancer. Results from studies using various imaging techniques are discussed and compared. For the different stages of PC, advantages and disadvantages of the different imaging modalities are discussed. Moreover, this review aims to give an outlook about upcoming, new imaging modalities and how they might be implemented in the future into clinical routine. Imaging patients suffering from PC should aim for exact diagnosis, accurate detection of PC lesions and should mirror the true tumor burden. Imaging should lead to the best patient treatment available in the current PC-stage and should avoid unnecessary therapeutic interventions. New image modalities such as long axial field of view PET/CT with photon-counting CT and radiopharmaceuticals like androgen receptor targeting radiopharmaceuticals open up new possibilities. In conclusion, PC imaging is growing and each image modality is aiming for improvement.
... An alternative imaging modality to evaluate for the progression of both bone and soft tissue metastasis for patients with mHSPC is whole body MRI. With this imaging modality, a diffusion-weighted imaging scan with background body signal suppression is performed which allows for the sensitive detection of bony metastases [37]. Meta-analyses have demonstrated that on a per-patient basis, whole body MRI has sensitivity and specificity of 95% and 96% respectively for the detection of bony metastases [38]. ...
Purpose
To summarize contemporary and emerging strategies for the diagnosis and management of metastatic hormone sensitive prostate cancer (mHSPC), focusing on diagnostic testing and therapeutics.
Methods
Literature review using PUBMED-Medline databases as well as clinicaltrials.gov to include reported or ongoing clinical trials on treatment for mHSPC. We prioritized the findings from phase III randomized clinical trials, systematic reviews, meta-analyses and clinical practice guidelines.
Results
There have been significant changes to the diagnosis and staging evaluation of mHSPC with the integration of increasingly accurate positron emission tomography (PET) imaging tracers that exceed the performance of conventional computerized tomography (CT) and bone scan. Germline multigene testing is recommended for the evaluation of patients newly diagnosed with mHSPC given the prevalence of actionable alterations that may create candidacy for specific therapies. Although androgen deprivation therapy (ADT) remains the backbone of treatment for mHSPC, approaches to first-line treatment include the integration of multiple agents including androgen receptor synthesis inhibitors (ARSI; abiraterone) Androgen Receptor antagonists (enzalutamide, darolutamide, apalautamide), and docetaxel chemotherapy. The combination of ADT, ARSI, and docetaxel chemotherapy has recently been evaluated in a randomized trial and was associated with significantly improved overall survival including in patients with a high burden of disease. The role of local treatment to the prostate with radiation has been evaluated in randomized trials with additional studies underway evaluating the role of cytoreductive radical prostatectomy.
Conclusion
The staging and initial management of patients with mHSPC has undergone significant advances in the last decade with advancements in the diagnosis, treatment and sequencing of therapies.
... Nakanishi et al. [23] who studied the role of WB-DWIBS in diagnosis of bony metastasis form prostatic cancer, he asserted that WB-MRI was the most reliable technique for detecting prostate cancer bony metastasis. It offered the benefit of detecting lesions that were missed by traditional imaging modalities like CT and BS. ...
Background
Whole-body diffusion-weighted magnetic resonance is being developed as a tool for assessing tumor spread. Patients with known primary tumors require meticulous evaluation to assess metastasis for better staging; we attempted to detect bony metastasis without radiation exposure. Our study's goal was to use whole-body diffusion-weighted imaging with background body signal suppression (WB-DWBIS) to evaluate bony metastasis in confirmed patients who have primary tumors.
Results
Our study included 90 patients with known primary cancer, 10 patients were excluded as they had no bony metastasis, from 80 patients: 36 (45.0%) having one site of metastasis, 36 (45%) having two sites of metastasis, and 8 (10.0%) having three sites of metastasis. 56 (70.0%) of the metastasis sites were bony metastasis, and 76 were mixed both bony and non-bony, including 32(40.0%) lung, 16 (20.0%) liver, and 28 (35%) lymph nodes. Sensitivity of bone scanning in detecting metastasis was as follows: 95.1% sensitivity and 92.0% accuracy, while that of whole-body diffusion-weighted image with background signals suppression was 94.8% sensitivity and 91.7% accuracy, WB-DWBIS inter-observer agreement in the detection of bony metastatic deposits in cancer patients was good (0.7 45, agreement = 93.2%).
Conclusions
Using WB-DWBIS images, bone lesion identification and characterization (site and number) were improved, producing outcomes similar to bone scanning without the use of ionizing radiation.
... In particular, the ADC may act as a useful differential definition by delivering reliable information for the GS of suspected prostate cancer (10). The ADC has also been shown to be helpful for classifying and identifying lesions as well as evaluating disease activity (13,14). ...
... Our study also supports their conclusions. Consequently, the ADC is calculated and has been adopted for evaluating multiple and large lesions (13). MRIbased ADC and T2WI scans showed good performance in malignant prostate lesions and predicting extracapsular extension and positive surgical margins (35). ...
Background:
Prostate-specific antigen (PSA) is a critical part of prostate cancer (PCa) screening, diagnosis, staging, and prognosis. However, elevated PSA levels can also be caused by several external factors. To improve the specificity and sensitivity of PSA in clinical practice, we explored whether markers or parameters may be used as prognostic targets for PCa by long-term follow-up.
Methods:
A total of 121 PCa patients who underwent laparoscopic radical prostatectomy (LRP) were included in our study, all of whom underwent imaging and preoperative pathological diagnosis. Endocrine therapy has long been applied to treat postoperative patients. The prognosis of enrolled patients was followed, and statistics were collected. Spearman's correlation analysis was applied to examine the relationship and clinical parameters. Kaplan-Meier analysis was used to process the clinical variables of PCa patients. Cox proportional hazards regression analysis was applied to examine univariate and multivariate variables.
Results:
The Gleason score (GS), PSA, clinical stage, nerve infiltration, organ confinement, Ki67 and apparent diffusion coefficient (ADC) were significantly associated with prognosis (all P < 0.05). The GS, PSA, clinical stage, organ confined, Ki67, nerve infiltration and ADC were included in the multivariate analysis (all P < 0.05). Ultimately, Ki67 and the ADC were found to provide meaningful predictive information (both P < 0.05).
Conclusions:
Ki67 and the ADC may be clinically and analytically valid prognostic biomarkers and imaging parameters in PCa. They may be useful for predicting the prognosis and risk of PCa patients undergoing postoperative routine endocrine therapy.
... Tumor-related inflammatory reaction plays an important role in tumor initiation, progression and metastasis, and inflammatory markers have great application potential in tumor diagnosis, disease assessment and prognosis assessment [11,12]. As studies [13][14][15] reveal, multiple inflammatory factors, including neutrophils, C-reactive protein, lymphocytes, interleukin family and tumor necrosis factor family, can affect the biological behav-iors of tumor tissues through various channels. Therefore, an inflammatory factor model based on serology detection may have certain clinical value for predicting bone metastasis in PCa patients. ...
Objective:
This study aims to establish and validate a predictive model for bone metastasis in prostate cancer patients based on multiple immune inflammatory parameters.
Methods:
In this retrospective study, 162 prostate cancer patients who met the inclusion criteria were selected by Urology Surgery, Shaanxi Provincial People's Hospital. Based on the medical record number of patients and the random number table method, 40 patients were randomly included in a validation group, and the rest were in a modeling group. The patients in the modeling group were divided into a metastatic group (n=67) and a non-metastatic group (n=55) according to the whole-body bone imaging results.
Results:
The predictive model was established based on the results of Logistics regression analysis: Logit (P) = -5.341 + 0.930*total Gleason score + 1.426*total prostate specific antigen + 0.836*neutrophil-lymphocyte ratio + 0.896*platelet lymphocyte ratio + 0.641*lymphocyte/monocyte ratio + 0.750*albumin/globulin ratio. ROC analysis showed that the areas under the curve of the predictive model for bone metastasis in the modeling and validation groups were 0.896 and 0.870, respectively. Hosmer-Lemeshow test showed that P=0.253, indicating a high degree of the fitting. External verification results showed that the C-index for predicting prostate cancer bone metastasis in the predictive model established in this study was 0.760 (95% CI: 0.670-0.851).
Conclusion:
The bone metastasis predictive model based on the multiple immune inflammatory parameters (neutrophil-lymphocyte ratio, platelet lymphocyte ratio, lymphocyte/monocyte ratio and albumin/globulin ratio) in prostate cancer patients can reasonably predict the occurrence of bone metastasis and is well worth clinical application.
... The computed tomography is available in our country, but it does not perform better than bone scintigraphy [13]. The whole-body magnetic resonance imaging if it is available, may be helpful in non-claustrophobic patients [14] [15]. Beyond being a therapeutic decision-making tool, the presence of bone metastases at scintigraphy is predictive of a shorter survival [16], axial metastases carrying a better prognosis than appendicular metastases [17]. ...
... DWIBS reflects the motion restriction of water molecules in areas of high cell density and is another tool for detecting metastasis [23]. The main advantage of DWIBS is that it is less invasive, as there is no exposure to radiation and images can be acquired without the use of contrast media [24]. However, lesions in bones with high signal intensity on T2-weighted images, such as hemangiomas or red bone marrow in patients with anemia, can be judged as abnormal signals. ...
Stereotactic body radiotherapy (SBRT) has excellent local control and low toxicity for spinal metastases and is widely performed for spinal oligometastases. However, its additional survival benefit to standard of care, including systemic therapy, is unknown because the results of large-scale randomized controlled trials regarding SBRT for oligometastases have not been reported. Consequently, the optimal patient population among those with spinal oligometastases and the optimal methodology for spine SBRT remain unclear. The present review article discusses two topics: evidence-based optimal patient selection and methodology. The following have been reported to be good prognostic factors: young age, good performance status, slow-growing disease with a long disease-free interval, minimal disease burden, and mild fluorodeoxyglucose accumulation in positron emission tomography. In addition, we proposed four measures as the optimal SBRT method for achieving excellent local control: (i) required target delineation; (ii) recommended dose fraction schedule (20 or 24 Gy in a single fraction for spinal oligometastases and 35 Gy in five fractions for lesions located near the spinal cord); (iii) optimizing dose distribution for the target; (iv) dose constraint options for the spinal cord.
