Can multiparametric magnetic resonance imaging predict upgrading of transrectal ultrasound biopsy results at more definitive histology?11Mohamed Abd-Alazeez receives funding from the Egyptian government. Mark Emberton and Hashim U. Ahmed receive funding from USHIFU and Advanced Medical Diagnostics for clinical trials. Mark Emberton is a paid consultant for Steba Biotech, USHIFU and Sanofi-Aventis. Mark Emberton has received research support by GSK for a study evaluating the role of MRI in men with prostate

Abd-Alazeez, Mohamed; Ahmed, Hashim U.; Arya, Manit; Allen, Clare; Δικαίος, Νικόλαος; Freeman, Alex; Emberton, Mark; Kirkham, Alex

doi:10.1016/j.urolonc.2014.01.008

Cited by 23 publications

(4 citation statements)

References 25 publications

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“…The prognostic significance of a visible lesion on mpMRI has been evaluated on several PCa endpoints including the detection of higher grade (Gleason ≥3+4) disease on biopsy[ 19 ], progression during AS, high grade/stage pathology at prostatectomy[ 20 ], and biochemical recurrence[ 21 ]. For men with newly diagnosed PCa, the presence of MRI-discernable lesions has been suggested as an adverse prognostic characteristic particularly for men initiating management with AS, where retrospective studies have suggested an increased risk for disease reclassification due to changes in tumor volume estimates[ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Association between a 17-gene genomic prostate score and multi-parametric prostate MRI in men with low and intermediate risk prostate cancer (PCa)

et al. 2017

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BackgroundWe aimed to directly compare results from multi-parametric prostate MRI (mpMRI) and a biopsy-based 17-gene RT-PCR assay providing a Genomic Prostate Score (GPS) among individuals who were candidates for active surveillance with low and intermediate risk prostate cancer (PCa).Patients and methodsWe evaluated the association between GPS results (scale 0–100) and endorectal mpMRI findings in men with clinically localized PCa. MR studies were reviewed to a five-tier scale of increasing suspicion of malignancy. Mean apparent diffusion coefficient (ADC) was calculated from a single dominant lesion. Mean rank of the GPS (0–100) among MRI strata was compared with the Kruskal-Wallis test and Dunn's multiple comparison test. Spearman's correlation was performed to examine the association between mean ADC and scaled GPS.ResultsOf 186 patients who received GPS testing, 100 were identified who received mpMRI. Mean GPS results differed between mpMRI categories (p = 0.001); however a broad range was observed in all mpMRI categories. Among men with biopsy Gleason pattern 3+3, mean GPS results were not significantly different among MRI groups (p = 0.179), but GPS differences were seen among MRI categories for patients with pattern 3+4 (p = 0.010). Mean ADC was weakly associated with GPS (σ = -0.151). Stromal response (p = 0.015) and cellular organization (p = 0.045) gene group scores differed significantly by MRI findings, but no differences were seen among androgen signaling or proliferation genes.ConclusionsAlthough a statistically significant association was observed between GPS results and MRI scores, a wide range of GPS values were observed across imaging categories suggesting that mpMRI and genomic profiling may offer non- overlapping clinical insights.

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Section: Discussionmentioning

confidence: 99%

Association between a 17-gene genomic prostate score and multi-parametric prostate MRI in men with low and intermediate risk prostate cancer (PCa)

et al. 2017

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“…Due to the rapid adoption and utilization of mpMRI for the evaluation of prostate cancer, several limitations were identified with this scoring system, and a refined version of PI-RADS was developed in conjunction with the American College of Radiology. ACR PI-RADS v2 sought to establish technical parameters for prostate MRI; standardize terminology of reports; facilitate the use of MRI for targeted biopsy; aid in risk stratification; and enhance communication, quality assurance, and research[ 7 , 8 ]. Overall ACR PI-RADS v2 assessment (henceforth simply referred to as “PI-RADS”) uses a 5-point scale based on the likelihood that a combination of MRI findings on DWI, T2W, and DCE correlates with the presence of a clinically significant cancer at a particular location in the prostate gland (Figs 1 and 2 ) .…”

Section: Introductionmentioning

confidence: 99%

Comparison of Multiparametric MRI Scoring Systems and the Impact on Cancer Detection in Patients Undergoing MR US Fusion Guided Prostate Biopsies

et al. 2015

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IntroductionMultiple scoring systems have been proposed for prostate MRI reporting. We sought to review the clinical impact of the new Prostate Imaging Reporting and Data System v2 (PI-RADS) and compare those results to our proposed Simplified Qualitative System (SQS) score with respect to detection of prostate cancers and clinically significant prostate cancers.MethodsAll patients who underwent multiparametric prostate MRI (mpMRI) had their images interpreted using PI-RADS v1 and SQS score. PI-RADS v2 was calculated from prospectively collected data points. Patients with positive mpMRIs were then referred by their urologists for enrollment in an IRB-approved prospective phase III trial of mpMRI-Ultrasound (MR/TRUS) fusion biopsy of suspicious lesions. Standard 12-core biopsy was performed at the same setting. Clinical data were collected prospectively.Results1060 patients were imaged using mpMRI at our institution during the study period. 341 participants were then referred to the trial. 312 participants underwent MR/TRUS fusion biopsy of 452 lesions and were included in the analysis. 202 participants had biopsy-proven cancer (64.7%) and 206 (45.6%) lesions were positive for cancer. Distribution of cancer detected at each score produced a Gaussian distribution for SQS while PI-RADS demonstrates a negatively skewed curve with 82.1% of cases being scored as a 4 or 5. Patient-level data demonstrated AUC of 0.702 (95% CI 0.65 to 0.73) for PI-RADS and 0.762 (95% CI 0.72 to 0.81) for SQS (p< 0.0001) with respect to the detection of prostate cancer. The analysis for clinically significant prostate cancer at a per lesion level resulted in an AUC of 0.725 (95% CI 0.69 to 0.76) and 0.829 (95% CI 0.79 to 0.87) for the PI-RADS and SQS score, respectively (p< 0.0001).ConclusionsmpMRI is a useful tool in the workup of patients at risk for prostate cancer, and serves as a platform to guide further evaluation with MR/TRUS fusion biopsy. SQS score provided a more normal distribution of scores and yielded a higher AUC than PI-RADS v2. However until our findings are validated, we recommend reporting of detailed sequence-specific findings. This will allow for prospectively collected data to be utilized in determining the impact of ongoing changes to these scoring systems as our understanding of mpMRI interpretation evolves.

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“…Patients without an identified tumor on MP-MRI are more suitable for AS compared to those with a visible tumor on MP-MRI [34]. Several groups have been successful with MRI implementation in the form of their own risk scales, such as the use of an ordinal five-point scale applied to a 5-mm template prostate map coupled with MP-MRI in 129 men with no prior biopsy history that detected 87 % of cancers, with a sensitivity of 100 % when detecting Gleason 4 + 3 disease and an NPV of 89-100 % [35,36]. Conversely, lesions not identified on MP-MRI were assigned low-risk and low burden and were more likely to be triaged in AS.…”

Section: Negative Predictive Value Of Mrimentioning

confidence: 99%

The Role of MRI in Active Surveillance for Prostate Cancer

et al. 2015

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Approximately one in seven American men will be diagnosed with prostate cancer during his lifetime, and at least 50% of newly diagnosed patients will present with low-risk disease. In the last decade, the decision-making paradigm for management has shifted due to high rates of disease detection and overtreatment, attributed to prostate-specific antigen screening, with more men deferring definitive treatment for active surveillance. The advent of multiparametric magnetic resonance imaging (MP-MRI) and MRI/ transrectal ultrasound-guided fusion-guided prostate biopsy has refined the process of diagnosis, identifying patients with clinically-significant cancer and larger disease burden who would most likely benefit from intervention. In parallel, the utilization of MP-MRI in the surveillance of low-grade, low-volume disease is on the rise, reflecting support in a growing body of literature. The aim of this review is to appraise and summarize the data evaluating the role of magnetic resonance imaging in active surveillance for prostate cancer.

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Cited by 23 publications

References 25 publications

Association between a 17-gene genomic prostate score and multi-parametric prostate MRI in men with low and intermediate risk prostate cancer (PCa)

Association between a 17-gene genomic prostate score and multi-parametric prostate MRI in men with low and intermediate risk prostate cancer (PCa)

Comparison of Multiparametric MRI Scoring Systems and the Impact on Cancer Detection in Patients Undergoing MR US Fusion Guided Prostate Biopsies

The Role of MRI in Active Surveillance for Prostate Cancer

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