Conspicuity of prostate cancer on multiparametric magnetic resonance imaging: A cross‐disciplinary translational hypothesis

Norris, Joseph M.; Simpson, Benjamin S.; Freeman, Alex; Kirkham, Alex; Whitaker, Hayley C.; Emberton, Mark

doi:10.1096/fj.202001466r

Cited by 7 publications

(7 citation statements)

References 69 publications

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“…Similarly, PI-RADS could be used as another means of assuring the patient that active surveillance is the treatment of choice, in patients with neglectable risk of distant failure. The score most likely goes beyond the standard risk assessment through significant association with routinely non-reported histopathological hallmarks [ 24 ] and genomic changes [ 25 , 26 , 27 , 28 ]. Moreover, the PI-RADS score of 5 and large axial measurements of the target lesion found in low or intermediate-risk group PCa patients could be an important predictive factor for the necessity of secondary pre-treatment biopsy or early confirmatory biopsy in patients opting for active surveillance.…”

Section: Discussionmentioning

confidence: 99%

The Prognostic Value of PI-RADS Score in CyberKnife Ultra-Hypofractionated Radiotherapy for Localized Prostate Cancer

Miszczyk

Rembak-Szynkiewicz

Magrowski

et al. 2022

Cancers

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Prostate Imaging-Reporting and Data System (PI-RADS) has been widely implemented as a diagnostic tool for significant prostate cancer (PCa); less is known about its prognostic value, especially in the setting of primary radiotherapy. We aimed to analyze the association between PI-RADS v. 2.1 classification and risk of metastases, based on a group of 152 patients treated with ultra-hypofractionated stereotactic CyberKnife radiotherapy for localized low or intermediate risk-group prostate cancer. We found that all distant failures (n = 5) occurred in patients diagnosed with a PI-RADS score of 5, and axial measurements of the target lesion were associated with the risk of developing metastases (p < 0.001). The best risk stratification model (based on a combination of greatest dimension, the product of multiplication of PI-RADS target lesion axial measurements, and age) achieved a c-index of 0.903 (bootstrap-validated bias-corrected 95% CI: 0.848–0.901). This creates a hypothesis that PI-RADS 5 and the size of the target lesion are important prognostic factors in early-stage PCa patients and should be considered as an adverse prognostic measure for patients undergoing early treatment such as radiation or focal therapy.

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Section: Discussionmentioning

confidence: 99%

The Prognostic Value of PI-RADS Score in CyberKnife Ultra-Hypofractionated Radiotherapy for Localized Prostate Cancer

Miszczyk

Rembak-Szynkiewicz

Magrowski

et al. 2022

Cancers

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“…Much less is known about the added value of MRI lesion features (PI-RADS/Likert) as an independent prognostic or predictor of outcome. Lesions visibility is being explored by different groups with so far inconclusive results [ 38 , 39 ]. In a review of the literature Stabile et alfound 6 studies on the predictive role of the PI-RADS score and concluded that reliable evidence was limited but there was a trend for better prediction of biochemical relapse after surgery [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Assessing the impact of MRI based diagnostics on pre-treatment disease classification and prognostic model performance in men diagnosed with new prostate cancer from an unscreened population

et al. 2022

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Introduction Pre-treatment risk and prognostic groups are the cornerstone for deciding management in non-metastatic prostate cancer. All however, were developed in the pre-MRI era. Here we compared categorisation of cancers using either only clinical parameters or with MRI enhanced information in men referred for suspected prostate cancer from an unscreened population. Patient and methods Data from men referred from primary care to our diagnostic service and with both clinical (digital rectal examination [DRE] and systematic biopsies) and MRI enhanced attributes (MRI stage and combined systematic/targeted biopsies) were used for this study. Clinical vs MRI data were contrasted for clinico-pathological and risk group re-distribution using the European Association of Urology (EAU), American Urological Association (AUA) and UK National Institute for Health Care Excellence (NICE) Cambridge Prognostic Group (CPG) models. Differences were retrofitted to a population cohort with long-term prostate cancer mortality (PCM) outcomes to simulate impact on model performance. We further contrasted individualised overall survival (OS) predictions using the Predict Prostate algorithm. Results Data from 370 men were included (median age 66y). Pre-biopsy MRI stage reassignments occurred in 7.8% (versus DRE). Image-guided biopsies increased Grade Group 2 and ≥ Grade Group 3 assignments in 2.7% and 2.9% respectively. The main change in risk groups was more high-risk cancers (6.2% increase in the EAU and AUA system, 4.3% increase in CPG4 and 1.9% CPG5). When extrapolated to a historical population-based cohort (n = 10,139) the redistribution resulted in generally lower concordance indices for PCM. The 5-tier NICE-CPG system outperformed the 4-tier AUA and 3-tier EAU models (C Index 0.70 versus 0.65 and 0.64). Using an individualised prognostic model, changes in predicted OS were small (median difference 1% and 2% at 10- and 15-years’ respectively). Similarly, estimated treatment survival benefit changes were minimal (1% at both 10- and 15-years’ time frame). Conclusion MRI guided diagnostics does change pre-treatment risk groups assignments but the overall prognostic impact appears modest in men referred from unscreened populations. Particularly, when using more granular tiers or individualised prognostic models. Existing risk and prognostic models can continue to be used to counsel men about treatment option until long term survival outcomes are available.

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“…7 There is also increasing evidence to suggest that mpMRI-visible lesions may associate with more aggressive clinical features. 8 Given this growing body of evidence linking risk, location and conspicuity on mpMRI, the Open access need to amalgamate these features is evident. Therefore, the objective of this systematic review and meta-analysis is to collate the extant evidence regarding the effect of prostate cancer zonal location on mpMRI conspicuity, for the first time.…”

Section: Introductionmentioning

confidence: 99%

Relationship of prostate cancer topography and tumour conspicuity on multiparametric magnetic resonance imaging: a protocol for a systematic review and meta-analysis

Satish¹,

Freeman

Kelly

et al. 2022

BMJ Open

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IntroductionMultiparametric magnetic resonance imaging (mpMRI) has improved the triage of men with suspected prostate cancer, through precision prebiopsy identification of clinically significant disease. While multiple important characteristics, including tumour grade and size have been shown to affect conspicuity on mpMRI, tumour location and association with mpMRI visibility is an underexplored facet of this field. Therefore, the objective of this systematic review and meta-analysis is to collate the extant evidence comparing MRI performance between different locations within the prostate in men with existing or suspected prostate cancer. This review will help clarify mechanisms that underpin whether a tumour is visible, and the prognostic implications of our findings.Methods and analysisThe databases MEDLINE, PubMed, Embase and Cochrane will be systematically searched for relevant studies. Eligible studies will be full-text English-language articles that examine the effect of zonal location on mpMRI conspicuity. Two reviewers will perform study selection, data extraction and quality assessment. A third reviewer will be involved if consensus is not achieved. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will inform the methodology and reporting of the review. Study bias will be assessed using a modified Newcastle-Ottawa scale. A thematic approach will be used to synthesise key location-based factors associated with mpMRI conspicuity. A meta-analysis will be conducted to form a pooled value of the sensitivity and specificity of mpMRI at different tumour locations.Ethics and disseminationEthical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations.PROSPERO registration numberCRD42021228087.

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Conspicuity of prostate cancer on multiparametric magnetic resonance imaging: A cross‐disciplinary translational hypothesis

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 7 publications

References 69 publications

The Prognostic Value of PI-RADS Score in CyberKnife Ultra-Hypofractionated Radiotherapy for Localized Prostate Cancer

The Prognostic Value of PI-RADS Score in CyberKnife Ultra-Hypofractionated Radiotherapy for Localized Prostate Cancer

Assessing the impact of MRI based diagnostics on pre-treatment disease classification and prognostic model performance in men diagnosed with new prostate cancer from an unscreened population

Relationship of prostate cancer topography and tumour conspicuity on multiparametric magnetic resonance imaging: a protocol for a systematic review and meta-analysis

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