Current status of MRI for the diagnosis, staging and prognosis of prostate cancer: implications for focal therapy and active surveillance

Villers, Arnauld; Lemaître, L.; Haffner, Jérémie; Puech, Philippe

doi:10.1097/mou.0b013e328329a2ed

Cited by 102 publications

(58 citation statements)

References 54 publications

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“…Inadequate identification of unilateral cancers was a major clinical problem in the FT implementation and, for this reason, new imaging modalities and biopsy techniques have been evaluated to better map prostate cancer within the gland. [9][10][11] Although the results are interesting, the efficacy, safety and superiority compared to conventional imaging and biopsy schemes will need to be determined before these approaches become standard.…”

Section: Discussionmentioning

confidence: 99%

“…6 However, conventional biopsy schemes have been shown to be unreliable in identifying appropriate patients for FT. 7,8 Several novel imaging techniques, including contrast enhanced ultrasound and magnetic resonance biopsy, have attempted to better define and visualize prostate cancer within the gland. 9,10 Even though the results are promising, they need validation before being introduced to the clinical setting. Three-dimensional transperineal mapping biopsies are promising, since they can be used either as a selection tool for FT candidates by identifying cancer location and extension within the prostate, or as a guide for the FT procedure.…”

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confidence: 99%

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Parameters predicting postoperative unilateral disease in patients with unilateral prostate cancer in diagnostic biopsy: a rationale for selecting hemiablative focal therapy candidates

Sfoungaristos

Perimenis

2013

CUAJ

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E82Cite as: Can Urol Assoc J 2013;7:E82-E87. http://dx.doi.org/10.5489/cuaj.268. Epub 2011 November 2. AbstractBackground: Focal hemiablative therapy for prostate cancer is a new treatment alternative. Unilateral and unifocal disease are its main limitations. The aim of this study was to identify the epidemiological, clinical and pathological parameters that may predict unilateral disease in patients diagnosed with prostate cancer. Methods:We performed a retrospective analysis of patients at our institution between January 2005 and January 2011. Only patients with unilateral disease in prostate biopsy were part of the study. The analysis included age, preoperative prostate-specific antigen (PSA) and its density, prostate volume, biopsy first and second Gleason pattern and Gleason summary, number of biopsy cores, percentage of cancer in biopsy material and the presence of highgrade prostatic intraepithelial neoplasia. Their role as potential predictors was evaluated by univariate and multivariate analysis. Results: A total of 161 patients had unilateral disease after prostate biopsy. A significant correlation was found between prostate volume, PSA density and percentage of cancer in biopsy material and the presence of unilateral disease in the surgical specimen. These are the same factors significant in the univariate analysis. The results of the multivariate analysis demonstrated that PSA density (p = 0.015) and percentage of cancer in biopsy material (p = 0.028) are the most significant predictors. Interpretation: Our results demonstrate that PSA density and the percentage of cancer in biopsy cores are significant predictors for prostate cancer unilaterality and should be considered for the selection of hemiablative focal therapy candidates.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Parameters predicting postoperative unilateral disease in patients with unilateral prostate cancer in diagnostic biopsy: a rationale for selecting hemiablative focal therapy candidates

Sfoungaristos

Perimenis

2013

CUAJ

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“…Performing a second biopsy prior to the inclusion in an AS program has also been proposed [23,24,25]. More recently, different imaging methods and molecular tests have also been introduced [26,27].…”

Section: Discussionmentioning

confidence: 99%

Histological Findings in Very Low Risk Prostate Cancer Patients Managed with Radical Prostatectomy

et al. 2017

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AbstractObjectives: To describe the histological findings in patients with prostate cancer (PCa) clinically classified as very low risk who underwent treatment with radical prostatectomy (RP). Material and methods: A retrospective observational study was conducted. Clinical records of patients who underwent RP between 2007-2015 who met Epstein criteria for very low risk disease were reviewed. Histological diagnosis was described and analyzed to determine if such criteria predicted very low risk. Results: A total of 609 records were reviewed; 83 (13.6%) met Epstein’s criteria. Mean age was 59 (SD±7) years and median PSA at diagnosis was 5.4 ng/dl (IQR 4.3 – 6.8). Pathology showed a median tumor volume of 4% (IQR 1 – 10%). Gleason score was 3+3 in 55 (66.3%) cases, but 28 (33.7%) were reclassified to a greater score. Two (2.4%) patients were reclassified as pT3a, 80 (96.4%) as pT2 and 1 (1.2%) was found to be pT0. In those subjected to pelvic lymphadenectomy (42.2%) no positive lymph nodes were found. Conclusions: Up to one-third of the patients clinically classified with very low risk PCa had a greater Gleason score. Only 3% had locally advanced tumors, which is comparable to previous studies. Epstein’s criteria seem to be adequate in predicting organ-confined disease.

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“…DCE-MRI can localize prostate cancer after failed EBRT with an accuracy as high as 83%, 20,23 and can assess response to focal therapies with HIFU and cryotherapy. 24 We have demonstrated the ability of DCE-MRI to successfully predict early outcome of photodynamic therapy with a sensitivity and NPV of 100%.…”

Section: Discussionmentioning

confidence: 99%

Dynamic contrast enhanced MRI as a predictor of vascular-targeted photodynamic focal ablation therapy outcome in prostate cancer post failed external beam radiation therapy

Barrett

Davidson

Wilson

et al. 2014

CUAJ

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Introduction: Photodynamic therapy (PDT) can be employed as a focal therapy for prostate cancer. Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) can potentially help identify tumour recurrence after failed external-beam radiotherapy (EBRT). The purpose of this study was to determine the ability of DCE-MRI to predict early response to PDT salvage treatment. Methods: Patients with post-EBRT prostate cancer recurrence were prospectively enrolled into a Phase I/II trial of PDT using WST09. A 15-patient subgroup of this cohort undergoing 1.5T DCE-MRI at baseline and 1-week post-PDT was retrospectively analyzed. The reference standard was prostate biopsy obtained 6 months post-PDT. Analysis was performed on a patient-by-patient basis, by prostate gland halves, and by prostate sextants. Results: Biopsy 6 months post-PDT identified cancer in 10/15 patients (66.7%), and in 24/90 sextants (26.7%). Residual cancer was identified in 22/37 sextants (59.5%) identified as being involved at baseline. DCE-MRI at 1 week correctly predicted recurrent disease with a sensitivity of 100% (10/10), specificity of 60% (3/5), positive predictive value of 83.3% (10/12), negative predictive value of 100% (3/3), and an overall accuracy of 86.7%, (13/15). When analysis was performed on prostate halves, the sensitivity and negative predictive value remained at 100%, with an improvement in specificity to 88.2% (15/17). The overall accuracy of DCE-MRI was similar regardless of analysis method: 86.7% on a patient-by-patient basis, 86.7% by prostate half and 83.3% by sextant. Changes in prostate-specific antigen (PSA) did not correlate to response. Conclusion: DCE-MRI shows promise as a tool to predict successful outcome when performed 1 week post-PDT and could potentially be used to inform the need for re-treatment at an early time-point.

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Current status of MRI for the diagnosis, staging and prognosis of prostate cancer: implications for focal therapy and active surveillance

Abstract: At present, high-resolution MRI with pelvic coil appears to offer the most readily available and useful imaging. Future studies should work towards helping define standard, reproducible approaches to imaging and image reporting for research and clinical practice.

Cited by 102 publications

References 54 publications

Parameters predicting postoperative unilateral disease in patients with unilateral prostate cancer in diagnostic biopsy: a rationale for selecting hemiablative focal therapy candidates

Parameters predicting postoperative unilateral disease in patients with unilateral prostate cancer in diagnostic biopsy: a rationale for selecting hemiablative focal therapy candidates

Histological Findings in Very Low Risk Prostate Cancer Patients Managed with Radical Prostatectomy

Dynamic contrast enhanced MRI as a predictor of vascular-targeted photodynamic focal ablation therapy outcome in prostate cancer post failed external beam radiation therapy

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