DWI and PRECISE criteria in men on active surveillance for prostate cancer: A multicentre preliminary experience of different ADC calculations

Abstract

A B S T R A C TPurpose: The PRECISE score estimates the likelihood of radiological progression in patients on active surveillance (AS) for prostate cancer (PCa) with serial multiparametric magnetic resonance imaging (mpMRI). A PRECISE score of 1 or 2 denotes radiological regression, PRECISE 3 indicates stability and PRECISE 4 or 5 implies progression.We evaluated the inter-reader reproducibility of different apparent diffusion coefficient (ADC) calculations and their relationship to the PRECISE score. Material and methods: Baseline and follow-up scans (on the same MR systems) of 30 patients with visible lesions from two different institutions (University College London and Sapienza University of Rome) were analysed by two radiologists (one from each site). The PRECISE score was initially assessed in consensus. At least six weeks later, to reduce the likelihood of being influenced by the consensus PRECISE reading, each radiologist independently calculated ADC for the following: lesion, non-cancerous tissue and urine in the bladder. Normalised ADC ratios were calculated with respect to normal prostatic tissue (npADC) and urine. Spearman's correlation (ρ), intraclass correlation coefficients (ICC), differences in ADC and ROC curves were computed. Results: Interobserver reproducibility was very good (ρ > 0.8; ICC > 0.90). Lesion ADC (0.91 vs 0.73 × 10 −3 mm 2 /s; p=0.025) and npADC ratio (0.68 vs 0.53; p=0.012) at follow-up mpMRI were different between patients with radiological regression or stability vs progression. Cut-offs of 0.77 × 10 −3 mm 2 /s (lesion ADC) and 0.59 (npADC ratio) could differentiate the two groups (area under the curve: 0.74 and 0.77, respectively). Conclusion: The ADC, npADC ratio and the PRECISE score should be recorded for MRI-based AS.

Network Analysis Integrating microRNA Expression Profiling with MRI Biomarkers and Clinical Data for Prostate Cancer Early Detection: A Proof of Concept Study

“…As expected, the lowest values were found in PCa patients, suggesting that ADC could be the one biomarker distinguishing PCa from non-PCa lesions. This value is in line with previously published works, confirming the role of low ADC values for csPCa diagnosis [23,27,28]. The MiRNA drivers of disease status could distinguish healthy donors from patients with either ciPCa or csPCa.…”

“…All the available sequences were used to accurately locate the lesion. In order to select an optimal reference for ADC normalisation, the radiologist used a previously validated methodology [23]. DCE quantitative pharmacokinetic parameters: Ktrans (influx transfer constant), Kep (efflux rate constant) and VE (fractional volume of extravascular extracellular space) were obtained using a dedicated software (OleaSphere), by placing ROIs traced on perfusion scans after selecting an appropriate arterial input function (AIF).…”

MRI as a screening tool for prostate cancer: current evidence and future challenges

“…For both bpMRI and mpMRI, T2-weighted images are critical for precise imaging of prostate anatomy. Diffusionweighted imaging (DWI), which assesses cell density, Table 1 Prevalence of clinically significant prostate cancer (csPCa) according to prostate-specific antigen (PSA) values, derived from a secondary analysis of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial [40], as well as prevalence of csPCA according to PI-RADS scores 3-5, derived from the PRECISION trial [8] as well as the validation trial for the PI-RADS 2.0 system [41] csPCa was defined as any Gleason score ≥ 7, death from PCa, or T2b status after radical prostatectomy in the PLCO trial and as any Gleason score ≥ 7 in the PRECISION trial and the validation trial for PI-RADS further helps distinguish cancerous and non-cancerous regions, since a higher cell density is encountered in cancerous regions [15]. In the third step, which is excluded in bpMRI, dynamic contrast enhancement (DCE), which relies on contrast agents, more clearly delineates the vascular supply within the prostate, which is preferentially taken up by malignant PCa [16].…”

Natural history of prostate cancer on active surveillance: stratification by MRI using the PRECISE recommendations in a UK cohort

“…As there are still no explicit recommendations on which PRECISE score should be considered the most representative when multiple scans are acquired, we used the highest PRECISE score for each patient during the study period in this analysis. [14,15] We applied the following interpretation to the PRECISE recommendations:…”

“…At present, there is limited literature on the application of the PRECISE recommendations in a clinical setting [14][15][16][17].…”