Magnetic resonance imaging of localized prostate cancer: coming of age in the psa era

Türkbey, Barış; Bernardo, Marcelino; Merino, María J.; Wood, Bradford J.; Pinto, Peter A.; Choyke, Peter L.

doi:10.4261/1305-3825.dir.4478-11.1

Cited by 25 publications

(28 citation statements)

References 69 publications

(57 reference statements)

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“…Multiparametric magnetic resonance imaging (MRI) of the prostate has been shown to have a high sensitivity and specificity for detecting prostate cancer (11)(12)(13)(14). Its accuracy in localizing prostate cancer was found to be superior to that of TRUS-guided biopsy in the prostate apex and transition zone (15,16).…”

Section: Discussionmentioning

confidence: 99%

MR-guided biopsy of the prostate: correlation of cancer detection rate with number of previous negative TRUS biopsies

Durmus¹,

Reichelt²,

Huppertz³

et al. 2013

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to investigate prostate cancer detection rate of magnetic resonance imaging (MRI)-guided biopsy and to elucidate possible relations to the number of prior negative transrectal ultrasonography (TRUS)-guided biopsies. MATERIALS AND METHODSEighty-seven consecutive patients (mean age, 65.0 years; mean prostate-specific antigen, 13.3 ng/mL) with at least one prior negative TRUS-guided biopsy and persistent suspicion of prostate cancer were included in this study. All patients underwent MRI-guided biopsy after a diagnostic multiparametric MRI examination at 1.5 Tesla. Specimens were immediately fixated and subsequently evaluated by an experienced uropathologist. Prostate cancer detection rates were calculated. Prostate cancer-positive and -negative cores were compared. Correlation between number of prior biopsies and presence of prostate cancer was evaluated. RESULTSCancer detection rates for patients with one (n=24), two (n=25), three (n=18), and four or more (n=20) negative TRUS-guided biopsies were 29.2%, 40.0%, 66.7%, and 35.0%, respectively (P = 0.087). The median number of removed cores per patient was 3 (range, 1-8) without a significant difference between patients with and without cancer (P = 0.48). Thirty of 36 cancer patients were at intermediate or high risk according to the D´Amico clinical risk score. Eleven of 15 high risk cancers were localized in the transition zone (P = 0.002). CONCLUSIONSThis study demonstrates high cancer detection rates of MRI-guided biopsy independent of the number of previous TRUS-guided biopsies and the number of taken prostate cores. MRI-guided biopsy therefore represents a less invasive and effective diagnostic tool for patients with prostate cancer suspicion and previous negative TRUS-guided biopsies.

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Section: Discussionmentioning

confidence: 99%

MR-guided biopsy of the prostate: correlation of cancer detection rate with number of previous negative TRUS biopsies

Durmus¹,

Reichelt²,

Huppertz³

et al. 2013

Diagn Interv Radiol

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“…Furthermore, MRI allows more accurate differentiation and segmentation of the transition zone and peripheral zone (18)(19)(20)(21). Our group had validated total prostate volume derived from image segmentation of prostate images obtained on a 3.0 T MRI with the weights of human radical prostatectomy specimens (22).…”

Section: Role Of Prostatic Volume Determination In Bph Managementmentioning

confidence: 99%

Clinical value of prostate segmentation and volume determination on MRI in benign prostatic hyperplasia

Garvey¹,

Türkbey²,

Truong³

et al. 2014

Diagn Interv Radiol

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Benign prostatic hyperplasia (BPH) is a nonmalignant pathological enlargement of the prostate, which occurs primarily in the transitional zone. BPH is highly prevalent and is a major cause of lower urinary tract symptoms in aging males, although there is no direct relationship between prostate volume and symptom severity. The progression of BPH can be quantified by measuring the volumes of the whole prostate and its zones, based on image segmentation on magnetic resonance imaging. Prostate volume determination via segmentation is a useful measure for patients undergoing therapy for BPH. However, prostate segmentation is not widely used due to the excessive time required for even experts to manually map the margins of the prostate. Here, we review and compare new methods of prostate volume segmentation using both manual and automated methods, including the ellipsoid formula, manual planimetry, and semiautomated and fully automated segmentation approaches. We highlight the utility of prostate segmentation in the clinical context of assessing BPH. Benign prostatic hyperplasia (BPH) can result in lower urinary tract symptoms, and is one of the most common diseases affecting aging men. BPH can compromise quality of life and is a major healthcare cost. Despite the high prevalence of BPH, few methods of accurately assessing prostate volume are actually used in clinical practice. While patient assessment of urinary symptoms dictates the need for treatment, it is highly subjective, whereas prostate volume change is a more objective measure of treatment response. The most common clinical model for approximating the prostate gland size is the ellipsoid model from transrectal ultrasonography (TRUS) imaging, which has been shown to underestimate prostate volume for prostates larger than 50 mL and to overestimate prostate volume for glands smaller than 30 mL (1). Despite its limitations, the TRUS method of prostate volume assessment is preferred in current clinical practice due to its availability and cost and time efficiency (2). More accurate prostate volume measurement with magnetic resonance (MR) planimetry is time-intensive and, thus, rarely performed.Prostate segmentation is an accurate technique for prostate volume determination that can be used in coregistration with various imaging modalities, such as magnetic resonance imaging (MRI) with positron emission tomography and MRI with ultrasonography. Segmentation can be used for both diagnostic and interventional procedures, including guided biopsies and focal ablation. Newly developed methods of automated prostate segmentation allow for efficient prostate volume determination, thereby enhancing decision support systems and computer-aided diagnosis tools.This article reviews the major methods of prostate volume determination currently in use, including the ellipsoid formula, manual planimetry, and semiautomated and fully automated segmentation. A clinical overview of BPH is also provided to highlight the utility of prostate segmentation in the clinical management...

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“…The lack of MR imaging studies of ejaculation is especially conspicuous. Multiparametric prostate MR imaging is used extensively for staging of prostate cancer detected at biopsy and for biopsy and treatment guidance (14–16). The detection and characterization of cancerous lesions at MR imaging are important.…”

mentioning

confidence: 99%

MR Imaging of the Prostate and Adjacent Anatomic Structures before, during, and after Ejaculation: Qualitative and Quantitative Evaluation

Medved

Sammet²,

Yousuf³

et al. 2014

Radiology

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Purpose To determine the possibility of obtaining high-quality magnetic resonance (MR) images before, during, and immediately after ejaculation and detecting measurable changes in quantitative MR imaging parameters after ejaculation. Materials and Methods In this prospective, institutional review board–approved, HIPAA-compliant study, eight young healthy volunteers (median age, 22.5 years), after providing informed consent, underwent MR imaging while masturbating to the point of ejaculation. A 1.5-T MR imaging unit was used, with an eight-channel surface coil and a dynamic single-shot fast spin-echo sequence. In addition, a quantitative MR imaging protocol that allowed calculation of T1, T2, and apparent diffusion coefficient (ADC) values was applied before and after ejaculation. Volumes of the prostate and seminal vesicles (SV) were calculated by using whole-volume segmentation on T2-weighted images, both before and after ejaculation. Pre- and postejaculation changes in quantitative MR parameters and measured volumes were evaluated by using the Wilcoxon signed rank test with Bonferroni adjustment. Results There was no significant change in prostate volumes on pre- and postejaculation images, while the SV contracted by 41% on average (median, 44.5%; P = .004). No changes before and after ejaculation were observed in T1 values or in T2 and ADC values in the central gland, while T2 and ADC values were significantly reduced in the peripheral zone by 12% and 14%, respectively (median, 13% and 14.5%, respectively; P = .004). Conclusion Successful dynamic MR imaging of ejaculation events and the ability to visualize internal sphincter closure, passage of ejaculate, and significant changes in SV volumes were demonstrated. Significant changes in peripheral zone T2 and ADC values were observed.

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Magnetic resonance imaging of localized prostate cancer: coming of age in the psa era

Cited by 25 publications

References 69 publications

MR-guided biopsy of the prostate: correlation of cancer detection rate with number of previous negative TRUS biopsies

MR-guided biopsy of the prostate: correlation of cancer detection rate with number of previous negative TRUS biopsies

Clinical value of prostate segmentation and volume determination on MRI in benign prostatic hyperplasia

MR Imaging of the Prostate and Adjacent Anatomic Structures before, during, and after Ejaculation: Qualitative and Quantitative Evaluation

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