Novel Imaging in Detection of Metastatic Prostate Cancer

Smith, Clayton; Laucis, Anna M.; Harmon, Stephanie; Mena, Esther; Lindenberg, Liza; Choyke, Peter L.; Türkbey, Barış

doi:10.1007/s11912-019-0780-8

Cited by 15 publications

(37 citation statements)

References 60 publications

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“…However, conventional imaging, such as bone or CT scans, has poor sensitivity to detect recurrence at PSA values less than 10 ng/mL. [19][20][21][22] As our experience with molecular imaging (eg, prostate-specific membrane antigen positron emission tomography/CT scan) improves, disease will be detected at lower thresholds, resulting in the identification of metastatic lesions when present at lower quantities and aiding in the stratification of who might most benefit from MDT or identifying those with higher subclinical disease burden than expected, who might best be treated with systemic therapies alone. 23 The large benefit of using peri-RT ADT also brings into question how MDT should be incorporated with ADT.…”

Section: Discussionmentioning

confidence: 99%

Radiation Therapy in the Definitive Management of Oligometastatic Prostate Cancer: The Johns Hopkins Experience

Deek

Phillips

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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Local consolidation of oligometastatic disease is a rapidly emerging treatment paradigm. This article reviews our institutional experience treating oligometastatic prostate cancer with definitive intent radiation therapy. We demonstrate that metastasisdirected therapy with stereotactic ablative radiation therapy to oligometastatic lesions can be effective across a wide range of oligometastatic prostate cancer Purpose: The use of radiation therapy (RT) in consolidating oligometastatic prostate cancer (OPCa) is a rapidly evolving treatment paradigm. We review our institutional experience using metastasis-directed therapy in the definitive management of men with OPCa. Methods and Materials: Patients with OPCa treated with definitive RT were included. The Kaplan-Meier method and multivariable Cox regression analysis were performed to assess biochemical progression-free survival (bPFS) and time to next intervention. Cumulative incidence functions were used to calculate rates of local failure. Toxicity was assessed using Common Terminology Criteria for Adverse Events (version 4).Results: This study analyzed 156 patients with OPCa and 354 metastatic lesions with median follow-up of 24.6 months. Of 150 patients with toxicity data, 53 (35%) experienced acute grade 1 toxicity, 8 (5%) had grade 2, and none had grade 3 toxicity. Only 13 patients (9%) had late toxicities. At 24 months, the cumulative incidence of local failure was 7.4%. Median bPFS for the entire cohort was 12.9 months and 52% at 1 year. On multivariable analysis, factors associated with prolonged bPFS were peri-RT androgen deprivation therapy (ADT), lower gross tumor volume, and hormonesensitive (HS) OPCa. Median time to next intervention, including repeat RT, was 21.6 months. Median bPFS for men with HS prostate cancer was 17.2 months International Journal of biology physics www.redjournal.org subtypes, but with differential efficacy. Continued study is warranted to investigate the use of radiation therapy over the wide range of patients with oligometastatic prostate cancer. compared with 7.2 months in men with castrate-resistant OPCa (P < .0001), and cumulative incidence of local failure at 24 months was lower with HS OPCa (4.8% vs 12.1%; P Z .034). We analyzed 28 men with HS OPCa treated with a course of peri-RT ADT (median, 4.3 months) with recovery of testosterone. At a median follow-up of 33.5 months, 20 patients had not developed bPFS, median bPFS had not been reached, and 24-month bPFS was 77%. Conclusions: Metastasis-directed therapy can be effective across a wide range of OPCa subtypes, but with differential efficacy. Further study is warranted to investigate the use of RT across the wide range of patients with OPCa. Ó 2019 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Volume 105 Number 5 2019 Radiation for oligometastatic prostate cancer 949 Abbreviations: BED Z biological dose equivalent; GTV Z gross tumor volume; PSA Z prostate-specific ...

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Section: Discussionmentioning

confidence: 99%

Radiation Therapy in the Definitive Management of Oligometastatic Prostate Cancer: The Johns Hopkins Experience

Deek

Phillips

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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“…Similarly, the combination of molecular imaging techniques with prostate MRI is not included in the present review, but has been recently reviewed elsewhere. 17 Quantitative Features Currently Available for Use in PI-RADS Size and Volume of Tumor PI-RADS v2.1 incorporates lesion size as part of the decision tree rules to differentiate between assessment of category 4 and 5 observations (likely or highly-likely to represent significant cancer). 9 This differentiation is based on data showing that larger tumors are associated with more aggressive disease.…”

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confidence: 99%

“…Novel MR applications, such as: diffusion kurtosis imaging (DKI), MRI fingerprinting, and other methods are briefly reviewed; however, due to lack of commercial availability and validation for use in clinical practice, they are not covered in depth. Similarly, the combination of molecular imaging techniques with prostate MRI is not included in the present review, but has been recently reviewed elsewhere 17 …”

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confidence: 99%

Quantitative Prostate MRI

Schieda

Lim

Zabihollahy

et al. 2020

Magnetic Resonance Imaging

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Prostate MRI is reported in clinical practice using the Prostate Imaging and Data Reporting System (PI‐RADS). PI‐RADS aims to standardize, as much as possible, the acquisition, interpretation, reporting, and ultimately the performance of prostate MRI. PI‐RADS relies upon mainly subjective analysis of MR imaging findings, with very few incorporated quantitative features. The shortcomings of PI‐RADS are mainly: low‐to‐moderate interobserver agreement and modest accuracy for detection of clinically significant tumors in the transition zone. The use of a more quantitative analysis of prostate MR imaging findings is therefore of interest. Quantitative MR imaging features including: tumor size and volume, tumor length of capsular contact, tumor apparent diffusion coefficient (ADC) metrics, tumor T1 and T2 relaxation times, tumor shape, and texture analyses have all shown value for improving characterization of observations detected on prostate MRI and for differentiating between tumors by their pathological grade and stage. Quantitative analysis may therefore improve diagnostic accuracy for detection of cancer and could be a noninvasive means to predict patient prognosis and guide management. Since quantitative analysis of prostate MRI is less dependent on an individual users' assessment, it could also improve interobserver agreement. Semi‐ and fully automated analysis of quantitative (radiomic) MRI features using artificial neural networks represent the next step in quantitative prostate MRI and are now being actively studied. Validation, through high‐quality multicenter studies assessing diagnostic accuracy for clinically significant prostate cancer detection, in the domain of quantitative prostate MRI is needed. This article reviews advances in quantitative prostate MRI, highlighting the strengths and limitations of existing and emerging techniques, as well as discussing opportunities and challenges for evaluation of prostate MRI in clinical practice when using quantitative assessment. Level of Evidence 5 Technical Efficacy Stage 2

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“…Identification of metastases in PC patients has a major impact on treatment selection and overall survival outcome [42]. In spite of novel emerging imaging techniques showing improved ability to detect clinically significant PC [17] and metastatic PC (mPC) [43], there are still limitations considering the diagnostic accuracy including the dependence on an experienced radiologist interpretation [44]. As of today, there is a lack of alternative non‐invasive methods that could discriminate mPC with sufficient sensitivity and specificity at time of diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Identification of a serum biomarker signature associated with metastatic prostate cancer

Emruli

Liljedahl

Axelsson

et al. 2021

Proteomics Clinical Apps

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Improved early diagnosis and determination of aggressiveness of prostate cancer (PC) is important to select suitable treatment options and to decrease overtreatment. The conventional marker is total prostate specific antigen (PSA) levels in blood, but lacks specificity and ability to accurately discriminate indolent from aggressive disease. Experimental design:In this study, we sought to identify a serum biomarker signature associated with metastatic PC. We measured 157 analytes in 363 serum samples from healthy subjects, patients with non-metastatic PC and patients with metastatic PC, using a recombinant antibody microarray.Results: A signature consisting of 69 proteins differentiating metastatic PC patients from healthy controls was identified. Conclusions and clinical relevance:The clinical value of this biomarker signature requires validation in larger independent patient cohorts before providing a new prospect for detection of metastatic PC.

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Novel Imaging in Detection of Metastatic Prostate Cancer

Cited by 15 publications

References 60 publications

Radiation Therapy in the Definitive Management of Oligometastatic Prostate Cancer: The Johns Hopkins Experience

Radiation Therapy in the Definitive Management of Oligometastatic Prostate Cancer: The Johns Hopkins Experience

Quantitative Prostate MRI

Identification of a serum biomarker signature associated with metastatic prostate cancer

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