Radiomics in prostate cancer imaging for a personalized treatment approach - current aspects of methodology and a systematic review on validated studies

Spohn, Simon K B; Bettermann, A.; Bamberg, Fabian; Benndorf, Matthias; Mix, M.; Nicolay, Nils H.; Fechter, Tobias; Hölscher, Tobias; Grosu, Radu; Chiti, Arturo; Grosu, Anca L.; Zamboglou, Constantinos

doi:10.7150/thno.61207

Cited by 46 publications

(46 citation statements)

References 156 publications

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“…The accuracy of MRI-based prognostic prediction could be improved through dedicated Radiomics models. Although Radiomics are largely focused on diagnostics [ 38 ], some authors present an exceptionally high correlation of MRI features with the risk of bone metastases [ 39 , 40 ]. On the other hand, these results are based on rather modest study groups, prone to overfitting, and unlike PI-RADS require a measurable increase in resources necessary for each patient’s initial evaluation.…”

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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“…In our exploratory analysis, SUVmax values ≥ median extracted from lymph nodes were associated with unfavorable BRFS, potentially representing patients with biologically more aggressive disease. Radiomic features (RFs) allow extracting deeper information from medical images ( 22 ), enabling non-invasive tumor characterization and prediction of lymph node involvement ( 23 ). Thus, image analysis through RF bears the potential to identify additional prognosticators and should be analyzed in the future.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Biochemical Recurrence After PSMA-PET-Guided Definitive Radiotherapy in Patients With De Novo Lymph Node-Positive Prostate Cancer

et al. 2022

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IntroductionThe National Comprehensive Cancer Network recommends external beam radiotherapy (EBRT) combined with androgen deprivation therapy (ADT) as the preferred treatment option for newly diagnosed node-positive (cN1) prostate cancer (PCa) patients. However, implementation of positron emission tomography targeting prostate-specific membrane antigen (PSMA-PET) in the staging of primary PCa patients has a significant impact on RT treatment concepts. This study aims to evaluate outcomes and their respective risk factors on patients with PSMA-PET-based cN1 and/or cM1a PCa receiving primary RT and ADT.MethodsForty-eight patients with cN0 and/or cM1a PCa staged by [18F]PSMA-1007-PET (n = 19) or [68Ga]PSMA-11-PET (n = 29) were retrospectively included. All patients received EBRT to the pelvis ± boost to positive nodes, followed by boost to the prostate. The impact of different PET-derived characteristics such as maximum standard uptake value (SUVmax) and number of PET-positive lymph nodes on biochemical recurrence-free survival (BRFS) (Phoenix criteria) and metastasis-free survival (MFS) was determined using Kaplan–Meier and Cox proportional hazard regression analyses.ResultsMedian follow-up was 24 months. Median initial serum prostate-specific antigen was 20.2 ng/ml (IQR 10.2–54.2). Most patients had cT stage ≥ 3 (63%) and ISUP grade ≥ 3 (85%). Median dose to the prostate, elective nodes, and PET-positive nodes was 75 Gy, 45 Gy, and 55 Gy, respectively. Ninety percent of patients received ADT with a median duration of 9 months (IQR 6–18). In univariate analysis, cM1a stage (p = 0.03), number of >2 pelvic nodes (p = 0.01), number of >1 abdominal node (p = 0.02), and SUVmax values ≥ median (8.1 g/ml for 68Ga-PSMA-11 and 7.9 g/ml for 18F-PSMA-1007) extracted from lymph nodes were significantly associated with unfavorable BRFS, but classical clinicopathological features were not. Number of >2 pelvic nodes (n = 0.03), number of >1 abdominal node (p = 0.03), and SUVmax values ≥ median extracted from lymph nodes were associated with unfavorable MFS. In multivariate analysis, number of >2 pelvic lymph nodes was significantly associated with unfavorable BRFS (HR 5.2, p = 0.01) and SUVmax values ≥ median extracted from lymph nodes had unfavorable MFS (HR 6.3, p = 0.02).ConclusionMore than 2 PET-positive pelvic lymph nodes are associated with unfavorable BRFS, and high SUVmax values are associated with unfavorable MFS. Thus, the number of PET-positive lymph nodes and the SUVmax value might be relevant prognosticators to identify patients with favorable outcomes.

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“… 33 – 36 Recent evidence are reported for detection of PCa lesions (especially PIRADS 3 lesions), 37 tumor delineation, 38 tumor localization, 39 and segmentation of prostate volume and lesions using PSMA-PET. 40 , 41 As current risk stratification models, which could predict oncological outcomes, are unable to accurately delineate the prognosis for each patient and for each stage of disease, there is an ongoing need for the detection of personalized and precise detections tools and treatment. 12 Radiomics features (RFs) analysis can give information for detection, risk stratification, and treatment.…”

Section: Introductionmentioning

confidence: 99%

Radiomics in prostate cancer: an up-to-date review

Ferro

Cobelli

Musi

et al. 2022

Therapeutic Advances in Urology

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Prostate cancer (PCa) is the most common worldwide diagnosed malignancy in male population. The diagnosis, the identification of aggressive disease, and the post-treatment follow-up needs a more comprehensive and holistic approach. Radiomics is the extraction and interpretation of images phenotypes in a quantitative manner. Radiomics may give an advantage through advancements in imaging modalities and through the potential power of artificial intelligence techniques by translating those features into clinical outcome prediction. This article gives an overview on the current evidence of methodology and reviews the available literature on radiomics in PCa patients, highlighting its potential for personalized treatment and future applications.

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Radiomics in prostate cancer imaging for a personalized treatment approach - current aspects of methodology and a systematic review on validated studies

Cited by 46 publications

References 156 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

Risk Factors for Biochemical Recurrence After PSMA-PET-Guided Definitive Radiotherapy in Patients With De Novo Lymph Node-Positive Prostate Cancer

Radiomics in prostate cancer: an up-to-date review

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