Reporting Magnetic Resonance Imaging in Men on Active Surveillance for Prostate Cancer: The PRECISE Recommendations—A Report of a European School of Oncology Task Force

Moore, Caroline M.; Giganti, Francesco; Albertsen, Peter C.; Allen, Clare; Bangma, Chris H.; Briganti, Alberto; Carroll, Peter R.; Haider, Masoom A.; Kasivisvanathan, Veeru; Kirkham, Alex; Klotz, Laurence; Ouzzane, A.; Padhani, Anwar R.; Panebianco, Valeria; Pinto, Peter A.; Puech, Philippe; Rannikko, Antti; Renard-Penna, Raphaële; Touijer, Karim; Türkbey, Barış; Poppel, H. Van; Valdagni, Riccardo; Walz, Jochen; Schoots, Ivo G.

doi:10.1016/j.eururo.2016.06.011

Cited by 204 publications

(149 citation statements)

References 11 publications

Supporting

Mentioning

142

Contrasting

Unclassified

Order By: Relevance

“…In addition, the clinical relevance of invisible regions with intermediate density and heterogeneous morphology remains unclear and warrants further investigation by studying their genetic background. With a growing population choosing active surveillance, we need to be aware of this error, especially when mpMRI is propagated as a monitoring tool without any biopsy procedure . Focal treatment plans may be expanded by margins beyond the visible lesion on mpMRI at the cost of increasing the treated healthy volume.…”

Section: Discussionmentioning

confidence: 99%

“…With a growing population choosing active surveillance, we need to be aware of this error, especially when mpMRI is propagated as a monitoring tool without any biopsy procedure. 40 Focal treatment plans may be expanded by margins beyond the visible lesion on mpMRI 11 at the cost of increasing the treated healthy volume. Therefore, we recommend developing guidelines for more accurate lesion delineation.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Histopathological Features of MRI‐Invisible Regions of Prostate Cancer Lesions

Houdt

Ghobadi

Schoots

et al. 2019

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Background Previous studies have reported tumor volume underestimation with multiparametric (mp)MRI in prostate cancer diagnosis. Purpose To investigate why some parts of lesions are not visible on mpMRI by comparing their histopathology features to those of visible regions. Study Type Retrospective. Population Thirty‐four patients with biopsy‐proven prostate cancer scheduled for prostatectomy (median 68.7 years). Field Strength/Sequence T2‐weighted, diffusion‐weighted imaging, T2 mapping, and dynamic contrast‐enhanced MRI on two 3T systems and one 1.5T system. Assessment Two readers delineated suspicious lesions on mpMRI. A pathologist delineated the lesions on histopathology. A patient‐customized mold enabled the registration of histopathology and MRI. On histopathology we identified mpMRI visible and invisible lesions. Subsequently, within the visible lesions we identified regions that were visible and regions that were invisible on mpMRI. For each lesion and region the following characteristics were determined: size, location, International Society of Urological Pathology (ISUP) grade, and Gleason subpatterns (density [dense/intermediate], tumor morphology [homogeneous/heterogeneous], cribriform growth [yes/no]). Statistical Tests With generalized linear mixed‐effect modeling we investigated which features explain why a lesion or a region was invisible on MRI. We compared imaging values (T2, ADC, and Ktrans) for these features with one‐way analysis of variance (ANOVA). Results Small, anterior, and ISUP grade 1–2 lesions (n = 34) were missed more frequent than large, posterior, ISUP grade ≥ 3 lesions (n = 35). Invisible regions on mpMRI had lower tumor density, heterogeneous tumor morphology, and were located in the transition zone. Both T2 and ADC values were higher in "intermediate" compared with "dense" regions (P = 0.002 and < 0.001) and in regions with heterogeneous compared with homogeneous morphology (P < 0.001 and 0.03). Ktrans was not significantly different (P = 0.24 and 0.99). Data Conclusion Regions of prostate cancer lesions that are invisible on mpMRI have different histopathology features than visible regions. This may have implications for monitoring during active surveillance and focal treatment strategies. Level of Evidence: 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2020;51:1235–1246.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Histopathological Features of MRI‐Invisible Regions of Prostate Cancer Lesions

Houdt

Ghobadi

Schoots

et al. 2019

Magnetic Resonance Imaging

View full text Add to dashboard Cite

show abstract

“…In addition, MRI might be useful for confirming the absence of any large anterior lesions that could have been missed during routine diagnosis 19 . However, robust, formally published data are needed before widespread implementation of MRI for this purpose 18,20 . Most likely, the semantics of AS will need to be augmented with MRI-related definitions as new evidence becomes available.…”

Section: Strengths and Weaknessesmentioning

confidence: 99%

Semantics in active surveillance for men with localized prostate cancer — results of a modified Delphi consensus procedure

et al. 2017

Self Cite

View full text Add to dashboard Cite

| Active surveillance (AS) is broadly described as a management option for men with low-risk prostate cancer, but semantic heterogeneity exists in both the literature and in guidelines. To address this issue, a panel of leading prostate cancer specialists in the field of AS participated in a consensus-forming project using a modified Delphi method to reach international consensus on definitions of terms related to this management option. An iterative three-round sequence of online questionnaires designed to address 61 individual items was completed by each panel member. Consensus was considered to be reached if ≥70% of the experts agreed on a definition. To facilitate a common understanding among all experts involved and resolve potential ambiguities, a face-to-face consensus meeting was held between Delphi survey rounds two and three. Convenience sampling was used to construct the panel of experts. In total, 12 experts from Australia, France, Finland, Italy, the Netherlands, Japan, the UK, Canada and the USA participated. By the end of the Delphi process, formal consensus was achieved for 100% (n = 61) of the terms and a glossary was then developed. Agreement between international experts has been reached on relevant terms and subsequent definitions regarding AS for patients with localized prostate cancer. This standard terminology could support multidisciplinary communication, reduce the extent of variations in clinical practice and optimize clinical decision making.312 | MAY 2017 | VOLUME 14 www.nature.com/nrurol CONSENSUS STATEMENT © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d .degree of monitoring than those on AS might receive, and in which palliative treatment is generally instituted if metastases or local symptoms develop. Interpreting and comparing research results is difficult owing to the nonstandardized use of the terms AS and WW and their intended and often mixed treatment objectives (curative or palliative) 5 . This semantic heterogeneity is also reflected in AS guidelines 6 . In these guidelines, AS is primarily recommended for patients with low-risk tumours; however, these guidelines contain various definitions of low-risk prostate cancer, as specified by different combinations of clinical criteria including clinical and pathological characteristics (such as tumour stage, serum PSA levels, biopsy Gleason score, tumour volume and serum PSA density). Furthermore, definitions of disease reclassification and progression differ among published guidelines and multiple criteria for initiation of curative treatment are proposed 6 .Problems resulting from the use of ambiguous language include hindered clinical decision making, particularly in multidisciplinary collaborations, and limited opportunities for research 7 . Moreover, such ambiguity has raised a barrier that hampers exchange of knowledge within and between fundamental domains of research and research groups 8 . An urgent need exists for uniform...

show abstract

“…Possible candidates are decreased T2 signal intensity or increased lesion diameter, change in apparent diffusion coefficient ratios, changes in gadolinium enhancement on dynamic contrast‐enhanced imaging, and suspicion of T3a/b disease. The PRECISE working group recommendations recently proposed an approach for reporting MRI in AS, but acknowledged evidence is lacking in this area . If protocol biopsies were avoided, what would be the clinical sequelae of delays in detecting those with cancer progression not detected by MRI? This is perhaps the most critical question with regard to determining the safety and utility of MRI in AS, but the answer will remain unknown until long‐term outcomes are reported; a delay of 6–12 months in detecting grade progression to low‐volume ISUP grade group 2 is likely to have a very low probability of resulting in metastasis or other harms.…”

mentioning

confidence: 99%

mentioning

confidence: 99%