Update of the Standard Operating Procedure on the Use of Multiparametric Magnetic Resonance Imaging for the Diagnosis, Staging and Management of Prostate Cancer

Bjurlin, Marc A.; Carroll, Peter R.; Eggener, Scott E.; Fulgham, Pat F.; Margolis, Daniel; Pinto, Peter A.; Rosenkrantz, Andrew B.; Rubenstein, Jonathan N.; Rukstalis, Daniel B.; Taneja, Samir S.; Türkbey, Barış

doi:10.1097/ju.0000000000000617

Cited by 162 publications

(124 citation statements)

References 29 publications

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“…However, distinct variation in performance among different validation populations [8] has demonstrated the limitations of multivariable risk-based approaches. Recently, multiparametric magnetic resonance imaging (mpMRI) of the prostate has become widely accepted based on its high sensitivity and specificity for the detection of clinically significant prostate cancer (csPCa; International Society of Urologic Pathology [ISUP] grade group [GG] 2-5) [9,10] and its potential to reduce unnecessary biopsies in up to 50% of men [11,12]. Subsequently, a new generation of prostate cancer RCs incorporating mpMRI data have been introduced, suggesting superior performance compared with RCs without imaging data and mpMRI alone [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Head-to-head Comparison of Conventional, and Image- and Biomarker-based Prostate Cancer Risk Calculators

Mortezavi

Pálsdóttir

Eklund

et al. 2021

European Urology Focus

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Background: A new generation of risk calculators (RCs) for prostate cancer (PCa) incorporating magnetic resonance imaging (MRI) data have been introduced. However, these have not been validated externally, and their clinical benefit compared with alternative approaches remains unclear. Objective: To assess previously published PCa RCs incorporating MRI data, and compare their performance with traditional RCs (European Randomized Study of Screening for Prostate Cancer [ERSPC] 3/4 and Prostate Biopsy Collaborative Group [PBCG]) and the blood-based Stockholm3 test. Design, setting, and participants: RCs were tested in a prospective multicenter cohort including 532 men aged 45-74 yr participating in the Stockholm3-MRI study between 2016 and 2017. Outcome measurements and statistical analysis: The probabilities of detection of clinically significant PCa (csPCa) defined as Gleason score !3 + 4 were calculated for each patient. For each RC and the Stockholm3 test, discrimination was assessed by area under the curve (AUC), calibration by numerical and graphical summaries, and clinical usefulness by decision curve analysis (DCA). Results and limitations: The discriminative ability of MRI RCs 1-4 for the detection of csPCa was superior (AUC 0.81-0.87) to the traditional RCs (AUC 0.76-0.80). The observed prevalence of csPCa in the cohort was 37%, but calibration-in-the-large predictions varied from 14% to 63% across models. DCA identified only one model including MRI data as clinically useful at a threshold probability of 10%. The Stockholm3 test achieved equivalent performance for discrimination (AUC 0.86) and DCA, but was underpredicting the actual risk. Conclusions: Although MRI RCs discriminated csPCa better than traditional RCs, their predicted probabilities were variable in accuracy, and DCA identified only one model as clinically useful. Patient summary: Novel risk calculators (RCs) incorporating imaging improved the ability to discriminate clinically significant prostate cancer compared with traditional tools. However, all but one predicted divergent compared with actual risks, suggesting that regional modifications be implemented before usage. The Stockholm3 test achieved performance comparable with the best MRI RC without utilization of imaging.

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Section: Introductionmentioning

confidence: 99%

Head-to-head Comparison of Conventional, and Image- and Biomarker-based Prostate Cancer Risk Calculators

Mortezavi

Pálsdóttir

Eklund

et al. 2021

European Urology Focus

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“…For focal therapies, it is imperative not only to accurately differentiate significant from indolent prostate cancer [ 6 , 7 ], but also to precisely identify the tumor borders. In recent years, multi-parametric prostate MRI (mpMRI) has emerged as a useful tool for the detection and risk stratification of primary prostate cancer and recently has been incorporated into American Urological Association (AUA) algorithms for patients with suspected or low-risk prostate cancer [ 8 – 10 ]. When used optimally, mpMRI can cost-effectively identify a significantly greater fraction of clinically significant cancers (Gleason score ≥ 7 [≥ 3 + 4]) compared to standard biopsy alone while minimizing the detection of low-risk cancer [ 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of tumor segmentation from multi-parametric prostate MRI and 18F-choline PET/CT for focal prostate cancer therapy applications

et al. 2018

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BackgroundThe study aims to assess the accuracy of multi-parametric prostate MRI (mpMRI) and 18F-choline PET/CT in tumor segmentation for clinically significant prostate cancer. 18F-choline PET/CT and 3 T mpMRI were performed in 10 prospective subjects prior to prostatectomy. All subjects had a single biopsy-confirmed focus of Gleason ≥ 3+4 cancer. Two radiologists (readers 1 and 2) determined tumor boundaries based on in vivo mpMRI sequences, with clinical and pathologic data available. 18F-choline PET data were co-registered to T2-weighted 3D sequences and a semi-automatic segmentation routine was used to define tumor volumes. Registration of whole-mount surgical pathology to in vivo imaging was conducted utilizing two ex vivo prostate specimen MRIs, followed by gross sectioning of the specimens within a custom-made 3D-printed plastic mold. Overlap and similarity coefficients of manual segmentations (seg1, seg2) and 18F-choline-based segmented lesions (seg3) were compared to the pathologic reference standard.ResultsAll segmentation methods greatly underestimated the true tumor volumes. Human readers (seg1, seg2) and the PET-based segmentation (seg3) underestimated an average of 79, 80, and 58% of the tumor volumes, respectively. Combining segmentation volumes (union of seg1, seg2, seg3 = seg4) decreased the mean underestimated tumor volume to 42% of the true tumor volume. When using the combined segmentation with 5 mm contour expansion, the mean underestimated tumor volume was significantly reduced to 0.03 ± 0.05 mL (2.04 ± 2.84%). Substantial safety margins up to 11–15 mm were needed to include all tumors when the initial segmentation boundaries were drawn by human readers or the semi-automated 18F-choline segmentation tool. Combining MR-based human segmentations with the metabolic information based on 18F-choline PET reduced the necessary safety margin to a maximum of 9 mm to cover all tumors entirely.ConclusionsTo improve the outcome of focal therapies for significant prostate cancer, it is imperative to recognize the full extent of the underestimation of tumor volumes by mpMRI. Combining metabolic information from 18F-choline with MRI-based segmentation can improve tumor coverage. However, this approach requires confirmation in further clinical studies.

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“…A Delphi consensus process was undertaken to formulate recommendations regarding three different areas in the diagnostic MRI pathway of PCa: (1) image quality assessment of mpMRI; (2) interpretation and reporting of mpMRI; and (3) reader experience and training requirements. The Delphi method is a technique of structured and systematic information gathering from experts on a specific topic using a series of questionnaires [13].…”

Section: Methodsmentioning

confidence: 99%

“…Multi-parametric MRI (mpMRI) in the diagnostic pathway of prostate cancer (PCa) has a well-established upfront role in the recently updated European Association of Urology (EAU) guideline and American Urological Association recommendations [1,2]. For biopsy-naïve men with suspicion of PCa, based on an elevated serum prostate-specific antigen level or abnormal digital rectal examination, it is now recommended to undergo a mpMRI before biopsy.…”

Section: Introductionmentioning

confidence: 99%

Focus on the Quality of Prostate Multiparametric Magnetic Resonance Imaging: Synopsis of the ESUR/ESUI Recommendations on Quality Assessment and Interpretation of Images and Radiologists’ Training

et al. 2020

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Objectives This study aims to define consensus-based criteria for acquiring and reporting prostate MRI and establishing prerequisites for image quality. Methods A total of 44 leading urologists and urogenital radiologists who are experts in prostate cancer imaging from the European Society of Urogenital Radiology (ESUR) and EAU Section of Urologic Imaging (ESUI) participated in a Delphi consensus process. Panellists completed two rounds of questionnaires with 55 items under three headings: image quality assessment, interpretation and reporting, and radiologists' experience plus training centres. Of 55 questions, 31 were rated for agreement on a 9-point scale, and 24 were multiple-choice or open. For agreement items, there was consensus agreement with an agreement ≥ 70% (score 7-9) and disagreement of ≤ 15% of the panellists. For the other questions, a consensus was considered with ≥ 50% of votes. Results Twenty-four out of 31 of agreement items and 11/16 of other questions reached consensus. Agreement statements were (1) reporting of image quality should be performed and implemented into clinical practice; (2) for interpretation performance, radiologists should use self-performance tests with histopathology feedback, compare their interpretation with expert-reading and use external performance assessments; and (3) radiologists must attend theoretical and hands-on courses before interpreting prostate MRI. Limitations are that the results are expert opinions and not based on systematic reviews or meta-analyses. There was no consensus on outcomes statements of prostate MRI assessment as quality marker. Conclusions An ESUR and ESUI expert panel showed high agreement (74%) on issues improving prostate MRI quality. Checking and reporting of image quality are mandatory. Prostate radiologists should attend theoretical and hands-on courses, followed by supervised education, and must perform regular performance assessments. Key Points • Multi-parametric MRI in the diagnostic pathway of prostate cancer has a well-established upfront role in the recently updated European Association of Urology guideline and American Urological Association recommendations. • Suboptimal image acquisition and reporting at an individual level will result in clinicians losing confidence in the technique and returning to the (non-MRI) systematic biopsy pathway. Therefore, it is crucial to establish quality criteria for the acquisition and reporting of mpMRI. • To ensure high-quality prostate MRI, experts consider checking and reporting of image quality mandatory. Prostate radiologists must attend theoretical and hands-on courses, followed by supervised education, and must perform regular self-and external performance assessments. Maarten de Rooij and Bas Israël contributed equally to this work.

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Update of the Standard Operating Procedure on the Use of Multiparametric Magnetic Resonance Imaging for the Diagnosis, Staging and Management of Prostate Cancer

Cited by 162 publications

References 29 publications

Head-to-head Comparison of Conventional, and Image- and Biomarker-based Prostate Cancer Risk Calculators

Head-to-head Comparison of Conventional, and Image- and Biomarker-based Prostate Cancer Risk Calculators

Accuracy of tumor segmentation from multi-parametric prostate MRI and 18F-choline PET/CT for focal prostate cancer therapy applications

Focus on the Quality of Prostate Multiparametric Magnetic Resonance Imaging: Synopsis of the ESUR/ESUI Recommendations on Quality Assessment and Interpretation of Images and Radiologists’ Training

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