Validation of 3 T MRI including diffusion-weighted imaging for nodal staging of newly diagnosed intermediate- and high-risk prostate cancer

Below, Catrin von; Daouacher, Georgios; Wassberg, Cecilia; Grzegorek, Rafael; Gestblom, Charlotta; Sörensen, Jens; Åhlström, Håkan; Waldén, Markus

doi:10.1016/j.crad.2015.12.001

Cited by 35 publications

(24 citation statements)

References 39 publications

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“…Furthermore, adding functional sequences into MRI protocol does not substantially improve N-staging. According to study by von Below et al sensitivity and specificity of detecting nodal metastases by MRI with DWI were 55% and 90% respectively [11]. Although these results are optimistic, mpMRI cannot replace or even constrain pelvic lymphadenectomy in selected PCa patients.…”

Section: Discussionmentioning

confidence: 98%

Endoscopic, Transperitoneal Radical Prostatectomy with 3.0-T mpMRI Stratifies Patients with Advanced Prostate Cancer

Michalak¹,

Kozikowski²,

Kawecki³

et al. 2016

Reprod Syst Sex Disord

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Objective: Recent years have brought a significant shift in case selection for the surgical treatment of prostate cancer (PCa). Primary surgical management is increasingly implemented in more aggressive tumors, however the role of radical prostatectomy (RP) in advanced cases remains controversial. The aim of the present study is to explore cancer diversity in patients who were subjected to endoscopic, transperitoneal RP due to very high-risk advanced PCa. Methods: Our database was screened for prostate cancer patients with clinically diagnosed seminal vesicles infiltration and/or invasion of other adjacent structures (cT3b-4 N0) and/or suspected nodal involvement (cT1-4 N1) who underwent ERP. Twenty cases were identified: 11 patients with cT3b-4 N0 disease and 9 patients with suspected nodal involvement. The preoperative tumor stage was assessed with the use of multiparametric magnetic resonance (mpMRI) in all cases. Results: Although the accuracy of mpMRI in the assessement of local tumor stage was 85%, the lymph node status was properly assessed preoperatively in 45% cases only. The pT3b-4 PCa was diagnosed in 13 cases (65%). Of them, 9 had lymph nodes metastases. Three patients (15%) were diagnosed with pT3a cancer, among them nodal metastases were confirmed in 2 cases. In the remaining 4 patients (20%), the tumor was confined to the prostate but in 1 of them pelvic lymph nodes were involved. Early, postoperative PSA was lower than 0.2 ng/ml in 13 patients (65%). Seventeen patients (85%) received additional treatment: androgen deprivation therapy in 7 cases (35%), radiation therapy in 10 cases (50%). No pad use was declared by 14 patients (70%). Conclusion: Radical prostatectomy thoroughly stratifies patients diagnosed with advanced prostate cancer. In more than a half of cases the clinical stage differs from the pathological disease status. Correct, postoperative prostate cancer stratification allows to personalize multidisciplinary treatment to reduce toxicity and improve oncological outcome.

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Section: Discussionmentioning

confidence: 98%

Endoscopic, Transperitoneal Radical Prostatectomy with 3.0-T mpMRI Stratifies Patients with Advanced Prostate Cancer

Michalak¹,

Kozikowski²,

Kawecki³

et al. 2016

Reprod Syst Sex Disord

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“…In order to overcome the limitations of quantitative ADC values, some studies have evaluated the diagnostic performance of DWI by means of a qualitative assessment using high- b -value images. In all instances this was done in combination with anatomical T2WI ( 37 , 50 , 51 ).…”

Section: Dwimentioning

confidence: 99%

Diffusion-weighted imaging (DWI) in lymph node staging for prostate cancer

Caglič

Barrett

2018

Transl. Androl. Urol

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In patients with prostate cancer, the presence of lymph node (LN) metastases is a critical prognostic factor and is essential for treatment planning. Conventional cross-sectional imaging performs poorly for nodal staging as both computed tomography (CT) and magnetic resonance imaging (MRI) are mainly dependent on size and basic morphological criteria. Therefore, extended pelvic LN dissection (ePLND) remains the gold standard for LN staging, however, it is an invasive procedure with its own drawbacks, thus creating a need for accurate preoperative imaging test. Incorporating functional MRI by using diffusion-weighted MRI has proven superior to conventional MRI protocol by means of both qualitative and quantitative assessment. Currently, the increased diagnostic performance remains insufficient to replace ePLND and the future role of DWI may be through combination with MR lymphangiography or with novel positron emission tomography (PET) tracers. In this article, the current state of data supporting DWI in LN staging of patients with prostate cancer is discussed.

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“…In a more recent prospective study utilizing a 3T MRI system and a non-quantitative approach to evaluation DWI and ADC maps, revealed 94% specificity and 41% sensitivity for anatomical region based analysis (mean positive lymph node size was 1.2 cm)[ 52 ]. In a prospective evaluation of detection of normal sized metastatic lymph nodes in initial staging of prostate and bladder carcinoma, there was increased detection utilizing DWI when compared to conventional cross-section imaging techniques with detection of metastasis in 64%-79% of patients[ 51 ].…”

Section: Lymph Node Imaging With Mrimentioning

confidence: 99%

Lymph node imaging in initial staging of prostate cancer: An overview and update

Zarzour

Galgano

McConathy

et al. 2017

WJR

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Accurate nodal staging at the time of diagnosis of prostate cancer is crucial in determining a treatment plan for the patient. Pelvic lymph node dissection is the most reliable method, but is less than perfect and has increased morbidity. Cross sectional imaging with computed tomography (CT) and magnetic resonance imaging (MRI) are non-invasive tools that rely on morphologic characteristics such as shape and size of the lymph nodes. However, lymph nodes harboring metastatic disease may be normal sized and non-metastatic lymph nodes may be enlarged due to reactive hyperplasia. The optimal strategy for preoperative staging remains a topic of ongoing research. Advanced imaging techniques to assess lymph nodes in the setting of prostate cancer utilizing novel MRI contrast agents as well as positron emission tomography (PET) tracers have been developed and continue to be studied. Magnetic resonance lymphography utilizing ultra-small super paramagnetic iron oxide has shown promising results in detection of metastatic lymph nodes. Combining MRL with diffusion-weighted imaging may also improve accuracy. Considerable efforts are being made to develop effective PET radiotracers that are performed using hybrid-imaging systems that combine PET with CT or MRI. PET tracers that will be reviewed in this article include [18F]fluoro-D-glucose, sodium [18F]fluoride, [18F]choline, [11C]choline, prostate specific membrane antigen binding ligands, [11C]acetate, [18F]fluciclovine, gastrin releasing peptide receptor ligands, and androgen binding receptors. This article will review these advanced imaging modalities and ability to detect prostate cancer metastasis to lymph nodes. While more research is needed, these novel techniques to image lymph nodes in the setting of prostate cancer show a promising future in improving initial lymph node staging.

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Validation of 3 T MRI including diffusion-weighted imaging for nodal staging of newly diagnosed intermediate- and high-risk prostate cancer

Cited by 35 publications

References 39 publications

Endoscopic, Transperitoneal Radical Prostatectomy with 3.0-T mpMRI Stratifies Patients with Advanced Prostate Cancer

Endoscopic, Transperitoneal Radical Prostatectomy with 3.0-T mpMRI Stratifies Patients with Advanced Prostate Cancer

Diffusion-weighted imaging (DWI) in lymph node staging for prostate cancer

Lymph node imaging in initial staging of prostate cancer: An overview and update

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