|
|
|
| Role of multi-parametric MRI of the prostate for screening and staging: Experience with over 1500 cases |
| Geoffrey Gaunaya, Vinay Patela, Paras Shaha, Daniel Moreirab, Simon J. Halla, Manish A. Viraa, Michael Schwartza, Jessica Kreshovera, Eran Ben-Levia, Robert Villania, Ardeshir Rastinehadc, Lee Richstonea
|
a Department of Urology, The Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA;
b Department of Urology, University of Illinois Chicago, Chicago, IL, USA;
c Department of Urology & Interventional Radiology, Mount Sinai Health System, New York City, NY, USA |
|
|
|
|
Abstract Objective: Contemporary prostate cancer (PCa) screening modalities such as prostate specific antigen (PSA) and digital rectal examination (DRE) are limited in their ability to predict the detection of clinically significant disease. Multi-parametric magnetic resonance imaging (mpMRI) of the prostate has been explored as a staging modality for PCa. Less is known regarding its utility as a primary screening modality. We examined our experience with mpMRI as both a screening and staging instrument.Methods: mpMRI studies performed between 2012 and 2014 in patients without PCa were cross-referenced with transrectal ultrasonography (TRUS) biopsy findings. Statistical analyses were performed to determine association of mpMRI findings with overall cancer diagnoses and clinically significant (Gleason score≥7) disease. Subgroup analyses were then performed on patients with a history of prior negative biopsy and those without a history of TRUS biopsy. mpMRI studies were also cross-referenced with RP specimens. Statistical analyses determined predictive ability of extracapsular extension (ECE), seminal vesicle involvement (SVI), and pathologic evidence of clinically significant disease (Gleason score≥7).Results: Four hundred biopsy naïve or prior negative biopsy patients had positive mpMRI studies. Overall sensitivity, specificity, positive and negative predictive values were 94%, 37%, 58%, and 87%, respectively and 95%, 31%, 42%, and 93%, respectively for overall cancer detection and Gleason score≥7 disease. In patients with no prior biopsy history, mpMRI sensitivity, specificity, positive and negative predictive values were 94%, 36%, 65%, and 82%, for all cancers, and 95%, 30%, 50%, and 89% for Gleason score≥7 lesions, respectively. In those with prior negative biopsy sensitivity, specificity, positive and negative predictive values were 94%, 37%, 52%, and 90% for all cancers, and 96%, 32%, 36%, and 96% for Gleason score≥7 lesions, respectively. Seventy-four patients underwent radical prostatectomy (RP) after mpMRI. Lesion size on mpMRI correlated with the presence of Gleason score≥7 cancers (P=0.005). mpMRI sensitivity, specificity, positive and negative predictive values were 84%, 39%, 81%, and 44% respectively, for Gleason≥7 cancer. For ECE and SVI, sensitivity and specificity were 58% and 98% and 44% and 97%, respectively..Conclusion: mpMRI is an accurate predictor of TRUS biopsy and RP outcomes. mpMRI has significant potential to change PCa management, particularly in the screening population, in whom a significant proportion may avoid TRUS biopsy. Further studies are necessary to determine how mpMRI should be incorporated into the current PCa screening and staging paradigms.
|
|
Received: 30 August 2016
Published: 16 February 2017
|
|
Corresponding Authors:
Lee Richstone, E-mail address:Lrichsto@northwell.edu
E-mail: Lrichsto@northwell.edu
|
|
|
| [1] |
S. Sfanos Karen,Yegnasubramanian Srinivasan,G. Nelson William,L. Lotan Tamara,Kulac Ibrahim,L. Hicks Jessica,Zheng Qizhi,J. Bieberich Charles,C. Haffner Michael,M. De Marzo Angelo. If this is true, what does it imply? How end-user antibody validation facilitates insights into biology and disease[J]. Asian Journal of Urology, 2019, 6(1): 10-25. |
| [2] |
Dong Liang,C. Zieren Richard,Xue Wei,M. de Reijke Theo,J. Pienta Kenneth. Metastatic prostate cancer remains incurable, why?[J]. Asian Journal of Urology, 2019, 6(1): 26-41. |
| [3] |
M. Armstrong Cameron,C. Gao Allen. Current strategies for targeting the activity of androgen receptor variants[J]. Asian Journal of Urology, 2019, 6(1): 42-49. |
| [4] |
B. Isaacs William,Xu Jianfeng. Current progress and questions in germline genetics of prostate cancer[J]. Asian Journal of Urology, 2019, 6(1): 3-9. |
| [5] |
Etheridge Tyler,Damodaran Shivashankar,Schultz Adam,A. Richards Kyle,Gawdzik Joseph,Yang Bing,Cryns Vincent,F. Jarrard David. Combination therapy with androgen deprivation for hormone sensitive prostate cancer: A new frontier[J]. Asian Journal of Urology, 2019, 6(1): 57-64. |
| [6] |
Chia-Yi Chu Gina,W.K. Chung Leland,Gururajan Murali,Hsieh Chia-Ling,Josson Sajni,Nandana Srinivas,Sung Shian-Ying,Wang Ruoxiang,Boyang Wu Jason,E. Zhau Haiyen. Regulatory signaling network in the tumor microenvironment of prostate cancer bone and visceral organ metastases and the development of novel therapeutics[J]. Asian Journal of Urology, 2019, 6(1): 65-81. |
| [7] |
Dicken Haley,J. Hensley Patrick,Kyprianou Natasha. Prostate tumor neuroendocrine differentiation via EMT: The road less traveled[J]. Asian Journal of Urology, 2019, 6(1): 82-90. |
| [8] |
Xu Lingfan,Chen Junyi,Liu Weipeng,Liang Chaozhao,Hu Hailiang,Huang Jiaoti. Targeting androgen receptor-independent pathways in therapy-resistant prostate cancer[J]. Asian Journal of Urology, 2019, 6(1): 91-98. |
| [9] |
Chen Kenneth,Jack Tay Kae,Mee Law Yan,Aydin Hakan,Ho Henry,Cheng Christopher,Shyi Peng Yuen John. Outcomes of combination MRI-targeted and transperineal template biopsy in restaging low-risk prostate cancer for active surveillance[J]. Asian Journal of Urology, 2018, 5(3): 184-193. |
| [10] |
Chen Shulian,Gao Rang,Li Hong,Wang Kunjie. Management of acquired rectourethral fistulas in adults[J]. Asian Journal of Urology, 2018, 5(3): 149-154. |
| [11] |
Chen Kenneth,Sim Allen,Kan Alex Ford. The effect of adjunct caudal block on postoperative analgesia in robot-assisted laparoscopic radical prostatectomy: A prospective randomized controlled, single blinded pilot study in a tertiary centre[J]. Asian Journal of Urology, 2018, 5(2): 122-126. |
| [12] |
Su Jiarui,Jonathan Aslim Edwin,Aydin Hakan,HoonTan Puay,Sun SienHo Henry. A rare case of isolated castrate resistant bilateral testicular metastases in advanced prostate cancer[J]. Asian Journal of Urology, 2018, 5(2): 127-130. |
| [13] |
S.J.Chung Amanda,H.Woo Henry. Update on minimally invasive surgery and benign prostatic hyperplasia[J]. Asian Journal of Urology, 2018, 5(1): 22-27. |
| [14] |
Per-Anders Abrahamsson. Intermittent androgen deprivation therapy in patients with prostate cancer:Connecting the dots[J]. Asian Journal of Urology, 2017, 4(4): 208-222. |
| [15] |
Jonathan Shunming Teo, Yee Mun Lee, Henry Sun Sien Ho. An update on transurethral surgery for benign prostatic obstruction[J]. Asian Journal of Urology, 2017, 4(3): 195-198. |
|
|
|
|
