scholarly journals The prevalence and locations of bone metastases using whole-body MRI in treatment-naïve intermediate- and high-risk prostate cancer

2020 ◽  
Author(s):  
Fredrik Ottosson ◽  
Eduard Baco ◽  
Peter M. Lauritzen ◽  
Erik Rud
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Bone Metastases ◽  
Whole Body ◽  
Gleason Grade ◽  
Grade Group ◽  
Whole Body Mri ◽  
High Risk Prostate Cancer ◽  
Treatment Naïve ◽  
Group 3

Abstract Objective The aim of this study was to assess the prevalence and distribution of bone metastases in treatment-naïve prostate cancer patients eligible for a metastatic workup using whole-body MRI, and to evaluate the results in light of current guidelines. Methods This single-institution, retrospective study included all patients with treatment-naïve prostate cancer referred to whole-body MRI during 2016 and 2017. All were eligible for a metastatic workup according to the guidelines: PSA > 20 ng/ml and/or Gleason grade group ≥ 3 and/or cT ≥ 2c and/or bone symptoms. The definition of a metastasis was descriptive and based on the original MRI reports. The anatomical location of metastases was registered. Results We included 161 patients with newly diagnosed prostate cancer of which 36 (22%) were intermediate-risk and 125 (78%) were high-risk. The median age and PSA were 71 years (IQR 64–76) and 13 ng/ml (IQR 8–28), respectively. Bone metastases were found in 12 patients (7%, 95% CI: 4–13), and all were high-risk with Gleason grade group ≥ 4. The pelvis was affected in 4 patients, and the spine + pelvis in the remaining 8. No patients demonstrated metastases to the spine without concomitant metastases in the pelvis. Limitations are the small number of metastases and retrospective design. Conclusion This study suggests that the overall prevalence of bone metastases using the current guidelines for screening is quite low. No metastases were seen in the case of Gleason grade group ≤ 3, and further studies should investigate if it necessary to screen non-high-risk patients. Key Points • The overall prevalence of bone metastases was 7% in the case of newly diagnosed intermediate- and high-risk prostate cancer. • The prevalence in high-risk patients was 10%, and no metastases were seen in patients with Gleason grade group ≤ 3. • The pelvic skeleton is the main site, and no metastases occurred in the spine without concomitant pelvic metastases.

Impact of initial treatment selection on clinical outcomes after biochemical failure in radiorecurrent high-risk prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 208-208
Author(s):  
Rebecca Levin-Epstein ◽  
Tahmineh Romero ◽  
Jessica Karen Wong ◽  
Kiri Cook ◽  
Robert Timothy Dess ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Initial Treatment ◽  
External Beam Radiotherapy ◽  
Oncologic Outcomes ◽  
Gleason Grade ◽  
Grade Group ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Median Interval

208 Background: Treatment of high risk prostate cancer (HRPCa) with external beam radiotherapy (EBRT) plus brachytherapy (BT) boost (EBRT+BT) has been prospectively associated with lower rates of BCR, albeit potentially with increased toxicity, and retrospectively linked to decreased distant metastasis (DM) and PCa-specific mortality (PCSM) compared to EBRT alone. However, it is unclear whether patients who develop BCR following either approach have similar downstream oncologic outcomes. Methods: We identified 706 out of 3820 men with HRPCa treated at 13 institutions from 1998-2015 with EBRT (n=468/2134) or EBRT+BT (n=238/1686) who developed BCR. We compared rates of DM, PCSM, and all-cause mortality (ACM) after BCR between treatment groups using Fine-Gray competing risk regression. Models were adjusted for age, Gleason grade group, initial PSA (iPSA), clinical T stage, time-dependent use of systemic salvage, and interval to BCR using inverse probability of treatment weighting. Results: Median follow-up was 9.9 years from RT and 4.8 years from BCR. Groups were similar in age, iPSA, presence of ≥2 HR features, and median interval to BCR (3.3 years). Most men received neoadjuvant/concurrent androgen deprivation therapy (ADT), 92.5% and 91.0% for EBRT and EBRT+BT, respectively, though for a longer duration with EBRT (median 14.7 vs. 9.0 months, p=0.0012). Local and systemic salvage rates were 2.3% and 36.3% after EBRT, and 2.6% and 43.6% after EBRT+BT, respectively. Initial EBRT+BT was associated with significantly lower rates of DM after BCR (HR 0.48, 95% CI 0.36-0.64, p<0.001). Rates of PCSM and ACM did not significantly differ (HR 0.93, 95% CI 0.67-1.30, p=0.93, and HR 0.8, 95% CI 0.6-1.1, p=0.11, respectively). Conclusions: In this large retrospective series of radiorecurrent HRPCa, initial treatment with EBRT+BT was associated with significantly lower rates of DM after BCR compared with EBRT, despite shorter ADT use and a similar median interval to BCR. Local salvage was widely underutilized in both groups. In the absence of salvage for local failure after EBRT, upfront treatment intensification with BT may reduce DM, though not PCSM or ACM, even after development of BCR.

Transitioning to whole-body SPECT/CT in prostate cancer staging: a new concept for a better imaging workflow

2019 ◽  
Vol 58 (06) ◽  
pp. 451-459 ◽  
Author(s):  
Matthias Weissinger ◽  
Jürgen Kupferschläger ◽  
Christian La Fougère ◽  
Helmut Dittmann ◽  
Francesco Fiz
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Bone Metastases ◽  
Clinical Symptoms ◽  
Field Of View ◽  
Whole Body ◽  
Acquisition Time ◽  
High Risk Prostate Cancer ◽  
Traditional Procedure ◽  
Risk Prostate Cancer

Abstract Aim Whole-body bone scan (BS) is the clinical standard in detecting bone metastases in prostate cancer patients. Additional SPECT/CT has allowed to significantly increase its diagnostic accuracy. However, performing both planar and additional SPECT/CT prolongs the total examination time and lowers patient throughput. In this study we aim to assess the diagnostic performance of a SPECT/CT-only protocol compared to the traditional procedure that is BS with a facultative SPECT/CT in case of unclear findings. Methods 50 patients with high-risk prostate cancer and suspected bone metastases were enrolled in this retrospective study. All patients received a whole-body Tc-99m-DPD BS followed by a 3 field-of-view (FOV) SPECT/CT (GE Discovery 670 Pro®) covering an area from the vertex to the mid-femur. Metastatic lesions were evaluated visually on BS and SPECT/CT and correlated to PSA-levels. Results Detection rate was up to 50 % higher in SPECT/CT than in BS (n = 2829 vs. n = 1942; p < 0.001), but 31/1942 (1.5 %) lesions detected on BS were located out of the SPECT/CT field-of-view. In our analysis a PSA-level of > 80 µg/l could be defined as a cut-off-value for metastatic spread beyond mid-thigh, as no patient with PSA< 80 µg/l had localizations outside the SPECT/CT field-of-view (AUCPSA = 0.95, p < 0.001 sensitivity: 100 %, specificity: 77 %, NPV: 100 %, PPV: 67 %). The SPECT/CT-only protocol did not prolong acquisition time significantly as compared to BS. Conclusions In patients with high-risk prostate cancer presenting with PSA < 80 µg/l and absent clinical symptoms, vertex to mid-thighs 3-FOV-SPECT/CT was representative for the entire skeletal system and was able to detect more lesions than planar acquisition. This procedure did not prolong patient handling time significantly.

18F-Fluorocholine PET Whole-Body MRI in the Staging of High-Risk Prostate Cancer

2018 ◽  
Vol 210 (3) ◽  
pp. 635-640 ◽  
Author(s):  
Ur Metser ◽  
Alejandro Berlin ◽  
Jaydeep Halankar ◽  
Grainne Murphy ◽  
Kartik S. Jhaveri ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Whole Body ◽  
Whole Body Mri ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

Small Cell-like Change in Central Zone Histology—A New Observation Mimicking Cribriform Intraductal Prostatic Adenocarcinoma

2021 ◽  
pp. 106689692110039
Author(s):  
Oleksandr N. Kryvenko
Keyword(s):  
Prostate Cancer ◽  
Central Zone ◽  
Intraepithelial Neoplasia ◽  
Small Cell ◽  
Prostatic Adenocarcinoma ◽  
Grade Group ◽  
Ki 67 ◽  
Neoplastic Process ◽  
Treatment Naïve ◽  
Group 3

A small cell-like change in prostate has been described in high-grade prostatic intraepithelial neoplasia (PIN), intraductal prostatic adenocarcinoma, and invasive prostate cancer. It occurs when these processes have a cribriform architecture. To date, small cell-like change has not been described in benign glands. Herein, I describe such a change in cribriform central zone histology from a radical prostatectomy with a spatially remote treatment naïve Grade Group 3 prostate cancer. The cancer did not have cribriform morphology or intraductal prostatic adenocarcinoma. The small cell-like change was positive for racemase in PIN-4 cocktail and no nuclei were highlighted by Ki-67. This is the first report of a small cell-like change in benign prostate tissue. Although rare, such finding in cribriform architecture of central zone histology can potentially be misinterpreted as a neoplastic process.

scholarly journals Biopsy Grade Group as a reliable prognostic factor for BCR in Afro-Caribbean men with intermediate- and high-risk prostate cancer

2019 ◽  
Vol 38 (6) ◽  
pp. 1493-1499
Author(s):  
Emmanuel Perrot ◽  
Sofiane Seddik ◽  
Gilles Gourtaud ◽  
Rémi Eyraud ◽  
Virginie Roux ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Prognostic Factor ◽  
Grade Group ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer
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