Case 12.18

2014 ◽  
pp. 598-600
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Signal Intensity ◽  
Central Zone ◽  
Peripheral Zone ◽  
Arterial Phase ◽  
Endorectal Coil ◽  
Triangular Region ◽  
Recent Diagnosis ◽  
The Right

62-year-old man with a recent diagnosis of prostate cancer; the Gleason score is 7 (3+4) on the left and 6 on the right Axial FRFSE T2-weighted images (Figure 12.18.1) obtained with an endorectal coil demonstrate a triangular region of low signal intensity within the peripheral zone of the prostate centrally. There is more heterogeneous decreased signal intensity in the anterior right peripheral zone and in the central zone. Axial arterial phase postgadolinium 3D SPGR images (...

Case 12.21

2014 ◽  
pp. 604-605
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Signal Intensity ◽  
Posterior Margin ◽  
Positive Margin ◽  
Robotic Prostatectomy ◽  
Arterial Phase ◽  
The Past ◽  
Endorectal Coil ◽  
The Right ◽  
P 53

53-year-old man who underwent robotic prostatectomy 4 years ago with a small positive margin in the right apex; PSA was initially zero postoperatively, but it has been slowly increasing in the past year Axial (Figure 12.21.1) and sagittal (Figure 12.21.2) T2-weighted FRFSE images obtained with an endorectal coil demonstrate a lobulated mass with mildly increased signal intensity along the right posterior margin of the bladder outlet extending inferiorly into the prostatectomy bed. Axial arterial phase postgadolinium 3D SPGR images (...

Location of local recurrence after MRI-guided partial prostate brachytherapy targeting only the peripheral zone: Implications for focal therapy.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 149-149 ◽  
Author(s):  
Konstantin Kovtun ◽  
Tobias Penzkofer ◽  
Neha Agrawal ◽  
Tina Kapur ◽  
Andriy Fedorov ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Local Recurrence ◽  
Central Zone ◽  
Peripheral Zone ◽  
Focal Therapy ◽  
Prostate Brachytherapy ◽  
Local Recurrences ◽  
Endorectal Coil ◽  
Mri Scans ◽  
Mri Guided

149 Background: Prostate cancer local recurrences usually occur at the same site as the dominant primary tumor in patients treated with radiation therapy to the whole gland. We characterized location of local recurrences in patients who were treated with MRI Guided Partial Brachytherapy in which only the peripheral zone was targeted. Methods: We retrospectively reviewed ten patients with initial cT1c, Gleason score 3+4 or less prostate cancer who developed biopsy proven local recurrences and had available imaging after MRI Guided Partial Brachytherapy targeting the peripheral zone from 1998 to 2006. All 10 patients had 1.5T endorectal coil MRI at diagnosis, performed primarily for staging and not for tumor localization, while at recurrence 8 had 3T endorectal coil MRI and 2 had 1.5T endorectal coil MRI. Scans consisted of at least T1 and T2 sequences. Two radiologists (C.T. and T.P.) blinded to clinical data reviewed diagnosis MRI scans together and quantified likelihood of tumor on a 1 to 5 scale in each section of an eight part prostate in both pre-treatment and recurrence scans. Local recurrence was judged to be in the same location as the baseline tumor if at least 50% of the tumor location overlapped. Results: Only 3 of 10 patients had local recurrences at the same location as the baseline tumor with a mean overlap of 64%. 7 of 10 patients had local recurrences at a different location with a mean overlap of 5%. 5 of 10 patients had recurrences in the central zone of the prostate which did not definitively show tumor on review of the initial 1.5T staging scan. Conclusions: After MRI-guided brachytherapy targeting only the peripheral zone in men initially staged with 1.5T MRI, 50% of the local recurrences occurred at the non-targeted central zone, raising the possibility that focal therapy directed only at the dominant tumor will result in increased out-of-field recurrences. Whether the superior ability of modern 3T multiparametric MRI to detect and precisely localize occult prostate cancer foci will reduce this risk is the subject of current study.

Case 12.23

2014 ◽  
pp. 608-609
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Lymph Node ◽  
Central Zone ◽  
Peripheral Zone ◽  
Anterior Wall ◽  
Seminal Vesicles ◽  
Extracapsular Extension ◽  
Endorectal Coil ◽  
The Right ◽  
Neurovascular Bundles

45-year-old man with hematuria and difficulty voiding Axial T2-weighted FRFSE images (Figure 12.23.1) obtained using an endorectal coil demonstrate a large infiltrative mass in the peripheral zone of the prostate. The mass invades the seminal vesicles and extends into the central zone in the apex. Note the loss of the well-defined posterior capsular margin indicating extracapsular extension, involvement of the right and probably the left neurovascular bundles, continuity of the mass with the anterior wall of the rectum, and the large perirectal lymph node on the first image....

Does tumor location affect prostate cancer prognosis?

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 45-45 ◽  
Author(s):  
Jun Akatsuka ◽  
Go Kimura ◽  
Kotaro Obayashi ◽  
Masayuki Sano ◽  
Masato Yanagi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Gland ◽  
Ejaculatory Duct ◽  
Prognostic Significance ◽  
Central Zone ◽  
Peripheral Zone ◽  
Recurrence Risk ◽  
Tumor Location ◽  
Cancer Prognosis ◽  
Prostate Cancer Prognosis

45 Background: Does tumor location affect prostate cancer prognosis? To clarify this question we conducted a retrospective study to characterize the incidence and prognostic significance of tumor location of prostate cancer. Methods: From 2000 to 2017, radical prostatectomy with no neoadjuvant therapy was performed in 916 cases in our hospital. Serial whole mount sections were reviewed to determine the incidence, clinicopathological features and prognostic significance of tumor location in the prostate gland. For the tumor location, we defined the subzones, which were made from subdivision of the McNeal’s zonal anatomy, are shown in Table 1 in detail. The peripheral zone (PZ) is composed of 8 subzones including A1, A2, A3 , M1, M2, M3, M4, M5. The transition zone (TZ) is composed of 5 subzones including T1, T2, T3, T4 and B1. The central zone (CZ) is composed of 3 subzones including M6, B2 and B3. Results: The median age was 67 and PSA was 8.6 ng/ml. The subzonal tumor incidence divided by all cases was the highest in A2, followed by M4, A1, M3, T2 in that order, while the lowest in B3, followed by M6, T4, T3, B1 in that order. The median follow-up time was 67 months. A 5-year PSA failure rate (5Y-PSAFR) was 23%. Among the subzones, the highest 5Y-PSAFR was seen in B3, followed by M6, B2, T4, A3, and the lowest was seen in M4, A2, T2, A1 in that order. A multivariate analysis for PSAF risk among subzones showed that B3 (HR 8.6, p <0.0001) and M6 (HR 3.3, p = 0.03) were the independent high risk subzones. Conclusions: We demonstrated that the cancer incidence and prognosis varies according to the location within the prostate gland. The B3 and M6 around the ejaculatory duct showed the lowest incidence, while these locations also had the highest recurrence risk. [Table: see text]

Multiparametric magnetic resonance imaging of multifocal prostate cancer to reveal intra-prostatic genomic heterogeneity and novel radio-genomic correlates: Results of the Smarter Prostate Interventions and Therapeutics (SPIRIT) study.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 20-20
Author(s):  
Glenn Bauman ◽  
Rohann Correa ◽  
Erfan Aref-Eshghi ◽  
Ryan Alfano ◽  
Bekim Sadikovic ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Gleason Score ◽  
Peripheral Zone ◽  
Imaging Biomarker ◽  
Low Grade ◽  
Gleason Grade ◽  
Resonance Imaging ◽  
Multiparametric Magnetic Resonance Imaging

20 Background: Multi-focality and heterogeneity in prostate cancer can confound the selection of appropriate clinical management. Our study aimed to explore radio-genomic correlations using multiparametric magnetic resonance imaging (mpMRI) against a histopathologic reference standard. Methods: Eight men with prostate cancer who underwent mpMRI followed by prostatectomy were selected for this pilot. Whole-mount histopathology was digitized and co-registered to corresponding MRI slices using a validated high-fidelity methodology.(1) Foci, including central/transitional and peripheral zone lesions were identified by a pathologist, and contoured on digitized histopathology specimens and these digitized maps were used to guide macrodissection of the individual foci for genomic copy-number aberration (CNA) analysis. Correlation of radiomics signatures with the histologic findings and genomic analysis was performed. Results: We found a broad range of CNAs revealing inter-patient and intra-prostatic heterogeneity. Recurrently-altered loci ( e.g., 8p21) containing genes of known significance ( e.g., NKX3-1) were observed. Only radiomic features derived from apparent diffusion coefficient (ADC) independently correlated with both Gleason grade (Rho=-0.62, p=0.003) and median CNA burden (Rho=-0.68, p<0.001). While greater CNA burden expectedly correlated with higher grade, intermediate-grade (Gleason score 3+4 or 4+3) lesions appeared more like either high-grade (Gleason scores ≥4+4) or low-grade (Gleason score 3+3) disease when clustered based on CNA and ADC metrics. Conclusions: These findings suggest ADC derived radiomic metrics may be a useful imaging biomarker across both central and peripheral zone lesion and could aid in further characterization of intra-prostatic biologic heterogeneity. These proof-of-principle data reveal novel radio-genomic correlations that could supplement histologic grading and conventional imaging, thus warranting expanded study and validation. 1) Int J Rad Oncol Biol Phys. 2016; 96(1):188-96.

The value of ADC, T2 signal intensity, and a combination of both parameters to assess Gleason score and primary Gleason grades in patients with known prostate cancer

2014 ◽  
Vol 57 (1) ◽  
pp. 107-114 ◽  
Author(s):  
Johannes Nowak ◽  
Uwe Malzahn ◽  
Alexander DJ Baur ◽  
Uta Reichelt ◽  
Tobias Franiel ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Signal Intensity

Critical analysis of the ability of the endorectal coil magnetic resonance imaging scan to predict pathologic stage, margin status, and postoperative prostate-specific antigen failure in patients with clinically organ-confined prostate cancer.

1996 ◽  
Vol 14 (6) ◽  
pp. 1770-1777 ◽  
Author(s):  
A V D'Amico ◽  
R Whittington ◽  
S B Malkowicz ◽  
D Schultz ◽  
M Schnall ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Gleason Score ◽  
Clinical Stage ◽  
Multivariable Analysis ◽  
Specific Antigen ◽  
Resonance Imaging ◽  
Endorectal Coil ◽  
Psa Failure ◽  
Biopsy Gleason Score

PURPOSE To determine whether there is a role for endorectal coil magnetic resonance imaging (erMRI) in the prediction of pathologic stage, margin status, and/or postoperative prostate-specific antigen (PSA) failure in patients with clinically organ-confined prostate cancer. PATIENTS AND METHODS Using erMRI, the radiologic-pathologic correlation of extracapsular extension (ECE) and seminal vesicle invasion (SVI) was evaluated in 445 surgically managed patients. Logistic regression multivariable analysis was applied to the clinical stage, PSA, biopsy Gleason grade, and erMRI findings to assess the outcomes of ECE, SVI, positive surgical margins (PSM), and postoperative PSA failure. RESULTS The accuracy of erMRI to predict for ECE and SVI numerically decreased with both increasing PSA and biopsy Gleason score because of the increasing false-negative scans in cases of microscopic transcapsular or seminal vesicle disease. Of patients who could not be categorized into low or high risk for postoperative PSA failure on the basis of clinical stage, preoperative PSA, and biopsy Gleason score, a negative or positive erMRI for ECE or SVI stratified these patients into groups with a 78% versus 21% (P < .0001) 3-year rate of actuarial freedom from PSA failure. In this subgroup, the overall accuracy of the erMRI was 70% +/- 6% and 94% +/- 2% for ECE and SVI, respectively. The most significant predictor on multivariable analysis of PSM was the erMRI finding of ECE (P = .0001). CONCLUSION This initial report suggests that a preoperative erMRI can identify clinically organ-confined prostate cancer patients at high risk for having ECE, SVI, and PSM that otherwise would be missed on the basis of the clinical stage, preoperative PSA, and biopsy Gleason score. Confirmatory studies are needed.

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