Diagnostic Performance of 68Ga Prostate-specific Membrane Antigen PET/MRI Compared with Multiparametric MRI for Detecting Clinically Significant Prostate Cancer

Radiology ◽  
2021 ◽  
pp. 204093
Author(s):  
David Margel ◽  
Hanna Bernstine ◽  
David Groshar ◽  
Yaara Ber ◽  
Orian Nezrit ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Performance ◽  
Multiparametric Mri ◽  
Prostate Specific Membrane Antigen ◽  
Clinically Significant ◽  
Specific Membrane

scholarly journals Prostate-specific membrane antigen positron emission tomography compared to multiparametric MRI for prostate cancer diagnosis: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052277
Author(s):  
Yi Zhao ◽  
Naomi Morka ◽  
Benjamin Scott S Simpson ◽  
Alex Freeman ◽  
Alex Kirkham ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Positron Emission Tomography ◽  
Meta Analysis ◽  
Multiparametric Mri ◽  
Emission Tomography ◽  
Prostate Specific Membrane Antigen ◽  
Positron Emission ◽  
Psma Pet ◽  
Specific Membrane

IntroductionThe introduction of multiparametric MRI (mpMRI) has improved almost every aspect of the prostate cancer diagnostic pathway. However, the novel imaging technique, prostate-specific membrane antigen positron emission tomography (PSMA PET) may have demonstrable accuracy in detecting and staging prostate cancer. Here, we describe a protocol for a systematic review and meta-analysis comparing mpMRI to PSMA PET for the diagnosis of suspected prostate cancer.Methods and analysisA systematic search of MEDLINE, EMBASE, PubMed and Cochrane databases will be conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be followed for screening, data extraction, statistical analysis and reporting. Included papers will be full-text articles providing original data, written in English articles and comparing the use of PSMA PET with mpMRI in the diagnosis of prostate cancer. All studies published between July 1977 and March 2021 will be eligible for inclusion. Study bias and quality will be assessed using Quadas-2 score. To ensure the quality of the reporting of studies, this protocol is written following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist.Ethics and disseminationEthical approval will not be required for this systematic review. Findings will be disseminated through peer-reviewed publications and presentations at both national and international conferences.PROSPERO registration numberCRD42021239296.

The role of PSMA PET/CT imaging in the diagnosis, staging and restaging of prostate cancer

2021 ◽  
Author(s):  
Dominic Bagguley ◽  
Sean Ong ◽  
James P Buteau ◽  
Sam Koschel ◽  
Nattakorn Dhiantravan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Imaging Technique ◽  
Imaging Techniques ◽  
Multiparametric Mri ◽  
Prostate Specific Membrane Antigen ◽  
Recurrent Prostate Cancer ◽  
Psma Pet ◽  
Pet Ct ◽  
Specific Membrane

Prostate-specific membrane antigen (PSMA) PET/CT is a novel imaging technique for the detection and staging of either primary or recurrent prostate cancer. Early studies demonstrated its improved sensitivity and specificity over and in combination with other currently employed imaging techniques, such as multiparametric MRI, bone scan, PET and CT. However, the lack of strength and confidence in these studies has meant incorporation of PSMA PET/CT into clinical guidelines and practice has been limited to date. In response, a number of high-quality prospective studies have recently emerged and reflect exciting results seen in preceding publications. Here we recount some of the key earlier publications, report results from the latest studies and look to the future discussing some of the eagerly awaited ongoing clinical trials.

scholarly journals Comparison of machine learning algorithms to predict clinically significant prostate cancer of the peripheral zone with multiparametric MRI using clinical assessment categories and radiomic features

2020 ◽  
Vol 30 (12) ◽  
pp. 6757-6769 ◽  
Author(s):  
Simon Bernatz ◽  
Jörg Ackermann ◽  
Philipp Mandel ◽  
Benjamin Kaltenbach ◽  
Yauheniya Zhdanovich ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Machine Learning ◽  
Clinical Significance ◽  
Clinical Assessment ◽  
Diagnostic Performance ◽  
Learning Algorithms ◽  
Peripheral Zone ◽  
Multiparametric Mri ◽  
Machine Learning Algorithms ◽  
Clinically Significant

Abstract Objectives To analyze the performance of radiological assessment categories and quantitative computational analysis of apparent diffusion coefficient (ADC) maps using variant machine learning algorithms to differentiate clinically significant versus insignificant prostate cancer (PCa). Methods Retrospectively, 73 patients were included in the study. The patients (mean age, 66.3 ± 7.6 years) were examined with multiparametric MRI (mpMRI) prior to radical prostatectomy (n = 33) or targeted biopsy (n = 40). The index lesion was annotated in MRI ADC and the equivalent histologic slides according to the highest Gleason Grade Group (GrG). Volumes of interest (VOIs) were determined for each lesion and normal-appearing peripheral zone. VOIs were processed by radiomic analysis. For the classification of lesions according to their clinical significance (GrG ≥ 3), principal component (PC) analysis, univariate analysis (UA) with consecutive support vector machines, neural networks, and random forest analysis were performed. Results PC analysis discriminated between benign and malignant prostate tissue. PC evaluation yielded no stratification of PCa lesions according to their clinical significance, but UA revealed differences in clinical assessment categories and radiomic features. We trained three classification models with fifteen feature subsets. We identified a subset of shape features which improved the diagnostic accuracy of the clinical assessment categories (maximum increase in diagnostic accuracy ΔAUC = + 0.05, p < 0.001) while also identifying combinations of features and models which reduced overall accuracy. Conclusions The impact of radiomic features to differentiate PCa lesions according to their clinical significance remains controversial. It depends on feature selection and the employed machine learning algorithms. It can result in improvement or reduction of diagnostic performance. Key Points • Quantitative imaging features differ between normal and malignant tissue of the peripheral zone in prostate cancer. • Radiomic feature analysis of clinical routine multiparametric MRI has the potential to improve the stratification of clinically significant versus insignificant prostate cancer lesions in the peripheral zone. • Certain combinations of standard multiparametric MRI reporting and assessment categories with feature subsets and machine learning algorithms reduced the diagnostic performance over standard clinical assessment categories alone.

Diagnostic performance of Gallium-68 prostate-specific membrane antigen (PSMA) PET/CT imaging in early-relapsed prostate cancer: Phase 3, prospective, multicenter study (IAEA-PSMA study).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 5078-5078
Author(s):  
Juliano J Cerci ◽  
Stefano Fanti ◽  
Keyword(s):  
Prostate Cancer ◽  
Detection Rate ◽  
Diagnostic Performance ◽  
Multicenter Trial ◽  
Definitive Treatment ◽  
Prostate Specific Membrane Antigen ◽  
Metastatic Recurrence ◽  
Psma Pet ◽  
Pet Ct ◽  
Specific Membrane

5078 Background: Biochemical recurrence (BCR) is a clinical challenge in prostate cancer (PCa) patients with impact on defintion of subsequent therapies. The use of positron emission tomography (PET) with prostate-specific membrane antigen (PSMA) presents better accuracy than standard imaging practice. This phase3, prospective, multicentric, international study evaluates the diagnostic performance and clinical impact of PSMA-PET/CT in evaluating BCR in PCa. Methods: Patients with PCa who have undergone primary definitive treatment and with rising PSA were recruited in the study. Overall 17 centers from 15 countries (Azerbaijan, Brazil, Colombia, India, Israel, Italy, Jordan, Lebanon, Malaysia, Mexico, Pakistan, Poland, South Africa, Turkey, and Uruguay) were involved. Images and data were centrally reviewed; data were collected for PSMA site of findings, positivity rate, defined as the percentage of patients with a positive 68Ga-PSMA PET/CT taking into account the composite standard: pathology, correlative imaging, PSA response, with at least 6 mo. clinical follow-up, and impact on patient management by determining changes in the treating physician’s documented clinical plans before and after 68Ga-PSMA PET/CT. Results: Were enrolled 1198 patients and presented final data from 1004 patients. 68Ga-PSMA PET/CT was positive in 654/1004 patients (65.1%); lesions were identified as: prostate/prostatic bed only in 13.7% cases; pelvic lymph nodes only 20.5%, and with any metastatic disease in 27.0%. There was a correlation between PSMA-PET/CT positivity and Gleason score (p<0.001): detection rate was 371/613 (60.5%) in patients with Gleason 7, 130/196 (66.3%) in Gleason 8, 140/180 (77.8%) in Gleason 9 and 13/15 (86.7%) in Gleason 10. There was also significant correlation between lesions identification and PSA values (p<0.001): detection rate was 21/41 (51.2%) for PSA <0.2, 84/188 (44.7%) for PSA between 0.2-0.5, 124/232 (53.4%) for PSA 0.5-1.0, 158/235 (67.2%) for PSA ≥1 and <2, 171/206 (83.0%) for PSA ≥2 and <4, and 96/102 (94,1%) in PSA 4 to 10. Also, treatment was modified based on PSMA results in 56.8% of patients. The 68Ga-PSMA PET/CT positivity was consistent and not statistically different among the countries. Conclusions: This is the largest multicenter trial on 68Ga-PSMA PET/CT detected local and metastatic recurrence in most men with BCR. 68Ga-PSMA PET/CT results changed the recommended treatment approaches in the majority of patients. This study confirms the reliability of PSMA PET in BC and the worldwide feasibility of such approach.

scholarly journals Evaluating the efficacy of a low-cost, minimally-invasive cognitive MRI targeted biopsy protocol in the Prostate Imaging Reporting and Data System (PI-RADS) version 2 era.

2019 ◽  
Author(s):  
Yuta Takeshima ◽  
Yoshinori Tanaka ◽  
Kotaro Takemura ◽  
Shusaku Nakazono ◽  
Eiko Yamashita ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Performance ◽  
Low Cost ◽  
Multiparametric Mri ◽  
Data System ◽  
Targeted Biopsy ◽  
Prostate Imaging ◽  
Biopsy Protocol ◽  
Clinically Significant ◽  
Systematic Biopsy

Abstract Background: New MRI-guided targeting biopsy methods have increased cancer yield of prostate biopsies. However, cost and time constraints have made it difficult for many institutions to implement these newer methods. We evaluated the diagnostic performance of a low-cost, minimally-invasive, cognitive MRI-targeted biopsy protocol based on 1.5T multiparametric MRI graded with Prostate Imaging Reporting and Data System version 2 that is easily implemented in any low- to intermediate- volume center. Methods: Retrospective analysis of 255 patients who underwent prostate biopsy between December 2016 and March 2019 at a single facility. Indication for biopsy was based on clinical parameters including 1.5T multiparametric MRI. In addition to 10-core systematic biopsy, targeted cores were obtained with cognitive recognition under ultrasound. A control group of 198 patients biopsied without prior MRI from January to December 2015 was also analyzed. Results: Prostate biopsy preceded by MRI had a significantly higher probability of detecting both prostate cancer (68.1% vs. 43.6%) and clinically significant cancer (56.2% vs. 29.4%) (p values< 0.01). Combination of systematic biopsy and targeted biopsy outperformed either regimen alone for detection of prostate cancer. Multivariate analysis showed PSA density and prostate imaging reporting and data system score were independent risk factors of prostate cancer. A proposed diagnostic model showed sensitivity of 88.6%, specificity of 55%, PPV of 81.2%, NPV of 68.8%, and accuracy of 78%. Prostate imaging reporting and data system score was correlated with a higher presence of prostate cancer, clinically significant prostate cancer, and a higher pathological grade. Conclusions: Incorporation of pre-biopsy MRI imaging, scoring, and targeted biopsy improved cancer yield and achieved diagnostic performance comparable to newer methods of higher cost. Future alterations of possible benefit included increasing the number of target cores per lesion, and combining prostate imaging reporting and data system score and PSA density as indicators for biopsy.

The CADMUS trial: A paired cohort, blinded study comparing multiparametric ultrasound targeted biopsies with multiparametric MRI targeted biopsies in the detection of clinically significant prostate cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 5008-5008
Author(s):  
Alistair Grey ◽  
Rebecca Scott ◽  
Bina Shah ◽  
Peter Acher ◽  
Sidath Liyanage ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Performance ◽  
Point Of Care ◽  
Low Cost ◽  
Reporting Quality ◽  
Multiparametric Mri ◽  
Lesion Detection ◽  
Gleason Grade ◽  
Clinically Significant ◽  
Targeted Biopsies

5008 Background: Multiparametric MRI (mpMRI) of the prostate followed by targeted biopsy is recommended in men at risk of prostate cancer. Dissemination of this pathway may be limited by cost, variable scan and reporting quality, and contraindicated in the presence of metallic implants and claustrophobia. Multi-parametric ultrasound (mpUSS) is a point of care test with low cost that combines b-mode, colour Doppler, elastography and contrast enhancement. CADMUS compared the diagnostic performance of mpUSS to mpMRI. Methods: CADMUS recruited 370 patients from seven sites to a prospective, multicentre, paired-cohort trial (ISRCTN 38541912). Ethics committee approval was obtained. Patients underwent both mpUSS and mpMRI independently, each with a positive test defined as a Likert score of >3. Those with either a positive mpUSS or mpMRI, or both, were advised to undergo targeted biopsies. Reporting of each scan was carried out blind to the other and prior to biopsy; patients advised for biopsy were blinded to which test was positive. The order of mpUSS and mpMRI targeting was randomised. Primary outcomes were proportion of positive tests and detection of clinically significant cancer (csPCa) defined as Gleason >4+3 of any length and/or maximum cancer core length of >6mm of any grade [PROMIS definition1]. Results: 306 completed both mpUSS and mpMRI. Agreement in lesion detection between mpUSS and mpMRI was 73.2% (kappa 0.06, p = 0.14). 257 with positive results on mpUSS, mpMRI or both had targeted biopsies. Agreement on detection of csPCa was 91.1% (expected 59.8%, kappa 0.78, p < 0.01). Overall, mpUSS detected 4.3% fewer csPCa than mpMRI (95% CI = [-8.3%, -1.5%]; p = 0.042 [Bonferroni correction]). mpUSS detected 7.2% (6/83) csPCa missed by mpMRI; mpMRI detected 20.5% (17/83) csPCa that mpUSS missed. At a less stringent definition of significant cancer, Gleason grade >3+4 of any length (definition 3), agreement was 89.1% (expected 55.6%, kappa 0.75, p < 0.01) mpUSS detected 5.4% fewer definition 3 cancers than mpMRI overall. mpUSS detected 7% (7/99) definition 3 cancers that mpMRI missed; mpMRI detected 21% (21/99) definition 3 cancers that mpUSS missed. Conclusions: The CADMUS trial shows mpUSS has a diagnostic performance approaching that of mpMRI and significant cancer detection is improved by the use of both scans over mpMRI alone. Clinical trial information: 38541912. [Table: see text]

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