Imaging characteristics of patients with prostate cancer with favorable 17-gene genomic prostate score on 3T multiparametric prostate MRI.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 14-14
Author(s):  
Aaron Katz ◽  
Corinne Liu ◽  
Kaitlin E. Kosinski
Keyword(s):  
Prostate Cancer ◽  
Transrectal Ultrasound ◽  
Prostate Mri ◽  
Prostate Imaging ◽  
Imaging Characteristics ◽  
Contrast Enhanced ◽  
Risk Prostate Cancer ◽  
Gene Test ◽  
Multiparametric Prostate Mri ◽  
Clinically Significant

14 Background: Our practice utilizes a biopsy-based 17 gene test that is clinically validated as a predictor of favorable pathology and used to guide use of active surveillance for men with very low, low, and intermediate risk prostate cancer. The purpose of this study was to evaluate the imaging characteristics and PIRADS score of prostate cancer patients with a Genomic Prostate Score (GPS) indicating favorable pathology. Methods: 300 consecutive 3T Multiparametric Prostate MRI (MP-MRI) were identified from March 26, 2012, to June 29, 2015. Thirty patients (age 44-84 years) with GPS scores indicating favorable pathology were included in the study. Prostate Imaging Reporting and Data System (PIRADS) scores were assigned to each MP-MRI. MRI index lesions were defined as discrete hypointense T2 signal with at least one anatomically corresponding abnormal functional MRI parameter (diffusion weighted and dynamic contrast-enhanced images). The MRI examinations were evaluated for number and laterality of MRI index lesions and in relation to biopsy pathology findings after the MP-MRI was performed. Results: Out of 30 MP-MRI, 7 (23.3%) PIRADS 5, 10 (33.3%) PIRADS 4, 10 (33.3%) PIRADS 3, 1 (3.3%) PIRADS 2, and 2 (6.7%) PIRADS 1. Thirteen (43%) had bilateral MRI index lesions. Twenty-six (87%) MP-MRI had 1-3 MRI index lesions, 2 (7%) had 4-6 MRI index lesions and 2 (7%) had no index lesions. Six (20%) patients underwent curative treatment. Four (13.3%) patients underwent a transrectal ultrasound guided targeted biopsy and one underwent a prostatectomy after the MP-MRI. One harbored Gleason 7 with a PIRADS 1, 2 harbored Gleason 7 with PIRADS 5, and two were benign with PIRADS scores of 3 and 4. Conclusions: Patients with prostate cancer with a GPS score indicating favorable pathology had PIRADS scores ranging from 5 to 1, with the majority indicating either high or very high likelihood of harboring clinically significant cancer. This may imply that MP-MRI should continue to play an important role in stratifying patients with prostate cancer, even in those with favorable pathology. A study with a larger sample size and biopsy results after the initial MP-MRI to look for tumor upgrading is needed.

Imaging characteristics of patients with prostate cancer who discontinued active holistic surveillance on 3T multiparametric prostate MRI.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 18-18
Author(s):  
Aaron Katz ◽  
Corinne Liu ◽  
Andrew S Fontes ◽  
Kaitlin E. Kosinski
Keyword(s):  
Prostate Cancer ◽  
Early Stage ◽  
Definitive Treatment ◽  
Vitamin Supplements ◽  
Prostate Mri ◽  
Special Diet ◽  
Imaging Characteristics ◽  
Multiparametric Prostate Mri ◽  
Clinically Significant

18 Background: Early-stage patients with prostate cancer can decide to go on Active Holistic Surveillance (AHS) to avoid over-treatment of a disease that has a high probability of being indolent. These patients are also placed on a special diet with vitamin supplements. We evaluate the imaging characteristics of this particular set of patients with prostate cancer with early-stage disease who are on a special diet and vitamin supplements, discontinued AHS and received definitive treatment. Methods: 300 consecutive 3T Multiparametric Prostate MRI (MP-MRI) were identified from March 26, 2012, to June 29, 2015. 200 patients (age 44 to 84 years) were identified in the active surveillance program. 114 patients had an initial MP-MRI prior to starting AHS and had at least one follow up MP-MRI after beginning AHS. 14 (12%) patients (age 60 to 79 years) discontinued AHS due to changes on a follow up MRI suggesting clinically significant prostate cancer. The MRI imaging findings were evaluated and correlated with pathology results, if available. Results: Of 14 patients, 3 (21%) patients had an enlarging MRI lesion compared to a previous MRI, 2 (14 %) patients had a new MRI lesion(s) suspicious for cancer, and 9 (64%) patients had suspicion or confirmation of extracapsular extension. 7 (50%) patients had a biopsy after a follow up MP-MRI with 6 (43%) demonstrating tumor upgrading. Length of time on AHS ranged from 4 months to 110 months. Prostate-specific antigen (PSA) levels and PSA density prior to beginning AHS ranged from 4.8 to 12.0 and 0.04 to 0.39, respectively. All were treated with definitive treatment, majority with unilateral focal cryoablation. Conclusions: The small number of patients with worsening disease on follow-up MP-MRI supports the role of AHS in patients with early-stage prostate cancer. MP-MRI is a useful tool in following patients on AHS and can extract patients who potentially may have clinically significant cancer and who may benefit from definitive treatment.

scholarly journals The Prostate Health Index aids multi-parametric MRI in diagnosing significant prostate cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yu-Hua Fan ◽  
Po-Hsun Pan ◽  
Wei-Ming Cheng ◽  
Hsin-Kai Wang ◽  
Shu-Huei Shen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Predictive Power ◽  
Transrectal Ultrasound ◽  
Health Index ◽  
Prostate Imaging ◽  
Prostate Biopsies ◽  
Prostate Health Index ◽  
Clinically Significant ◽  
Prostate Health

AbstractTo evaluate the performance of the Prostate Health Index (PHI) in magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion prostate biopsy for the detection of clinically significant prostate cancer (csPCa). We prospectively enrolled 164 patients with at least one Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) ≥ 3 lesions who underwent MRI-TRUS fusion prostate biopsy. Of the PSA-derived biomarkers, the PHI had the best performance in predicting csPCa (AUC 0.792, CI 0.707–0.877) in patients with PI-RADS 4/5 lesions. Furthermore, the predictive power of PHI was even higher in the patients with PI-RADS 3 lesions (AUC 0.884, CI 0.792–0.976). To minimize missing csPCa, we used a PHI cutoff of 27 and 7.4% of patients with PI-RADS 4/5 lesions could have avoided a biopsy. At this level, 2.0% of cases with csPCa would have been missed, with sensitivity and NPV rates of 98.0% and 87.5%, respectively. However, the subgroup of PI-RADS 3 was too small to define the optimal PHI cutoff. PHI was the best PSA-derived biomarker to predict csPCa in MRI-TRUS fusion prostate biopsies in men with PI-RADS ≥ 3 lesions, especially for the patients with PI-RADS 3 lesions who gained the most value.

scholarly journals Multiparametric MRI-Targeted TRUS Prostate Biopsies Using Visual Registration

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Philippe Puech ◽  
Adil Ouzzane ◽  
Vianney Gaillard ◽  
Nacim Betrouni ◽  
Benoit Renard ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Yield ◽  
Transrectal Ultrasound ◽  
Multiparametric Mri ◽  
Ultrasound Guided ◽  
Prostate Biopsies ◽  
Multiparametric Prostate Mri ◽  
Clinically Significant ◽  
Prostate Cancers ◽  
Targeted Biopsies

Prebiopsy multiparametric prostate MRI (mp-MRI), followed by transrectal ultrasound-guided (TRUS-G) target biopsies (TB) of the prostate is a key combination for the diagnosis of clinically significant prostate cancers (CSPCa), to avoid prostate cancer (PCa) overtreatment. Several techniques are available for guiding TB to the suspicious mp-MRI targets, but the simplest, cheapest, and easiest to learn is “cognitive,” with visual registration of MRI and TRUS data. This review details the successive steps of the method (target detection, mp-MRI reporting, intermodality fusion, TRUS guidance to target, sampling simulation, sampling, TRUS session reporting, and quality insurance), how to optimize each, and the global indications of mp-MRI-targeted biopsies. We discuss the diagnostic yield of visually-registered TB in comparison with conventional biopsy, and TB performed using other registration methods.

scholarly journals Comparative prostate MRI before and after chronic granulomatous prostatitis following intravesical bacillus Calmette–Guérin therapy

2021 ◽  
Vol 7 (2) ◽  
pp. FSO637
Author(s):  
Julien Sarkis ◽  
Georges Nawfal ◽  
Elias El-Haddad ◽  
Georges Abi Tayeh ◽  
Nathalie Mahfoud ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Specific Antigen ◽  
Bacillus Calmette Guerin ◽  
Case Presentation ◽  
Prostate Mri ◽  
Prostate Imaging ◽  
Bcg Therapy ◽  
Before And After ◽  
Multiparametric Prostate Mri ◽  
Granulomatous Prostatitis

Background: Granulomatous prostatitis (GnP) is an interesting complication of bacillus Calmette–Guérin (BCG) therapy as it mimics prostate cancer on clinical, biochemical and imaging examinations. In the era of multiparametric prostate MRI (mpMRI), differentiation of GnP from prostate cancer on imaging is essential. Case presentation: We report a case of post-BCG GnP in a patient with nonmuscle invasive bladder cancer, presenting with a prostate-specific antigen level of 21.6 ng/ml and prostate imaging reporting and data system (PI-RADS) 5 peripheral lesions. A mpMRI performed 6 months before showed a score 2 of PI-RADS. Conclusion: The comparison of mpMRI images before and after BCG administration gives urologists, oncologists and radiologists a precise idea of the mpMRI changes that occur following BCG administration to eventually prevent unnecessary biopsies in future patients.

Histopathologic correlation of PI-RADS V.2 lesions on 3T multiparametric prostate MRI.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 10-10 ◽  
Author(s):  
Aaron Katz ◽  
Corinne Liu ◽  
Kaitlin E. Kosinski
Keyword(s):  
Scoring System ◽  
Transrectal Ultrasound ◽  
Low Grade ◽  
High Grade ◽  
Exact Test ◽  
Prostate Mri ◽  
Trus Biopsy ◽  
Treatment Naïve ◽  
Multiparametric Prostate Mri ◽  
Clinically Significant

10 Background: Prostate Imaging Reporting and Data System (PIRADS) Version 2 was recently issued by The American College of Radiology. Each score, from 1 to 5, corresponds to the likelihood of clinically significant cancer. We aim to evaluate the correlation between a higher PIRADS score and the presence of high grade tumor on histopathology. Methods: 300 consecutive 3T Multiparametric Prostate MRI (MP-MRI) were identified from March 26, 2012, to June 29, 2015. We reviewed patient charts and a total of 102 patients underwent either a transrectal ultrasound guided (TRUS) biopsy or a total prostatectomy after the MP-MRI. Thirty-four patients were excluded due to prior radiation or cryoablation to the prostate, leaving 68 treatment-naive patients (44-84 years). MP-MRIs were re-interpreted utilizing the new PIRADS V.2 scoring system and correlated with pathology findings. Statistical comparisons were made using R (v.3.1.2) and Fisher’s exact test. Results: High grade (Gleason 8-10) tumors were found only in MP-MRI with a PIRADS score of 5 and a higher percentage of tumor is found in MP-MRI with PIRADS scores of 4 and 5 (80%) when compared to PIRADS scores of 2 and 3 (32%). Low grade (Gleason 6-7) tumors were also found in both PIRADS 4 and 5 categories. There was a significant relationship between a higher PIRADS score and a finding of cancer on pathology (p = 0.0003, OR=0.118, 95% CI 0.03-0.41). Conclusions: The PIRADS scoring system is a useful tool in suggesting the likelihood of clinically significant cancer, with high grade tumors found only in MP-MRI with a score of PIRADS 5. However, MP-MRI and PIRADS criteria alone are not sufficient for determining clinically significant prostate cancer since both high grade and low grade tumors were found in PIRADS 5 and 4 categories. Correlation with other clinical parameters and biopsy is required for confirmation. A larger scale study would be helpful for further delineation. [Table: see text]

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