MRI-TRUS fusion-guided biopsy in obese patients: Does it reduce risk of prostate cancer upgrade on final pathology compared to systematic 12-core biopsy?

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 110-110
Author(s):  
Samuel A Gold ◽  
Jonathan Bloom ◽  
Amir H Lebastchi ◽  
Graham Hale ◽  
Sherif Mehralivand ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Stage ◽  
Lesion Size ◽  
Normal Weight ◽  
Lesion Location ◽  
Prostate Imaging ◽  
Prostate Biopsies ◽  
Increased Risk ◽  
Prostate Size ◽  
Reduce Risk

110 Background: Epidemiologic data suggests a link between obesity and increased risk of aggressive prostate cancer (PCa). Therefore, the accurate detection of prostate cancer is paramount in obese men. We sought to characterize the PCa lesions seen on multiparametric magnetic resonance imaging (mpMRI) in both obese (OB) and non-obese (nOB) patients. In addition, we examined whether obesity affects the accuracy of fusion biopsy (FBx) versus systematic biopsy (SBx). Methods: Data from patients who underwent FBx, SBx, or both, and subsequent prostatectomy at a single institution between 2007-2017 were reviewed. Men were stratified into three groups based on body mass index (BMI): normal weight (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0). mpMRIs were analyzed to determine prostate size, lesion size, lesion location, and evidence of ≥T3 disease. FBx and SBx were compared to prostatectomy specimens. These variables were then analyzed between the OB and nOB groups. Results: 487 patients were included: 109 (19%) normal weight, 266 (48%) overweight, and 185 (33%) obese. No statistical differences were noted in age, PSA, or clinical stage. mpMRI showed similar prostate size, index and total lesion diameter, lesion location, and Prostate Imaging Reporting and Data System (PIRADS) score between BMI categories. In OB patients, FBx was better able to predict final Gleason score (GS) than SBx, 60% vs 47%, p = 0.0474, OR 1.67 (1.00-2.80). The rate of upgrading after SBx was higher for OB men versus nOB men, 44% vs 34%, p = 0.034, OR 1.52 (1.01-2.29). However, risk of upgrading returned to that of nOB men with FBx, 20% vs 17%, p = 0.538, OR 1.21 (0.658-2.23). Conclusions: FBx is a more accurate measure of the true GS in OB patients than SBx, and there is a significantly greater risk of underrepresenting PCa on SBx in OB patients. These findings were not associated with differences in prostate sizes and lesion characteristics on mpMRI. This suggests that obesity may cause technical challenges with prostate biopsies that may be overcome by improved visualization and targeting of FBx.

scholarly journals Comparison of Likert and PI-RADS version 2 MRI scoring systems for the detection of clinically significant prostate cancer

2020 ◽  
Vol 93 (1112) ◽  
pp. 20200298 ◽  
Author(s):  
Jeries P Zawaideh ◽  
Evis Sala ◽  
Maria Pantelidou ◽  
Nadeem Shaida ◽  
Brendan Koo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Detection Rates ◽  
Prostate Imaging ◽  
Prostate Biopsies ◽  
Threshold Score ◽  
Lesion Level ◽  
Clinically Significant ◽  
Histological Results

Objective: To compare the performance of Likert and Prostate Imaging–Reporting and Data System (PI-RADS) multiparametric (mp) MRI scoring systems for detecting clinically significant prostate cancer (csPCa). Methods: 199 biopsy-naïve males undergoing prostate mpMRI were prospectively scored with Likert and PI-RADS systems by four experienced radiologists. A binary cut-off (threshold score ≥3) was used to analyze histological results by three groups: negative, insignificant disease (Gleason 3 + 3; iPCa), and csPCa (Gleason ≥3 +4). Lesion-level results and prostate zonal location were also compared. Results: 129/199 (64.8%) males underwent biopsy, 96 with Likert or PI-RADS score ≥3, and 21 with negative MRI. A further 12 patients were biopsied during follow-up (mean 507 days). Prostate cancer was diagnosed in 87/199 (43.7%) patients, 65 with (33.6%) csPCa. 30/92 (32.6%) patients with negative MRI were biopsied, with an NPV of 83.3% for cancer and 86.7% for csPCa. Likert and PI-RADS score differences were observed in 92 patients (46.2%), but only for 16 patients (8%) at threshold score ≥3. Likert scoring had higher specificity than PI-RADS (0.77 vs 0.66), higher area under the curve (0.92 vs 0.87, p = 0.002) and higher PPV (0.66 vs 0.58); NPV and sensitivity were the same. Likert had more five score results (58%) compared to PI-RADS (36%), but with similar csCPa detection (81.0 and 80.6% respectively). Likert demonstrated lower proportion of false positive in the predominately AFMS-involving lesions. Conclusion: Likert and PI-RADS systems both demonstrate high cancer detection rates. Likert scoring had a higher AUC with moderately higher specificity and lower positive call rate and could potentially help to reduce the number of unnecessary biopsies performed. Advances in knowledge: This paper illustrates that the Likert scoring system has potential to help urologists reduce the number of prostate biopsies performed.

scholarly journals The Metabolic Syndrome and Biochemical Recurrence following Radical Prostatectomy

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Jennifer M. Post ◽  
Jennifer L. Beebe-Dimmer ◽  
Hal Morgenstern ◽  
Christine Neslund-Dudas ◽  
Cathryn H. Bock ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Metabolic Syndrome ◽  
Radical Prostatectomy ◽  
Racial Differences ◽  
Biochemical Recurrence ◽  
African American Men ◽  
Racially Diverse ◽  
The Metabolic Syndrome ◽  
Increased Risk ◽  
Reduce Risk

Metabolic syndrome refers to a set of conditions that increases the risk of cardiovascular disease and has been associated with an increased risk of prostate cancer, particularly among African American men. This study aimed to estimate the association of metabolic syndrome with biochemical recurrence (BCR) in a racially diverse population. Among 383 radical prostatectomy patients, 67 patients had documented biochemical recurrence. Hypertension was significantly, positively associated with the rate of BCR (hazard ratio (HR) = 2.1; 95%  CI = 1.1, 3.8). There were distinct racial differences in the prevalence of individual metabolic syndrome components; however, the observed associations with BCR did not differ appreciably by race. We conclude that hypertension may contribute to a poorer prognosis in surgically treated prostate cancer patients. Our findings suggest that targeting components of the metabolic syndrome which are potentially modifiable through lifestyle interventions may be a viable strategy to reduce risk of BCR in prostate cancer.

Is BMI a risk factor for active surveillance progression in patients with prostate cancer diagnosed by MRI-Trus fusion biopsy?

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 124-124 ◽  
Author(s):  
Kareem Rayn ◽  
Samuel Gold ◽  
Graham R. Hale ◽  
Joey Baiocco ◽  
Jonathan Bloom ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Factor ◽  
Active Surveillance ◽  
Progression Free Survival ◽  
Normal Weight ◽  
Fusion Biopsy ◽  
Patient Demographics ◽  
Increased Risk ◽  
Risk Of Progression ◽  
The Impact

124 Background: MRI−TRUS fusion biopsy (FBx) use in the diagnosis of prostate cancer (PCa) results in a more accurate assessment of disease burden and has increasingly been incorporated into urologic practice. In addition, with more men choosing active surveillance (AS) and the reports of increased PCa aggressiveness with obesity, we wanted to study the impact of obesity on the risk of PCa progression in men on AS diagnosed and followed by MRI and MRI−TRUS FBx. Methods: A retrospective review was performed on a prospectively maintained database of all men who underwent MRI−TRUS FBx at our institution from January 2007 to May 2015. Patient demographics, clinical data, imaging, pathology, treatment and outcomes were recorded. Patients who enrolled on AS were stratified by BMI into normal weight (BMI 18.5−24.9), overweight (BMI 25.0−29.9), and obese (BMI ≥ 30.0). Statistical analysis was performed using SPSS software. Results: 204 men were enrolled in AS. Within the AS cohort, 51 (25%) had a normal weight, 101 (49.5%) were overweight, and 52 (25.5%) were obese. Age, BMI, PSA and mean estimated progression free survival time are described for each of these groups in Table 1. The overall rate of progression was 32.8%. Of the patients who progressed, 18 (26.9%) were normal weight, 32 (15.7%) were overweight and 17 (25.4%) were obese. On multivariate analysis, BMI was not a risk factor for AS progression, HR = 1.00 (p = 0.99, 95% CI = 0.95−1.06). Conclusions: There is evidence of increased risk of aggressive PCa specific death in obese patients. However, we demonstrate that in patients diagnosed by FBx, obesity does not confer an additional risk of progression on AS. This may be due to the improved characterization of cancer volume and grade by MRI−TRUS fusion biopsy. Further study is required to determine risk factors for AS progression in patients undergoing FBx. This research was supported by the Intramural Research Program of the National Cancer Institute, NIH, Medical Research Scholars Program.

scholarly journals A Retrospective Study on Pathologic Features and Racial Disparities in Prostate Cancer

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Steven A. Bigler ◽  
Charles R. Pound ◽  
Xinchun Zhou
Keyword(s):  
Prostate Cancer ◽  
African American ◽  
Racial Disparities ◽  
Tumor Evolution ◽  
Prostate Biopsies ◽  
Pathologic Features ◽  
Increased Risk ◽  
Initial Biopsy ◽  
Pathology Reports ◽  
African American Race

We reviewed more than 3,000 pathology reports on prostate cancer-related surgical specimens and analyzed racial disparities in histological and clinical features at the time of initial biopsy, diagnosis of prostate cancer, and prostatectomy, as well as in characteristics of tumor evolution between African American and Caucasian patients. As compared to Caucasians, African American patients had younger age, higher cancer detection rate, higher Gleason score of prostate cancer, and more bilateral involvement of the prostate. African Americans also had larger prostates, greater volume of tumor, and more positive margins. The diagnosis of HGPIN or ASAP in prostate biopsies and African American race conferred an increased risk of diagnosis of prostate cancer. The interval between prior noncancerous biopsy and the subsequent biopsy with diagnosis of prostate cancer was shorter in men with HGPIN, with ASAP, or of African American race.

Impact of different definitions of high-risk prostate cancer on survival after radical prostatectomy.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 113-113
Author(s):  
Kenneth Gerard Nepple ◽  
Gurdarshan S Sandhu ◽  
Dorina Kallogjeri ◽  
Seth A. Strope ◽  
Robert L. Grubb ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Cancer Survival ◽  
Clinical Stage ◽  
High Risk Patients ◽  
High Risk Prostate Cancer ◽  
Increased Risk ◽  
Risk Prostate Cancer ◽  
Risk Patients

113 Background: Multiple definitions of high risk prostate cancer exist. Studies have primarily correlated these definitions with biochemical recurrence and not with survival. We applied six previously described high risk definitions to men treated with radical prostatectomy and evaluated their ability to predict survival outcomes in a multi-institutional cohort. Methods: The study population included 6477 men treated with radical prostatectomy between 1995 and 2005 and followed for a median of 67 months. The six high risk definitions were 1) preoperative PSA≥20ng/ml, 2) biopsy Gleason score 8-10, 3) clinical stage≥T2c, 4) clinical stage T3, 5) D’Amico definition, or 6) National Comprehensive Cancer Network definition. Survival was evaluated with the Kaplan-Meier method to generate unadjusted prostate cancer survival estimates. To control for the competing risks of age and comorbidity, multivariable Cox proportional hazard regression models were used to estimate the hazard ratio for prostate cancer specific mortality (PCSM) and overall mortality (OM) in high risk patients compared to low/intermediate risk. Results: High risk patients comprised between 0.7% (cT3) and 8.2% (D’Amico) of the study population. The 10-year Kaplan Meier prostate cancer survival estimates varied from 89.7% for PSA≥20 to 69.7% for cT3. On multivariable analysis controlling for age and comorbidity, high risk prostate cancer (of all definitions) had an increased risk of PCSM compared to low/intermediate risk with a hazard ratio (HR) ranging from 4.38 for PSA≥20 to 19.97 for cT3 (all p<0.0001). For OM, again controlling for age and comorbidity, high risk patients of all definitions except preoperative PSA≥20 (HR=0.98, p=0.99) were associated with increased risk of OM (HR range: 1.72 for D’Amico, 1.73 for stage≥T2c, 1.88 for NCCN, 2.63 for Gleason 8-10, 3.31 for cT3; all p<0.01). Conclusions: In a contemporary cohort of men with high risk prostate cancer treated with radical prostatectomy, the majority of men experienced long term prostate cancer survival. However, heterogeneity in survival outcomes existed based on the definition of high risk used. Clinical stage T3 and high Gleason score were most strongly associated with PCSM and OM.

scholarly journals Prospective Image Quality and Lesion Assessment in the Setting of MR-Guided Radiation Therapy of Prostate Cancer on an MR-Linac at 1.5 T: A Comparison to a Standard 3 T MRI

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1533
Author(s):  
Haidara Almansour ◽  
Saif Afat ◽  
Victor Fritz ◽  
Fritz Schick ◽  
Marcel Nachbar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Image Quality ◽  
Outcome Measures ◽  
Quality Criteria ◽  
Lesion Size ◽  
Geometric Distortion ◽  
Diagnostic Confidence ◽  
Prostate Imaging ◽  
Lesion Conspicuity

The objective of this study is to conduct a qualitative and a quantitative image quality and lesion evaluation in patients undergoing MR-guided radiation therapy (MRgRT) for prostate cancer on a hybrid magnetic resonance imaging and linear accelerator system (MR-Linac or MRL) at 1.5 Tesla. This prospective study was approved by the institutional review board. A total of 13 consecutive patients with biopsy-confirmed prostate cancer and an indication for MRgRT were included. Prior to radiation therapy, each patient underwent an MR-examination on an MRL and on a standard MRI scanner at 3 Tesla (MRI3T). Three readers (two radiologists and a radiation oncologist) conducted an independent qualitative and quantitative analysis of T2-weighted (T2w) and diffusion-weighted images (DWI). Qualitative outcome measures were as follows: zonal anatomy, capsule demarcation, resolution, visibility of the seminal vesicles, geometric distortion, artifacts, overall image quality, lesion conspicuity, and diagnostic confidence. All ratings were performed on an ordinal 4-point Likert scale. Lesion conspicuity and diagnostic confidence were firstly analyzed only on MRL. Afterwards, these outcome parameters were analyzed in consensus with the MRI3T. Quantitative outcome measures were as follows: anteroposterior and right left diameter of the prostate, lesion size, PI-RADS score (Prostate Imaging—Reporting and Data System) and apparent diffusion coefficient (ADC) of the lesions. Intergroup comparisons were computed using the Wilcoxon-sign rank test and t tests. A post-hoc regression analysis was computed for lesion evaluation. Finally, inter-/intra-reader agreement was analyzed using the Fleiss kappa and intraclass correlation coefficient. For T2w images, the MRL showed good results across all quality criteria (median 3 and 4). Furthermore, there were no significant differences between MRL and MRI3T regarding capsule demarcation or geometric distortion. For the DWI, the MRL performed significantly less than MRI3T across most image quality criteria with a median ranging between 2 and 3. However, there were no significant differences between MRL and MRI3T regarding geometric distortion. In terms of lesion conspicuity and diagnostic confidence, inter-reader agreement was fair for MRL alone (Kappa = 0.42) and good for MRL in consensus with MRI3T (Kappa = 0.708). Thus, lesion conspicuity and diagnostic confidence could be significantly improved when reading MRL images in consensus with MRI3T (Odds ratio: 9- to 11-fold for the T2w images and 5- to 8–fold for the DWI) (p < 0.001). For measures of lesion size, anterior-posterior and right-left prostate diameter, inter-reader and intersequence agreement were excellent (ICC > 0.90) and there were no significant differences between MRL and MRI3T among all three readers. In terms of Prostate Imaging Reporting and Data System (PIRADS) scoring, no significant differences were observed between MRL and MRI3T. Finally, there was a significant positive linear relationship between lesion ADC measurements (r = 0.76, p < 0.01) between the ADC values measured on both systems. In conclusion, image quality for T2w was comparable and diagnostic even without administration of spasmolytic- or contrast agents, while DWI images did not reach diagnostic level and need to be optimized for further exploitation in the setting of MRgRT. Diagnostic confidence and lesion conspicuity were significantly improved by reading MRL in consensus with MRI3T which would be advisable for a safe planning and treatment workflow. Finally, ADC measurements of lesions on both systems were comparable indicating that, lesion ADC as measured on the MRL could be used as a biomarker for evaluation of treatment response, similar to examinations using MRI3T.

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 Pitfalls in Prostate Cancer Magnetic Resonance Imaging

2021 ◽  
Vol 42 (01) ◽  
pp. 080-088
Author(s):  
Kuldeep Yadav ◽  
Binit Sureka ◽  
Poonam Elhence ◽  
Gautam Ram Choudhary ◽  
Himanshu Pandey
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Wide Spectrum ◽  
Strong Predictor ◽  
Targeted Biopsy ◽  
Resonance Imaging ◽  
Prostate Imaging ◽  
Prostate Biopsies ◽  
Pictorial Essay

AbstractImage-guided prostate biopsies are changing the outlook of prostate cancer (PCa) diagnosis, with the degree of suspicion on multiparametric magnetic resonance imaging (mp-MRI) being a strong predictor of targeted biopsy outcome. It is important not only to detect these suspicious lesions but also to be aware of the potential pitfalls in mp-MRI prostate imaging. The aim of this pictorial essay is to show a wide spectrum of representative cases, which are frequently misdiagnosed as PIRADS ⅘ while reporting mp-MRI of the prostate. We provide some valuable recommendations to avoid these fallacies and improve mp-MRI of prostate evaluation.

Effects of physical condition and body composition on cancer risk in a nationwide cohort of 31,158 men from Finland.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 1565-1565
Author(s):  
Jorma Tauno Juhani Sormunen ◽  
Melina Arnold ◽  
Isabelle Soerjomataram ◽  
Eero Pukkala
Keyword(s):  
Physical Activity ◽  
Prostate Cancer ◽  
Cancer Risk ◽  
Cancer Incidence ◽  
Physical Condition ◽  
Military Service ◽  
Early Adulthood ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Increased Risk

1565 Background: Regular physical activity seems to protect men from colorectal cancer and possibly also from prostate cancer. In the case of other cancers the evidence is adding up, and physical activity seems to have a small protective effect to its incidence. The aim of this study was to analyse the effects of physical condition (PC) in early adulthood on cancer incidence later in life. Methods: We collected data on general health, anthropometry and PC for 31,158 Finnish men born in 1958 from the time of their military service between the ages of 17 and 30 years. Using linkage with the Finnish Cancer Registry, all men were followed-up for cancer incidence up to 2014. Results: Overweight and obesity (body mass index (BMI) ≥ 25 kg/m2) were associated with an increased overall cancer risk [hazard ratio (HR): 1.08, 95% confidence interval (CI): 0.89-1.30] when compared to those with BMI < 25 kg/m2. Those with normal weight but bad PC had an increased risk of all cancers combined as compared to those with normal weight and good PC (HR 1.18, 95% CI: 1.01-1.38), which further increased in those who were also overweight (HR 1.30, 95% CI: 1.01-1.69). We noticed an increased overall cancer risk in men in who entered service with minor health problems (HR 1.46, 95% CI 1.19-1.80), when compared to those that were completely healthy. This was especially observed for advanced prostate cancer (HR: 3.35, 95% CI: 1.14-9.90). Increased HRs, yet statistically insignificant, were also seen for colorectal and other obesity-related cancers. Conclusions: Good PC at young age seems to protect men from cancer later in life. Early adulthood obesity, when combined with bad PC, seems to further increase cancer risk.

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