Multiparametric MRI and Radiomics in Prostate Cancer: A Review of the Current Literature

Prostate cancer (PCa) represents the fourth most common cancer and the fifth leading cause of cancer death of men worldwide. Multiparametric MRI (mp-MRI) has high sensitivity and specificity in the detection of PCa, and it is currently the most widely used imaging technique for tumor localization and cancer staging. mp-MRI plays a key role in risk stratification of naïve patients, in active surveillance for low-risk patients, and in monitoring recurrence after definitive therapy. Radiomics is an emerging and promising tool which allows a quantitative tumor evaluation from radiological images via conversion of digital images into mineable high-dimensional data. The purpose of radiomics is to increase the features available to detect PCa, to avoid unnecessary biopsies, to define tumor aggressiveness, and to monitor post-treatment recurrence of PCa. The integration of radiomics data, including different imaging modalities (such as PET-CT) and other clinical and histopathological data, could improve the prediction of tumor aggressiveness as well as guide clinical decisions and patient management. The purpose of this review is to describe the current research applications of radiomics in PCa on MR images.

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Diagnostic Role of 18F-PSMA-1007 PET/CT in Prostate Cancer Staging: A Systematic Review

Diagnostics ◽

10.3390/diagnostics11030552 ◽

2021 ◽

Vol 11 (3) ◽

pp. 552

Author(s):

Salam Awenat ◽

Arnoldo Piccardo ◽

Patricia Carvoeiras ◽

Giovanni Signore ◽

Luca Giovanella ◽

...

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Diagnostic Accuracy ◽

Metastatic Disease ◽

Cancer Staging ◽

Relevant Information ◽

Cochrane Library ◽

Number Of Patients ◽

Pet Ct

Background: The use of prostate-specific membrane antigen (PSMA)-targeted agents for staging prostate cancer (PCa) patients using positron emission tomography/computed tomography (PET/CT) is increasing worldwide. We performed a systematic review on the role of 18F-PSMA-1007 PET/CT in PCa staging to provide evidence-based data in this setting. Methods: A comprehensive computer literature search of PubMed/MEDLINE and Cochrane Library databases for studies using 18F-PSMA-1007 PET/CT in PCa staging was performed until 31 December 2020. Eligible articles were selected and relevant information was extracted from the original articles by two authors independently. Results: Eight articles (369 patients) evaluating the role of 18F-PSMA-1007 PET/CT in PCa staging were selected. These studies were quite heterogeneous, but, overall, they demonstrated a good diagnostic accuracy of 18F-PSMA-1007 PET/CT in detecting PCa lesions at staging. Overall, higher primary PCa aggressiveness was associated with higher 18F-PSMA-1007 uptake. When compared with other radiological and scintigraphic imaging methods, 18F-PSMA-1007 PET/CT had superior sensitivity in detecting metastatic disease and the highest inter-reader agreement. 18F-PSMA-1007 PET/CT showed similar results in terms of diagnostic accuracy for PCa staging compared with PET/CT with other PSMA-targeted tracers. Dual imaging with multi-parametric magnetic resonance imaging and 18F-PSMA-1007 PET/CT may improve staging of primary PCa. Notably, 18F-PSMA-1007-PET/CT may detect metastatic disease in a significant number of patients with negative standard imaging. Conclusions: 18F-PSMA-1007 PET/CT demonstrated a good accuracy in PCa staging, with similar results compared with other PSMA-targeted radiopharmaceuticals. This method could substitute bone scintigraphy and conventional abdominal imaging for PCa staging. Prospective multicentric studies are needed to confirm these findings.

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Bi- or multiparametric MRI in a sequential screening program for prostate cancer with PSA followed by MRI? Results from the Göteborg prostate cancer screening 2 trial

European Radiology ◽

10.1007/s00330-021-07907-9 ◽

2021 ◽

Author(s):

Jonas Wallström ◽

Kjell Geterud ◽

Kimia Kohestani ◽

Stephan E. Maier ◽

Marianne Månsson ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Screening Program ◽

Prostate Cancer Screening ◽

High Sensitivity ◽

Multiparametric Mri ◽

False Positives ◽

Quality Data ◽

Gadolinium Contrast ◽

Sequential Screening

Abstract Objectives The PIRADS Steering Committee has called for “higher quality data before making evidence-based recommendations on MRI without contrast enhancement as an initial diagnostic work up,” however, recognizing biparametric (bp) MRI as a reasonable option in a low-risk setting such as screening. With bpMRI, more men can undergo MRI at a lower cost and they can be spared the invasiveness of intravenous access. The aim of this study was to assess cancer detection in bpMRI vs mpMRI in sequential screening for prostate cancer (PCa). Methods Within the ongoing Göteborg PCa screening 2 trial, we assessed cancer detection in 551 consecutive participants undergoing prostate MRI. In the same session, readers first assessed bpMRI and then mpMRI. Four targeted biopsies were performed for lesions scored PIRADS 3–5 with bpMRI and/or mpMRI. Results Cancer was detected in 84/551 cases (15.2%; 95% CI: 12.4–18.4) with mpMRI and in 83/551 cases (15.1%; 95% CI: 12.3–18.2%) with bpMRI. The relative risk (RR) for cancer detection with bpMRI compared to mpMRI was 0.99 (95% one-sided CI: > 94.8); bpMRI was non-inferior to mpMRI (10% non-inferiority margin). bpMRI resulted in fewer false positives, 45/128 (35.2%), compared to mpMRI, 52/136 (38.2%), RR = 0.92; 95% CI: 0.84–0.98. Of 8 lesions scored positive only with mpMRI, 7 were false positives. The PPV for MRI and targeted biopsy was 83/128 (64.8%) for bpMRI and 84/136 (61.8%) for mpMRI, RR = 1.05, 95% CI: 1.01–1.10. Conclusions In a PSA-screened population, bpMRI was non-inferior to mpMRI for cancer detection and resulted in fewer false positives. Key Points • In screening for prostate cancer with PSA followed by MRI, biparametric MRI allows radiologists to detect an almost similar number of prostate cancers and score fewer false positive lesions compared to multiparametric MRI. • In a screening program, high sensitivity should be weighed against cost and risks for healthy men; a large number of men can be saved the exposure of gadolinium contrast medium by adopting biparametric MRI and at the same time allowing for a higher turnover in the MRI room.

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Comparison of PSMA-ligand PET/CT and multiparametric MRI for the detection of recurrent prostate cancer in the pelvis

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-019-04438-w ◽

2019 ◽

Vol 46 (11) ◽

pp. 2289-2297 ◽

Cited By ~ 7

Author(s):

Ali Afshar-Oromieh ◽

Bernd Vollnberg ◽

Ian Alberts ◽

Alexandrine Bähler ◽

Christos Sachpekidis ◽

...

Keyword(s):

Prostate Cancer ◽

Multiparametric Mri ◽

Recurrent Prostate Cancer ◽

Psma Ligand ◽

Pet Ct

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The dose distribution in dominant intraprostatic tumour lesions defined by multiparametric MRI and PSMA PET/CT correlates with the outcome in patients treated with primary radiation therapy for prostate cancer

Radiation Oncology ◽

10.1186/s13014-018-1014-1 ◽

2018 ◽

Vol 13 (1) ◽

Cited By ~ 12

Author(s):

Constantinos Zamboglou ◽

Christina Marie Klein ◽

Benedikt Thomann ◽

Thomas Franz Fassbender ◽

Hans C. Rischke ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Dose Distribution ◽

Multiparametric Mri ◽

Primary Radiation ◽

Psma Pet ◽

Pet Ct

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68Ga-PSMA PET/CT for restaging prostate cancer after definitive therapy: Results of a prospective single-center trial

European Urology Supplements ◽

10.1016/s1569-9056(18)31762-7 ◽

2018 ◽

Vol 17 (2) ◽

pp. e1326

Author(s):

M. Borghesi ◽

F. Ceci ◽

C. Paolo ◽

G. Tiziano ◽

F. Andrea ◽

...

Keyword(s):

Prostate Cancer ◽

Single Center ◽

Psma Pet ◽

Pet Ct ◽

Definitive Therapy

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[68Ga-]PSMA-11 PET/CT and multiparametric MRI for gross tumor volume delineation in a slice by slice analysis with whole mount histopathology as a reference standard – Implications for focal radiotherapy planning in primary prostate cancer

Radiotherapy and Oncology ◽

10.1016/j.radonc.2019.07.005 ◽

2019 ◽

Vol 141 ◽

pp. 214-219 ◽

Cited By ~ 17

Author(s):

Alisa S. Bettermann ◽

Constantinos Zamboglou ◽

Selina Kiefer ◽

Cordula A. Jilg ◽

Simon Spohn ◽

...

Keyword(s):

Prostate Cancer ◽

Gross Tumor Volume ◽

Tumor Volume ◽

Multiparametric Mri ◽

Radiotherapy Planning ◽

Reference Standard ◽

Volume Delineation ◽

Primary Prostate Cancer ◽

Pet Ct ◽

Whole Mount

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Clinicopathological predictors of positive 68Ga-PSMA-11 PET/CT in PSA-only recurrence of localized prostate cancer following definitive therapy

Annals of Nuclear Medicine ◽

10.1007/s12149-019-01340-1 ◽

2019 ◽

Vol 33 (5) ◽

pp. 326-332 ◽

Cited By ~ 2

Author(s):

Ahmet Murat Aydin ◽

Bahadir Haberal ◽

Meylis Artykov ◽

Cenk Yucel Bilen ◽

Sertac Yazici

Keyword(s):

Prostate Cancer ◽

Localized Prostate Cancer ◽

Pet Ct ◽

Definitive Therapy

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Association of NaF PET/CT findings with PSA and alkaline phosphatase in untreated castration-sensitive prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.122 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 122-122

Author(s):

Anna Couvillon ◽

Baris Turkbey ◽

Maria Liza Lindenberg ◽

Peter L. Choyke ◽

Mirna Martinez ◽

...

Keyword(s):

Prostate Cancer ◽

Alkaline Phosphatase ◽

High Risk ◽

Imaging Technique ◽

Specific Antigen ◽

High Sensitivity ◽

Ct Scans ◽

Ct Findings ◽

Pet Ct ◽

Pet Ct Scan

122 Background: NaF PET/CT is an emerging imaging technique with potentially high sensitivity in detecting bone metastasis (mets), however, its role in castration-‐sensitive prostate cancer (CSPC) is undefined and it remains unclear which CSPC patients should have NaF PET/CT. Methods: We retrospectively reviewed NaF PET/CT scans done on 45 patients with untreated, high risk CSPC with the goal of determining which disease features were associated with positive findings. Two blinded radiologists reviewed each scan and determined by consensus if findings were negative for metastasis (0% liklihood of mets), possible (50%), probable (75%), or consistent with mets (90%). Prostate specific antigen (PSA) and alkaline phosphatase (AP) values were then evaluated at time of NaF scan when available. Results: Of the 45 patients 2 were Gleason 6, 5 were Gleason 7, 36 were Gleason 8 to 10, 2 unknown. When grouped by findings on NaF PET/CT, there were no substantial differences seen between median PSA or AP values. When patients with both PSA and AP values > median were evaluated, there was no clear association with NaF PET/CT findings. Conclusions: Preliminary findings from this small retrospective analysis suggest that there may be limited associations between PSA and/or AP with findings on NaF PET/CT scan in untreated patients with CSPC. Further analysis in larger cohorts of pts is required. [Table: see text]

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Risk of metastatic disease using [18F]PSMA-1007 PET/CT for primary prostate cancer staging

EJNMMI Research ◽

10.1186/s13550-021-00869-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Venkata Avinash Chikatamarla ◽

Satomi Okano ◽

Peter Jenvey ◽

Alexander Ansaldo ◽

Matthew J. Roberts ◽

...

Keyword(s):

Prostate Cancer ◽

Metastatic Disease ◽

Primary Tumour ◽

Cancer Staging ◽

Disease Detection ◽

Clinical Variables ◽

Imaging Characteristics ◽

Primary Prostate Cancer ◽

Pet Ct ◽

Grade 3

Abstract Background Accurate prostate cancer imaging is critical for patient management. Multiple studies have demonstrated superior diagnostic accuracy of [68Ga]-PSMA-11 PET/CT over conventional imaging for disease detection, with validated clinical and biochemical predictors of disease detection. More recently [18F]PSMA-1007 offers theoretical imaging advantages, but there is limited evidence of clinical and biochemical predictors of scan findings in the staging population. This study investigates the association of clinical variables with imaging characteristics among patients who underwent [18F]PSMA-1007 PET/CT for primary staging of men with histopathologically confirmed prostate carcinoma. A retrospective review of 194 consecutive patients imaged between May 2019 to May 2020 was performed. Association between imaging variables (presence and distribution of metastatic disease, primary tumour SUVmax) and clinical variables (EAU risk criteria) were assessed using descriptive statistics, logistic regression model and ROC analysis. Results The median age, PSA level and ISUP grade were 70 years, 10 ng/mL and ISUP grade 3, respectively. There were 36.6% of patients with intermediate-risk and 60.8% of patients with high-risk disease. ISUP grade was associated with the presence of metastasis overall (p = 0.008) as well as regional nodal (p = 0.003), non-regional nodal (p = 0.041) and bone (p = 0.006) metastases. PSA level was associated with metastatic disease overall (p = 0.001), regional (p = 0.001) and non-regional nodal metastases (p = 0.004), but not with bone metastases (p = 0.087). There were too few visceral metastases for meaningful analysis. SUVmax of the primary prostatic tumour was associated with ISUP grade (p = 0.004), PSA level (p < 0.001) and AJCC stage (p = 0.034). PSA > 20 ng/mL and ISUP grade > 3 had a specificity of 85% (95% CI 78–91%) and 60% (95% CI 50–68%) and a sensitivity of 36% (95% CI 25–49%) and 62% (95% CI 49–74%), respectively, for detection of metastatic disease. Conclusion Metastatic disease according to [18F]PSMA-1007 PET/CT was associated with ISUP grade and PSA level. This is the largest study using [18F]PSMA-1007 PET/CT to confirm a positive correlation of PSA level, ISUP grade and stage with primary prostate tumour SUVmax.

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