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Validating multiparametric MRI for diagnosis and monitoring of prostate cancer in patients for active surveillance

  • Urology - Original Paper
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Abstract

Purpose

To compare multiparametric magnetic resonance imaging (mpMRI) with transrectal ultrasound-guided prostate biopsy (TRUS-bx) for the diagnosis and monitoring of small-volume prostate cancer (PCa) in patients on active surveillance (AS).

Methods

In a retrospective cross-sectional validation study, 100 patients on AS for PCa underwent a systematic 12-core TRUS-bx (the gold standard) as well as mpMRI, on either a 1.5 or 3 Tesla scanner (32 and 68 patients, respectively). Three pathologists reported biopsy histology separately. A single, experienced radiologist scored mpMRI scans using the PI-RADS system. We compared left- and right-sided PI-RADS scores of the peripheral zone with TRUS-bx results of the relevant prostate lobe. We then estimated the specificity and sensitivity of mpMRI in diagnosing low-grade low-risk PCa in our AS cohort.

Results

The sensitivity of mpMRI was 37 % (95 % CI 28–47 %) and specificity was 85 % (CI 76–92 %) for cancer. The negative predictive value was 51 % (CI 44–60 %), and the positive predictive value was 76 % (CI 62–87 %). The positive and negative likelihood ratios were 2.5 and 0.7, respectively.

Conclusion

Because of its low specificity and low negative predictive value, mpMRI is not suitable for diagnosing low-grade small-volume PCa. However, because of a specificity of 85 % and a negative likelihood ratio of 0.7, mpMRI may be useful for follow-up of previously TRUS-bx diagnosed patients who are on AS.

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References

  1. Bloch BN, Lenkinski RE, Rofsky NM (2008) The role of magnetic resonance imaging (MRI) in prostate cancer imaging and staging at 1.5 and 3 tesla: the beth israel deaconess medical center (BIDMC) approach. Cancer 4(4–5):251–262

    Google Scholar 

  2. Dickinson L, Ahmed HU, Allen C, Barentsz JO, Carey B, Futterer JJ et al (2011) Magnetic resonance imaging for the detection, localisation, and characterisation of prostate cancer: recommendations from a European consensus meeting. Eur Urol 59(4):477–494

    Article  PubMed  Google Scholar 

  3. Choi YJ, Kim JK, Kim N, Kim KW, Choi EK, Cho KS (2007) Functional MR imaging of prostate cancer. Radiographics 27(1):63–75

    Article  PubMed  Google Scholar 

  4. Hou AH, Swanson D, Barqawi AB (2009) Modalities for imaging of prostate cancer. Adv Urol. doi:10.1155/2009/818065

    PubMed  PubMed Central  Google Scholar 

  5. Padhani AR, Gapinski CJ, Macvicar DA, Parker GJ, Suckling J, Revell PB et al (2000) Dynamic contrast enhanced MRI of prostate cancer: correlation with morphology and tumour stage, histological grade and PSA. Clin Radiol 55(2):99–109

    Article  CAS  PubMed  Google Scholar 

  6. Umbehr M, Bachmann LM, Held U, Kessler TM, Sulser T, Weishaupt D et al (2009) Combined magnetic resonance imaging and magnetic resonance spectroscopy imaging in the diagnosis of prostate cancer: a systematic review and meta-analysis. Eur Urol 55(3):575–590

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hodge KK, McNeal JE, Terris MK, Stamey TA (1989) Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 142(1):71

    CAS  PubMed  Google Scholar 

  8. Chen S-S, Chiu L-P, Chen K-K (2010) Comparison of transrectal ultrasound-guided biopsy of the prostate and transurethral resection of the prostate for detection of prostate cancer in patients with moderate lower urinary tract symptoms. J Chin Med Assoc 73(11):568–572

    Article  PubMed  Google Scholar 

  9. D’Amico AV, Desjardin A, Chung A, Chen MH, Schultz D, Whittington R et al (1998) Assessment of outcome prediction models for patients with localized prostate carcinoma managed with radical prostatectomy or external beam radiation therapy. Cancer 82(10):1887–1896

    Article  PubMed  Google Scholar 

  10. Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villiers G, Rouviere O, Logager V, Fütterer JJ (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22(4):746–757. doi:10.1007/s00330-011-2377-y

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hoeks CM, Barentsz JO, Hambrock T, Yakar D, Somford DM, Heijmink SW et al (2011) Prostate cancer: multiparametric MR imaging for detection, localization, and staging. Radiology 261(1):46–66

    Article  PubMed  Google Scholar 

  12. Penzkofer T, Tempany-Afdhal CM (2014) Prostate cancer detection and diagnosis: the role of MR and its comparison to other diagnostic modalities—a radiologist’s perspective. NMR Biomed 27(1):3–15

    Article  PubMed  Google Scholar 

  13. Batura D, Gopal RG (2013) The national burden of infections after prostate biopsy in England and Wales: a wake-up call for better prevention. J Antimicrob Chemother 68:247–249

    Article  CAS  PubMed  Google Scholar 

  14. Nam RK, Saskin R, Lee Y, Liu Y, Law C, Klotz LH et al (2010) Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol 183(3):963–969

    Article  PubMed  Google Scholar 

  15. Gopal Rao G, Batura D (2014) Emergency hospital admissions attributable to infective complications of prostate biopsy despite appropriate prophylaxis: need for additional infection prevention strategies? Int Urol Nephrol 46(2):309–315

    Article  CAS  PubMed  Google Scholar 

  16. Roethke M, Anastasiadis G, Lichy M, Werner M, Wagner P, Kruck S et al (2012) MRI-guided prostate biopsy detects clinically significant cancer: analysis of a cohort of 100 patients after previous negative TRUS biopsy. World J Urol 30(2):213–218

    Article  CAS  PubMed  Google Scholar 

  17. Kumar V, Jagannathan NR, Thulkar S, Kumar R (2012) Prebiopsy magnetic resonance spectroscopy and imaging in the diagnosis of prostate cancer. Int J Urol 19(7):602–613

    Article  CAS  PubMed  Google Scholar 

  18. Ehdaie B, Shariat SF (2013) Magnetic resonance imaging–targeted prostate biopsy: back to the future. Eur Urol 63(1):141–142

    Article  PubMed  Google Scholar 

  19. Moran M, Marignol M, Perry P, Fagan F, Gaffney G, Meaney M et al (2013) 355 Parametric diffusion weighted imaging at 3 tesla accurately predicts histological outcomes in men presenting for a TRUS-guided biopsy of the prostate. Eur Urol Suppl 12(1):e355. doi:10.1016/S1569-9056(13)60840-4

    Article  Google Scholar 

  20. Villers V, Marliere M, Ouzzane O, Puech P, Lemaître L (2012) MRI in addition to or as a substitute for prostate biopsy: the clinician’s point of view. Diagn Interv Imaging 93(4):262–267

    Article  CAS  PubMed  Google Scholar 

  21. Fascelli M, George AK, Frye T, Turkbey B, Choyke PL, Pinto PA (2015) The role of MRI in active surveillance for prostate cancer. Curr Urol Rep 16(6):42

    Article  PubMed  Google Scholar 

  22. Yerram NK, Volkin D, Turkbey B, Nix J, Hoang AN, Vourganti S et al (2012) Low suspicion lesions on multiparametric magnetic resonance imaging predict for the absence of high-risk prostate cancer. BJU Int 110(11 Pt B):E-783–E-788. doi:10.1111/j.1464-410X.2012.11646.x

    Article  Google Scholar 

  23. Coakley FV, Chen I, Qayyum A, Westphalen AC, Carroll PR, Hricak H et al (2007) Validity of prostate-specific antigen as a tumour marker in men with prostate cancer managed by watchful-waiting: correlation with findings at serial endorectal magnetic resonance imaging and spectroscopic imaging. BJU Int 99(1):41–45

    Article  CAS  PubMed  Google Scholar 

  24. Rastinehad AR, Baccala AA, Chung PH, Proano JM, Kruecker J, Xu S et al (2011) D’Amico risk stratification correlates with degree of suspicion of prostate cancer on multiparametric magnetic resonance imaging. J Urol 185(3):815–820

    Article  PubMed  PubMed Central  Google Scholar 

  25. Stephenson SK, Chang EK, Marks LS (2014) Screening and detection advances in magnetic resonance image-guided prostate biopsy. Urol Clin North Am 41(2):315–326

    Article  PubMed  PubMed Central  Google Scholar 

  26. Da Rosa MR, Milot L, Sugar L, Vesprini D, Chung H, Loblaw A et al (2015) A prospective comparison of MRI-US fused targeted biopsy versus systematic ultrasound-guided biopsy for detecting clinically significant prostate cancer in patients on active surveillance. J Magn Reson Imaging 41(1):220–225

    Article  PubMed  Google Scholar 

  27. Fradet V, Kurhanewicz J, Cowan JE, Karl A, Coakley FV, Shinohara K, Carroll PR (2010) Prostate cancer managed with active surveillance: role of anatomic MR imaging and MR spectroscopic imaging. Radiology 256(1):176–183

    Article  PubMed  PubMed Central  Google Scholar 

  28. Abdi H, Black P (2015) Evolving use of multi parametric MRI in prostate cancer detection. http://thischangedmypractice.com/mri-prostate-cancer-detection/. Accessed 12 Nov 2015

  29. Pokorny MR, de Rooij M, Duncan E, Schröder FH, Parkinson R, Barentsz JO, Thompson LC (2014) Prospective study of diagnostic accuracy comparing prostate cancer detection by transrectal ultrasound-guided biopsy versus magnetic resonance (MR) imaging with subsequent mr-guided biopsy in men without previous prostate biopsies. Eur Urol 66(1):22–29

    Article  PubMed  Google Scholar 

  30. Monzen Y, Kurose T, Okazaki H, Mito M, Wadasaki K et al (2012) MRI of prostate cancer at 1.5T and 3T comparison of image quality in tumor detection. ESR. doi:10.1594/ecr2012/C-0048

    Google Scholar 

  31. Hu Y, Ahmed HU, Carter T, Arumainayagam N, Lecornet E, Barzell W et al (2012) A biopsy simulation study to assess the accuracy of several transrectal ultrasonography (TRUS)-biopsy strategies compared with template prostate mapping biopsies in patients who have undergone radical prostatectomy. BJU Int 110(6):812–820

    Article  PubMed  Google Scholar 

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Acknowledgments

This work is partly derived from a thesis submitted by the first author for the degree of MSc Urology, University College of London and Dr Anwar Padhani’s help and supervision are gratefully acknowledged.

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Authors and Affiliations

  1. Department of Urology, London North West Healthcare NHS Trust, Harrow, London, Middlesex, HA1 3UJ, UK

    Iqbal Sahibzada, Deepak Batura & Giles Hellawell

Authors
  1. Iqbal Sahibzada
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  2. Deepak Batura
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  3. Giles Hellawell
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Corresponding author

Correspondence to Deepak Batura.

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Conflict of interest

Dr Sahibzada and Mr Hellawell declare that they have no conflict of interest. Mr Batura has received speaker honoraria from Astellas.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Sahibzada, I., Batura, D. & Hellawell, G. Validating multiparametric MRI for diagnosis and monitoring of prostate cancer in patients for active surveillance. Int Urol Nephrol 48, 529–533 (2016). https://doi.org/10.1007/s11255-016-1212-4

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  • DOI: https://doi.org/10.1007/s11255-016-1212-4

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