Localization Of Prostate Cancer Research Articles

ESR Essentials: using the right scoring system in prostate MRI-practice recommendations by ESUR.

MRI has gained prominence in the diagnostic workup of prostate cancer (PCa) patients, with the Prostate Imaging Reporting and Data System (PI-RADS) being widely used for cancer detection. Beyond PI-RADS, other MRI-based scoring tools have emerged to address broader aspects within the PCa domain. However, the multitude of available MRI-based grading systems has led to inconsistencies in their application within clinical workflows. The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) assesses the likelihood of clinically significant radiological changes of PCa during active surveillance, and the Prostate Imaging for Local Recurrence Reporting (PI-RR) scoring system evaluates the risk of local recurrence after whole-gland therapies with curative intent. Underlying any system is the requirement to assess image quality using the Prostate Imaging Quality Scoring System (PI-QUAL). This article offers practicing radiologists a comprehensive overview of currently available scoring systems with clinical evidence supporting their use for managing PCa patients to enhance consistency in interpretation and facilitate effective communication with referring clinicians. KEY POINTS: Assessing image quality is essential for all prostate MRI interpretations and the PI-QUAL score represents the standardizedtool for this purpose. Current urological clinical guidelines for prostate cancer diagnosis and localization recommend adhering to the PI-RADS recommendations. The PRECISE and PI-RR scoring systems can be used for assessing radiological changes of prostate cancerduring active surveillance and the likelihood of local recurrence after radical treatments respectively.

Discrepancy in the Location of Prostate Cancer Indicated on Biparametric Magnetic Resonance Imaging and Pathologically Diagnosed Using Surgical Specimens.

Accurate diagnosis of the localization of prostate cancer (PCa) on magnetic resonance imaging (MRI) remains a challenge. We aimed to assess discrepancy between the location of PCa pathologically diagnosed using surgical specimens and lesions indicated as possible PCa by the Prostate Imaging Reporting and Data System on MRI. The primary endpoint was the concordance rate between the site of probable clinically significant PCa (csPCa) identified using biparametric MRI (bpMRI) and location of PCa in the surgical specimen obtained using robot-assisted total prostatectomy. Among 85 lesions identified in 30 patients; 42 (49.4%) were identified as possible PCa on MRI. The 85 PCa lesions were divided into positive and negative groups based on the bpMRI results. None of the patients had missed csPCa. Although the diagnostic accuracy of bpMRI was relatively high for PCas located in the middle of the prostate (p = 0.029), it was relatively low for PCa located at the base of the prostate, all of which were csPCas. Although current modalities can accurately diagnose PCa, the possibility that PCa is present with multiple lesions in the prostate should be considered, even if MRI does not detect PCa.

Multi-Parametric Evaluation of Prostate Cancer on MRI

Background: Prostate cancer is the most common malignancy among men globally and the second leading cause of cancer-related deaths. The increasing prevalence, particularly in aging populations, underscores the urgent need for accurate diagnostic tools to facilitate early detection, precise staging, and effective management. Traditional diagnostic methods, including Digital Rectal Examination (DRE) and Prostate-Specific Antigen (PSA) testing, have limitations in sensitivity and specificity, leading to unnecessary procedures and missed diagnoses. Objective: This study aims to evaluate the efficacy of multiparametric Magnetic Resonance Imaging (mpMRI) in the diagnosis and staging of prostate cancer, comparing its accuracy with conventional diagnostic methods and examining its role in improving patient outcomes. Methods: A retrospective descriptive cross-sectional study was conducted at the Diagnostic Center of Combined Military Hospital, Lahore, from January 2021 to June 2023. Sixty male patients suspected of having prostate cancer, based on elevated PSA levels (>10 ng/mL) or clinical symptoms, were included. mpMRI scans were performed using a Siemens Avanto MRI Machine 1.5T, incorporating T2-weighted imaging, Diffusion-Weighted Imaging (DWI), and Dynamic Contrast-Enhanced (DCE) MRI. The Prostate Imaging Reporting and Data System (PI-RADS) was employed for interpretation. Statistical analysis was conducted using SPSS 26.0, with chi-square tests applied to assess the association between mpMRI findings and prostate cancer diagnosis. Results: mpMRI identified prostate cancer with a sensitivity of 85% and specificity of 88.3%, as evidenced by abnormal MRI findings in 53 out of 60 patients. Elevated PSA levels were confirmed in 90% of the cases. T2-weighted imaging demonstrated hypointensity in the peripheral zone in 70% of patients, while DWI and ADC mapping showed restricted diffusion in 85% of the cases. DCE-MRI revealed post-contrast enhancement in 40% of the participants. The PI-RADS scoring system effectively graded the severity of prostate lesions, with 38.3% of cases categorized as PI-RADS IV. Conclusion: Multiparametric MRI significantly enhances the accuracy of prostate cancer diagnosis and staging, surpassing traditional diagnostic methods in sensitivity and specificity. By providing detailed anatomical and functional information, mpMRI facilitates early detection, accurate localization, and appropriate management of prostate cancer, potentially improving patient outcomes.

A Clinically Feasible Electrode Array for 3D Intraoperative Electrical Impedance Tomography-Based Surgical Margin Assessment in Robot-Assisted Radical Prostatectomy.

A novel small form factor circular electrode array was designed specifically for electrical impedance tomography (EIT) based assessment of surgical margins during robot assisted radical prostatectomy (RARP). The electrode array consists of 33 gold-plated electrodes arranged within a 9.5mm diameter circular footprint on the end of a surgical probe that can be introduced through a standard 12mm laparoscopic port used during RARP. The electrode array contains 8 larger, low-contact impedance outer electrodes dedicated for current drive and an internal grid of 25 smaller electrodes for simultaneous voltage measurement. Separating electrode geometry by function is designed to improve current delivery, speed, and resolution while reducing hardware requirements. Simulations demonstrated that 1mm diameter hemispherical prostate cancer inclusions could be localized within regions of adipose and benign prostate tissue; 1.5mm diameter inclusions were required for localization within muscle tissue. A 2.38mm diameter aluminum rod in 0.2 S/m saline could be localized throughout the imaging domain with a position error of less than 2.5mm for depths from the electrode array surface of up to 1.7mm. Ex vivo tissue experiments with a bovine model demonstrate visual congruence of muscle and adipose tissue locations between the sample and reconstructed images. Simulation and experimental results indicate good detection and location of inclusions. These results suggest the proposed electrode array design can provide sufficient accuracy in the detection and localization of prostate cancer against clinically relevant background tissues for use during RARP.

Combiner and HyperCombiner networks: Rules to combine multimodality MR images for prostate cancer localisation

One of the distinct characteristics of radiologists reading multiparametric prostate MR scans, using reporting systems like PI-RADS v2.1, is to score individual types of MR modalities, including T2-weighted, diffusion-weighted, and dynamic contrast-enhanced, and then combine these image-modality-specific scores using standardised decision rules to predict the likelihood of clinically significant cancer. This work aims to demonstrate that it is feasible for low-dimensional parametric models to model such decision rules in the proposed Combiner networks, without compromising the accuracy of predicting radiologic labels. First, we demonstrate that either a linear mixture model or a nonlinear stacking model is sufficient to model PI-RADS decision rules for localising prostate cancer. Second, parameters of these combining models are proposed as hyperparameters, weighing independent representations of individual image modalities in the Combiner network training, as opposed to end-to-end modality ensemble. A HyperCombiner network is developed to train a single image segmentation network that can be conditioned on these hyperparameters during inference for much-improved efficiency. Experimental results based on 751 cases from 651 patients compare the proposed rule-modelling approaches with other commonly-adopted end-to-end networks, in this downstream application of automating radiologist labelling on multiparametric MR. By acquiring and interpreting the modality combining rules, specifically the linear-weights or odds ratios associated with individual image modalities, three clinical applications are quantitatively presented and contextualised in the prostate cancer segmentation application, including modality availability assessment, importance quantification and rule discovery.

Reduction of Late Urinary Toxicity from Prostate Cancer Radiotherapy via Intrafractional MV-kV Image Guidance

Prostate cancer localization during radiotherapy is difficult and introduces positional variability during treatment. Here we evaluate the impact on treatment toxicities of an in-house system that uses MV and kV imaging guidance (MKIG) to track implanted fiducials during stereotactic body radiotherapy (SBRT) for localized prostate cancer. A 3D MKIG platform that tracks prostate implanted fiducials in real-time was built and clinically translated to replace a prior commercial approach called intrafraction motion review (IMR), which tracks thefiducials in 2D kV view only. MKIG has been shown to correct both superior-inferior and anterior-posterior (AP) motions that are harmful to critical organs and is superior to IMR for intrafractional motion management, which is less sensitive to AP motions. From 2017 to 2019, 150 patients with localized prostate cancer were treated with SBRT to 40 Gy in 5 fractions. During the delivery of volumetric modulated arc therapy, orthogonal MV-kV pairs were simultaneously acquired at every 20° gantry rotation and rigidly registered to the reference image templates created from the planning CT. Calculated 3D translations of implanted fiducials were used to localize the prostate and alert the therapist to interrupt and reposition the prostate when exceeding a 1.5-2 mm threshold. A comparison cohort of 121 prostate patients was treated from 2015 to 2016 with the same prescription dose and treatment technique but instead managed by IMR, where the therapist interrupted treatment based on a 2mm expansion of the fiducial contours superimposed on the kV images. Statistics of intrafractional interruptions, patient shifts, and overall delivery time were collected to evaluate the efficacy of the clinical workflow. The incidence of late grade ≥2 toxicities was analyzed to assess clinical complications. The median follow-up time was 5.5 years (range of 3.6 to 8.0 years). The MKIG cohort had more interruptions per fraction (1.09 vs. 0.28) and longer average delivery time per fraction (579±205s vs. 357±117s) than IMR. 75% of shifts resulting from MKIG were less than 3mm, compared to 51% in IMR, indicating that MKIG tended to detect and correct smaller deviations (p<0.001). The baseline International Prostate Symptom Score was 7.9 in the MKIG cohort vs. 8.4 in IMR (p = 0.41). The incidence of late grade ≥2 urinary toxicity was lower in the MKIG than IMR cohort: 10.7% vs. 19.8% (p = 0.05). One grade ≥2 rectal toxicity was observed in the IMR cohort but none in MKIG. Wehave demonstrated that MKIG is a clinically practical and effective method for monitoring and correcting prostate positional deviations during SBRT of prostate cancer. MKIG is better suited than 2D IMR to localize the prostate and trigger patient repositioning during treatment. A statistically and clinically significant reduction in urinary toxicity was observed. The potential expansion of MKIG to other clinical sites and translation to other centers should be considered.

Current magnetic resonance imaging-based diagnostic strategies for prostate cancer.

Recent developments in multiparametric MRI and MRI-targeted biopsy have made it possible to detect clinically significant cancers more accurately and efficiently than ever before. Furthermore, software that enables easy MRI/US image fusion has been developed and is already available on the market, and this has provided a tailwind for the spread of MRI-based prostate cancer diagnostic strategies. Such precise diagnosis of prostate cancer localization is essential for highly accurate focal therapy. In addition, a recent large-scale study applying MRI to community screening for prostate cancer has reported its usefulness. By contrast, concerns about overdiagnosis and overtreatment, the existence of inter-reader variability in MRI diagnosis, and issues with current MRI-targeted biopsy have emerged. In this article, we review the development of multiparametric MRI and MRI-targeted biopsy to date and the current issues and discuss future directions.

DWI CAPACITY IN PROSTATE CANCER DIAGNOSING

Relevance: Prostate cancer is one of the leading causes of cancer deaths in men worldwide. Transrectal ultrasound-guided (TRUS) prostate biopsy is the most important diagnostic step, without which a definitive diagnosis cannot be made. Despite this, TRUS-guided prostate biopsy has a high rate of false negatives and is often accompanied by various clinical complications. Multiparametric MRI (mpMRI) is now widely used in routine urological and oncological practice. An element of mpMRI is diffusion-weighted imaging (DWI), which is successfully used in detecting and localizing clinically significant prostate cancer.&#x0D; The study aimed to evaluate the DWI capacity in diagnosing prostate cancer.&#x0D; Methods: 52 patients, 48-86 years old, with suspected prostate cancer, underwent mpMRI. DWI sequences obtained using T2-weighted imaging (T2WI) were compared with each other and compared with the anatomical structure of the prostate. Suspicious prostate cancer sites were marked as regions of interest, for which an apparent diffusion coefficient (ADC) was calculated. A 12-point TRUS-guided biopsy confirmed the presence or absence of prostate cancer.&#x0D; Results: When analyzing quantitative measurements, ADC showed low values for cancer in the central gland (transitional zone and central zone) – 0.610±0.157×10-3 mm2/s, p=0.0001, and for cancer in the peripheral zone – 0.651±0.228×10-3 mm2/s, p=0.0004, compared to normal tissue. It was found that the highest sensitivity value (87.5%) is typical for ADC central gland, and the lower value for ADC peripheral zone is 75%. The highest specificity value (90.9%) was observed in ADC peripheral zone, and a lower value in ADC central gland – was 84.1%.&#x0D; Conclusion: DWI is an effective non-invasive method for detecting and localizing prostate cancer, providing a qualitative (visual) and quantitative assessment of prostate cancer.

DWI CAPACITY IN PROSTATE CANCER DIAGNOSING

Relevance: Prostate cancer is one of the leading causes of cancer deaths in men worldwide. Transrectal ultrasound-guided (TRUS) prostate biopsy is the most important diagnostic step, without which a definitive diagnosis cannot be made. Despite this, TRUS-guided prostate biopsy has a high rate of false negatives and is often accompanied by various clinical complications. Multiparametric MRI (mpMRI) is now widely used in routine urological and oncological practice. An element of mpMRI is diffusion-weighted imaging (DWI), which is successfully used in detecting and localizing clinically significant prostate cancer.&#x0D; The study aimed to evaluate the DWI capacity in diagnosing prostate cancer.&#x0D; Methods: 52 patients, 48-86 years old, with suspected prostate cancer, underwent mpMRI. DWI sequences obtained using T2-weighted imaging (T2WI) were compared with each other and compared with the anatomical structure of the prostate. Suspicious prostate cancer sites were marked as regions of interest, for which an apparent diffusion coefficient (ADC) was calculated. A 12-point TRUS-guided biopsy confirmed the presence or absence of prostate cancer.&#x0D; Results: When analyzing quantitative measurements, ADC showed low values for cancer in the central gland (transitional zone and central zone) – 0.610±0.157×10-3 mm2/s, p=0.0001, and for cancer in the peripheral zone – 0.651±0.228×10-3 mm2/s, p=0.0004, compared to normal tissue. It was found that the highest sensitivity value (87.5%) is typical for ADC central gland, and the lower value for ADC peripheral zone is 75%. The highest specificity value (90.9%) was observed in ADC peripheral zone, and a lower value in ADC central gland – was 84.1%.&#x0D; Conclusion: DWI is an effective non-invasive method for detecting and localizing prostate cancer, providing a qualitative (visual) and quantitative assessment of prostate cancer.

Deep Learning Based Localisation and Segmentation of Prostate Cancer from mp-MRI Images

Prostate Cancer (PCa) is one of the most common diseases in adult males. Currently, mp-MRI imaging represents the most promising technique for screening, diagnosing, and managing this cancer. However, the multiple mp-MRI sequences' visual interpretation is not straightforward and may present crucial inter-reader variability in the diagnosis, especially when the images contradict each other. In this work, we propose a computer-aided diagnostic system to assist the radiologist inlocating and segmenting prostate lesions. As fully convolutional neural networks (UNet) have proved themselves the leading algorithm for biomedical image segmentation, we investigate their use to find PCa lesions and segment for accurate lesions contours jointly. We offer a fully automatic system via MultiResUNet, initially proposed to segment skin cancer. We trained and validated an altered version of the MultiResUnet model using an augmented Radboudumc prostate cancer dataset and obtained encouraging results. An accuracy of 98.34\% is achieved, outperforming the concurrent system based on deep architecture.

Head-to-Head Comparison of 18F-PSMA-1007 Positron Emission Tomography/Computed Tomography and Multiparametric Magnetic Resonance Imaging with Whole-mount Histopathology as Reference in Localisation and Staging of Primary Prostate Cancer

BackgroundAccurate local staging is critical for treatment planning and prognosis in prostate cancer (PCa). Although multiparametric magnetic resonance imaging (mpMRI) has high specificity for detection of extraprostatic extension (EPE) and seminal vesicle invasion (SVI), its sensitivity remains limited. 18F-PSMA-1007 positron emission tomography/computed tomography (PET/CT) may be more accurate in determining T stage. ObjectiveTo assess the diagnostic performance of 18F-PSMA-1007 PET/CT in comparison to mpMRI for intraprostatic tumour localisation and detection of EPE and SVI in men with primary PCa undergoing robot-assisted radical prostatectomy (RARP). Design, setting, and participantsBetween February 2019 and October 2020, 105 treatment-naïve patients with biopsy-proven intermediate- or high-risk PCa undergoing mpMRI and 18F-PSMA-1007 PET/CT before RARP were prospectively enrolled. Outcome measurements and statistical analysisThe diagnostic accuracy of 18F-PSMA-1007 PET/CT and mpMRI for intraprostatic tumour localisation and detection of EPE and SVI was assessed via histopathological examination of whole-mount RP specimens. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were calculated. The McNemar test was used to compare outcomes between imaging modalities. Results and limitationsIn 80 RP specimens, 129 PCa lesions were found, of which 96 were clinically significant PCa (csPCa). Per-lesion sensitivity for localisation of overall PCa was 85% (95% confidence interval [CI] 77–90%) with PSMA PET/CT and 62% (95% CI 53–70%) with mpMRI (p < 0.001). Per-lesion sensitivity for csPCa was 95% (95% CI 88–98%) with PSMA PET/CT and 73% (95% CI 63–81%) with mpMRI (p < 0.001). The diagnostic accuracy of PSMA PET/CT and mpMRI for detection of EPE per lesion did not significantly differ (sensitivity 45%, 95% CI 31–60% vs 55%, 95% CI 40–69%; p = 0.3; specificity 85%, 95% CI 75–92% vs 90%, 95% CI 81–86%; p = 0.5). The sensitivity and specificity of PSMA PET/CT and mpMRI for detection of SVI did not significantly differ (sensitivity 47%, 95% CI 21–73% vs 33%, 95% CI 12–62; p = 0.6; specificity 94%, 95% CI 88–98% vs 96%, 95% CI 90–99%; p = 0.8). Conclusions18F-PSMA-1007 is a promising imaging modality for localising intraprostatic csPCa but did not show additional value in assessing EPE and SVI in comparison to mpMRI. Patient summaryA new imaging technique called PET/CT (positron emission tomography/computed tomography) with the radioactive tracer 18F-PSMA-1007 shows promise in identifying the location of clinically significant prostate cancer. However, it does not seem to be of additional value over magnetic resonance imaging (MRI) for determining the local tumour stage.

The Journal of Urology ® Home Study Course 2023 Volume 209/210

<i>The Journal of Urology</i> ® Home Study Course 2023 Volume 209/210

First-in-patient study of OTL78 for intraoperative fluorescence imaging of prostate-specific membrane antigen-positive prostate cancer: a single-arm, phase 2a, feasibility trial

Targeted real-time imaging during robot-assisted radical prostatectomy provides information on the localisation and extent of prostate cancer. We assessed the safety and feasibility of the prostate-specific membrane antigen (PSMA)-targeted fluorescent tracer OTL78 in patients with prostate cancer. In this single-arm, phase 2a, feasibility trial with an adaptive design was carried out in The Netherlands Cancer Institute, Netherlands. Male patients aged 18 years or older, with PSMA PET-avid prostate cancer with an International Society of Urological Pathology (ISUP) grade group of 2 or more, who were scheduled to undergo robot-assisted radical prostatectomy with or without extended pelvic lymph node dissection were eligible. All patients had a robot-assisted radical prostatectomy using OTL78. Based on timing and dose, patients received a single intravenous infusion of OTL78 (0·06 mg/kg 1-2 h before surgery [dose cohort 1], 0·03 mg/kg 1-2 h before surgery [dose cohort 2], or 0·03 mg/kg 24 h before surgery [dose cohort 3]). The primary outcomes, assessed in all enrolled patients, were safety and pharmacokinetics of OTL78. This study is completed and is registered in the European Trial Database, 2019-002393-31, and the International Clinical Trials Registry Platform, NL8552, and is completed. Between June 29, 2020, and April 1, 2021, 19 patients were screened for eligibility, 18 of whom were enrolled. The median age was 69 years (IQR 64-70) and median prostate-specific antigen concentration was 15 ng/mL (IQR 9·3-22·0). In 16 (89%) of 18 patients, robot-assisted radical prostatectomy was accompanied by an extended pelvic lymph node dissection. Three serious adverse events occurred in one (6%) patient: an infected lymphocele, a urosepsis, and an intraperitoneal haemorrhage. These adverse events were considered unrelated to the administration of OTL78 or intraoperative fluorescence imaging. No patient died, required a dose reduction, or required discontinuation due to drug-related toxicity. The dose-normalised maximum serum concentration (Cmax/dose) in patients was 84·1 ng/mL/mg for the 0·03 mg/kg dose and 79·6 ng/mL/mg for the 0·06 mg/kg dose, the half-life was 5·1 h for the 0·03 mg/kg dose and 4·7 h for the 0·06 mg/kg dose, the volume of distribution was 22·9 L for the 0·03 mg/kg dose and 19·5 L for the 0·06 mg/kg dose, and the clearance was 3·1 L/h for the 0·03 mg/kg dose and 3·0 L/h for the 0·06 mg/kg dose. This first-in-patient study showed that OTL78 was well tolerated and had the potential to improve prostate cancer detection. Optimal dosing was 0·03 mg/kg, 24 h preoperatively. PSMA-directed fluorescence imaging allowed real-time identification of visually occult prostate cancer and might help to achieve complete oncological resections. On Target Laboratories.

A Retrospective Multicenter Analysis of the Incidence of Bone-Only Disease at PSMA PET/CT in Castration Resistant Prostate Cancer Patients.

PSMA PET/CT has unprecedented accuracy for localization of initial or recurrent prostate cancer (PC), which can be applied in a metastasis-directed therapy approach. PSMA PET/CT (PET) also has a role in the selection of patients for metastasis-directed therapy or radioligand therapy and therapy assessment in CRPC patients. The purpose of this multicenter retrospective study was to determine the incidence of bone-only metastasis in CRPC patients who underwent PSMA PET/CT for restaging, as well as identifying potential predictors of bone-only PET positivity. The study analyzed data from 179 patients from two centers in Essen and Bologna. Results showed that 20.1% of the patients had PSMA uptake only in the bone, with the most frequent lesions located in the vertebrae, ribs, and hip bone. Half half of the patients showed oligo disease in bone and may benefit from a bone-metastasis-directed therapy. Initial positive nodal status and solitary ADT were shown to be negative predictors of osseous metastasis. The role of PSMA PET/TC in this patient population needs to be further explored in terms of its role in the evaluation and adoption of bone-specific therapies.

Evaluation of Multiparametric Magnetic Resonance Imaging and Correlation with Radical Prostatectomy Histopathology Specimen in Prostate Cancer.

Magnetic resonance imaging (MRI) has shown a great potential in the evaluation and management of prostate cancer. In this study, we would like to evaluate the benefit of multiparametric MRI in the detection and localization of prostate cancer by comparing it with the gold standard of histopathology from radical prostatectomy. In this single-centre prospective study, 90 consecutive patients underwent radical prostatectomy from November 2016 to May 2018. All patients first underwent multiparametric (mp)-MRI, and all suspicious regions of interest were delineated and recorded on a 5-point scale as defined in prostate imaging reporting and data system version 2 (PI-RADS V2) score. All radical prostatectomy specimens, acquired after robotic radical prostatectomy with extended pelvic lymphadenectomy, were sent for histopathological examination (HPE). The mean age of the 90 patients was 65.3years, and the mean serum prostate-specific antigen (PSA) was 16.9ng/ml. The sensitivity and specificity of mp-MRI in the detection of the corresponding region of interest (ROI) on HPE were 67.4% and 89.3% respectively. Positive predictive value (PPV), negative predictive value (NPV), and accuracy of mp-MRI in the detection of corresponding ROI on HPE were 86.3%, 73.3%, and 78.3% respectively. The mp-MRI detected 96.8% solitary lesions and 61.7% multifocal lesions on the corresponding ROI on HPE. Multiparametric MRI has an excellent specificity and reasonable sensitivity for the diagnosis of prostate cancer. It is a good modality for the detection of solitary tumours, higher-grade tumours, detection of seminal vesicle invasion and extracapsular extension and helps in the decision-making process before radical prostatectomy, focal therapy or selecting an appropriate candidate for active surveillance.

A Systematic Review of the Variability in Performing and Reporting Intraprostatic Prostate-specific Membrane Antigen Positron Emission Tomography in Primary Staging Studies

ContextProstate cancer (PCa) remains one of the leading causes of cancer-related deaths in men worldwide. Men at risk are typically offered multiparametric magnetic resonance imaging and, if suspicious, a targeted biopsy. However, false-negative rates of magnetic resonance imaging are consistently 18%; therefore, there is growing interest in improving the diagnostic performance of imaging through novel technologies. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is being utilised for PCa staging and, more recently, for intraprostatic tumour localisation. However, significant variability has been observed in how PSMA PET is performed and reported. ObjectiveIn this review, we aim to evaluate how pervasive this variability is in trials investigating the performance of PSMA PET in primary PCa workup. Evidence acquisitionFollowing the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we performed an optimal search in five different databases. After removing duplicates, 65 studies were included in our review. Evidence synthesisStudies dated back as early as 2016, with numerous different source countries. There was variation in the reference standard for PSMA PET, with some using biopsy specimens or surgical specimens, and in some cases, a combination of the two. Similar inconsistencies were noted when studies selected histological definitions of clinically significant PCa, while some omitted their definition altogether. The most significant variations in performing PSMA PET were the radiotracer type, dose, acquisition time after injection, and the PET camera being utilised. Substantial variation in the reporting of PSMA PET was noted, with no consistency in defining what constitutes a positive intraprostatic lesion. Across 65 studies, four different definitions were used. ConclusionsThis systematic review has highlighted considerable variation in obtaining and performing a PSMA PET study in the context of primary PCa diagnosis. Given the discrepancy in how PSMA PET was performed and reported, it questions the homogony of studies from centre to centre. Standardisation of PSMA PET is required for this to become a consistently useful and reproducible modality in the diagnosis of PCa. Patient summaryProstate-specific membrane antigen (PSMA) positron emission tomography (PET) is being utilised for staging and localisation of prostate cancer (PCa); however, there is significant variability in performing and reporting PSMA PET. Standardisation of PSMA PET is required for results to be consistently useful and reproducible for the diagnosis of PCa.

Irreversible electroporation for prostate cancer using PSMA PET-CT.

To demonstrate the clinical usefulness of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) computerized tomography (CT) for irreversible electroporation (IRE) in prostate cancer patients. From January to May 2021, 17 men were diagnosed with localized prostate cancer through preoperative mpMRI and [18F] florastamin PSMA PET-CT imaging, followed by transperineal MRI-ultrasound fusion-guided biopsy. The patients underwent IRE focal therapy at the target lesions under general anesthesia. To evaluate the treatment outcome, serum prostate-specific antigen (PSA) levels were followed up in the 1st, 3rd, 6th, 9th, 12th months, and mpMRI was taken in the 1st and 12th months, followed by MR fusion biopsy in the 12th month post-IRE. The mean age of the patients was 66.1±9.3 with a median PSA of 7.5ng/ml. After the treatment, PSA nadir was 4.06±3.4, and 11 (64.7%) achieved decline of PSA more than 50% from the baseline. Rate of negative biopsy for prostate cancer is 88% (15/17) at 12monthsMR fusion biopsy after the IRE treatment. Among the relapsed cases, 1 (6.9%) patient recurred at margin of treated area, and 1 (6.9%) patient was from outfield recurrence. When excluding initial four patients, none of the patients had cancer recur. When treating with IRE focal therapy, PSMA-PET CT is a potentially valuable diagnostic approach for localizing prostate cancer; it supports the detection of lesions with conventional mpMRI, enabling to perform the procedure more completely.

The influence of genetic and environmental factors on the incidence of prostate cancer in men

Introduction The prostate gland is a small reproductive organ found in men. It consists of 3 zones: central, peripheral and transitional. The most common localization of prostate cancer in elderly men is the peripheral zone. Prostate cancer is one of the most common cancers in men. It ranks second in terms of incidence and fifth in terms of lethality among men worldwide. There are many factors that contribute to the development of prostate cancer in men. We can divide them into two large groups: genetic factors and environmental factors. These include, among others: older age, ethnicity / race, positive family history, genetic predisposition, type of diet, obesity, smoking or higher height. Each of the above factors has a different impact on the incidence of prostate cancer, which has been demonstrated on the basis of the results of numerous studies and will be summarized in the following review. Materiał and Methods This review was based on available data collected in the PubMed database, using the following keywords: „Prostate Cancer”, „Epidemiology of Prostate Cancer” and „Risk factors of Prostate Cancer”. Conclusions Prostate cancer is a serious problem affecting men all over the world. Every year we observe an increasing incidence of this disease, which makes prostate cancer one of the most common cancers affecting men. There are many factors affecting the occurrence of this cancer, but it is extremely difficult to study their exact impact on the development of prostate cancer. Therefore, new initiatives and research should be undertaken to broadly understand the etiology and risk factors of this cancer.

Utility of Magnetic Resonance Imaging for Localizing Prostate Cancer Near the Urethra in Men Who Are Candidates for Focal Gland Ablation.

Given that treatment near the urethra is often limited to reduce side effects, in this study we aim to determine whether prostate MRI can accurately identify the distance of prostate cancer to the urethra in a cohort of men who were potential candidates for focal gland ablation. A single-institution analysis was performed of men who underwent MRI, targeted biopsy, and radical prostatectomy from July 2012 to April 2021. Men who were candidates for focal gland ablation were identified. The ability of MRI to identify prostate cancer within 5 mm of the prostatic urethra as confirmed on whole-mount pathology was assessed. Multivariate regression was utilized to determine characteristics associated with prostate cancer within 5 mm of the urethra on whole-mount pathology. In 48 out of 67 men (72%), the tumor was within 5 mm of the urethra on whole-mount pathology. MRI was concordant with whole-mount pathology in 49 out of 67 men (73%). The sensitivity of MRI for identifying cancer within 5 mm of the urethra was 77% (65%-89%) and the specificity was 63% (42%-89%). The positive predictive value was 84% (range 73%-95%) and negative predictive value was 52% (32%-73%). In adjusted analysis, PSA density and Prostate Imaging-Reporting and Data System were not significantly associated with having prostate cancer within close proximity of the urethra. A significant number of men who are potential candidates for focal gland ablation have cancer within close proximity to the urethra that could serve as a significant source of in-field recurrence. The sensitivity of MRI for identifying these lesions is 77% and can be used to further improve patient selection for focal gland ablation.

Prostate cancer malignancy detection and localization from mpMRI using auto-deep learning as one step closer to clinical utilization

Automatic diagnosis of malignant prostate cancer patients from mpMRI has been studied heavily in the past years. Model interpretation and domain drift have been the main road blocks for clinical utilization. As an extension from our previous work we trained on a public cohort with 201 patients and the cropped 2.5D slices of the prostate glands were used as the input, and the optimal model were searched in the model space using autoKeras. As an innovative move, peripheral zone (PZ) and central gland (CG) were trained and tested separately, the PZ detector and CG detector were demonstrated effective in highlighting the most suspicious slices out of a sequence, hopefully to greatly ease the workload for the physicians.