Malignant Prostatic Lesions Research Articles

Basal cell markers:34BE12 and p63, improving detection of basal cells in atypical prostatic lesions


 Background: The diagnosis of prostatic pathology may be of challenging , as some difficult and suspected, atypical cases may lack basal cell layer by routine H&E sections . Antibodies against 34BE12(HMW-CK) and p63 aid the diagnosis of such cases , to distinguish benign from malignant prostatic lesions.
 Objective: to identify basal cells in atypical prostatic lesions ,and distinguish benign from malignant prostatic lesions.
 Type of the study: A retro-spective study.
 Methods: 115cases of paraffin embedded prostatic tissue blocks ,diagnosed as : 76 cases were benign prostatic hyperplasia( BPH) , 9 cases were high grade –prostatic intraepithelial neoplasia (HG-PIN) , and 30 cases were prostatic carcinoma(PCa) .Sections from each blocks were prepared for immunostaining with 34BE12 and p63.
 Results : basal cells were detected in cases of BPH , and HG-PIN , and absent in all cases of prostatic carcinoma ,using basal cell markers . Negative benign glands(>2) were found in 71.6% and 38.2% for BPH and 57.1% and 55.6% for HG-PIN immunostained with high molecular weight cytokeratin (34BE12) and p63 , respectively, and significantly reduced to 9.0% and 11.1% for BPH and HG-PIN, respectively with combined using of both markers .Conclusion : Combination of both basal cell markers (34BE12 , p63) improving basal cell detection in atypical ,suspected prostatic lesions and distinguish benign from malignant lesions.

Evaluation of the Performance of the Ultrasound (US) Elastographic Q-Analysis Score Combined With the Prostate Imaging Reporting and Data System for Malignancy Risk Stratification in Prostate Nodules Based on Transrectal US-Magnetic Resonance Imaging Fusion Imaging.

This study retrospectively evaluated the prognostic performance of the ultrasound elastographic Q-analysis score (EQS) combined with the Prostate Imaging Reporting and Data System (PI-RADS) for malignancy risk stratification in prostate nodules based on transrectal ultrasound-magnetic resonance imaging fusion imaging. Sixty-two patients who were suspected to have PCa between October 2017 and May 2018 in our hospital were retrospectively evaluated. The performance of the EQS and PI-RADS was evaluated by patients' receiver operating characteristic curves in differentiating malignant and benign prostate nodules. The combination of the EQS and PI-RADS methods for prostate imaging was evaluated. Sixty-two prostate nodules in 62 patients were included. All of the patients underwent biopsy; 29 cases were prostate cancer, and the rest were benign prostate lesions. Both the EQS and PI-RADS were significantly higher in malignant nodules than in benign nodules. The sensitivity, specificity, area under the curve, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value, and Youden index of an EQS cutoff of 2.05 were 86.2%, 81.8%, 85.9%, 4.73, 0.169, 80.6%, 87.1%, and 68%, respectively. The corresponding numbers for a PI-RADS cutoff of 4 were 82.7%, 69.7%, 84.2%, 2.72, 0.25, 70.6%, 82.1%, and 52.4%. The "tandem" method had a higher diagnostic specificity (87.9%), positive likelihood ratio (6.55), and positive predictive value (85.1%). The "parallel" method had a higher diagnostic sensitivity (96.5%), negative likelihood ratio (0.06), and negative predictive value (95.2%). both the EQS and PI-RADS had good diagnostic performance in differentiating between malignant and benign prostate lesions. The combination of the EQS and PI-RADS improved the diagnostic performance to a certain degree.

Role of Multi-Parametric Magnetic Resonance Imaging (MRI) in Assessment of Malignant Prostatic Lesions

Background: carcinoma of the prostate is an important health problem. It is the one of the most frequently diagnosed solid malignant tumor among men. Multi-parametric MRI of the prostate has been increasingly used as an imaging technique through the last years. Objective: our study aimed to evaluate the sensitivity of multiparametric magnetic resonance (MR) imaging in detection of cancer prostate, using the Prostate Imaging Reporting and Data System (PIRADS) version 2.0. Patients and Methods: thirty patients were enrolled in the study. All patients with elevated PSA values greater than 4 ng/ml underwent sextant TRUS guided biopsies. MRI examination was done either prior to the TRUS biopsy or at least 3 weeks after the TRUS biopsy. Results: the application of PI-RADS version 2 has significantly improved the diagnostic performance in detection of clinically significant cancer. Considering PIRADS score greater than 3 as a strong indicator for malignancy, the sensitivity of PI-RADS version 2 was 80% for detection of malignant lesions in general (significant and insignificant). Moreover, our study revealed an 88% sensitivity and 33% specificity of mp-MRI in detection of clinically significant cancer prostate (with PIRADS score 4 or more for clinically significant caner that have a Gleason score 7 or more, or extraprostatic extension), with a significant p value <0. 001. Conclusion: as a preoperative imaging tool, use of PI-RADS version 2 helps to diagnose clinically significant prostate cancer, considering PI-RADS scores of 4 and 5 to be associated with the presence of clinically significant cancer.

Role of Multi-Parametric Magnetic Resonance Imaging (MRI) in Assessment of Malignant Prostatic Lesions

Role of Multi-Parametric Magnetic Resonance Imaging (MRI) in Assessment of Malignant Prostatic Lesions

Value of semi-quantitative indices of 68Ga-PSMA-11 PET/CT in differential diagnosis of malignant and benign prostate lesions

Objective To evaluate the value of semi-quantitative indices of 68Ga-prostate specific membrane antigen (PSMA)-11 PET/CT in differentiating malignant and benign prostate lesions. Methods From November 2017 to June 2018, 30 patients (age: 52-86 years) who underwent 68Ga-PSMA-11 PET/CT imaging in the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed, and the serum total prostate specific antigen (tPSA) and free prostate specific antigen (fPSA) were examined within 1 week before PET/CT imaging. Semi-quantitative indices of 68Ga-PSMA-11 PET/CT on prostate lesions were measured by automatic segmentation algorithm method, including PSMA-related lesion volume (VPSMA), maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), peak standardized uptake value (SUVpeak) and total lesion uptake value of PSMA (TLUPSMA). The indices were compared between malignant and benign prostate lesions, and the optimal cut-off values for differentiating malignant and benign prostate lesions were obtained by receiver operating characteristic (ROC) curve analysis. Results According to the pathological results, 19 patients had malignant lesions and 11 were with benign diseases. The differences of tPSA, SUVmax, SUVmean, SUVpeak and TLUPSMA between malignant and benign prostate lesions were statistically significant (u values: 17.00-48.00, all P 0.05). The optimal cut-off value of tPSA was 18.30 μg/L for differentiating malignant and benign prostate lesions, with sensitivity of 13/17 (PSA of 2 patients were missing), specificity of 9/11 and area under curve (AUC) of 0.743. The optimal cut-off values of SUVmax, SUVmean and SUVpeak were 5.50, 3.09 and 3.56, respectively, with all corresponding sensitivity of 18/19, all specificity of 9/11, and AUC of 0.902, 0.907 and 0.919, respectively. The optimal cut-off value of TLUPSMA was 54.81 cm3, with sensitivity of 14/19, specificity of 9/11 and AUC of 0.804. Conclusion The semi-quantitative indices of 68Ga-PSMA-11 PET/CT are valuable for differentiating malignant and benign prostate lesions, in which SUVpeak is superior to other indices. Key words: Prostatic neoplasms; Prostate-specific membrane antigen; Isotope labeling; Gallium radioisotopes; Positron-emission tomography; Tomography, X-ray computed; Diagnosis, differential

Using biparametric MRI radiomics signature to differentiate between benign and malignant prostate lesions

PurposeTo investigate the efficiency of radiomics signature in discriminating between benign and malignant prostate lesions with similar biparametric magnetic resonance imaging (bp-MRI) findings. Experimental designOur study consisted of 331 patients underwent bp-MRI before pathological examination from January 2013 to November 2016. Radiomics features were extracted from peripheral zone (PZ), transition zone (TZ), and lesion areas segmented on images obtained by T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and its derivative apparent-diffusion coefficient (ADC) imaging. The individual prediction model, built using the clinical data and biparametric MRI features (Bp signature), was prepared using data of 232 patients and validated using data of 99 patients. The predictive performance was calculated and demonstrated using receiver operating characteristic (ROC) curves, calibration curves, and decision curves. ResultsThe Bp signature, based on the six selected radiomics features of bp-MRI, showed better discrimination in the validation cohort (area under the curve [AUC], 0.92) than on each subcategory images (AUC, 0.81 on T2WI; AUC, 0.77 on DWI; AUC, 0.89 on ADC). The differential diagnostic efficiency was poorer with the clinical model (AUC, 0.73), built using the selected independent clinical risk factors with statistical significance (P < 0.05), than with the Bp signature. Discrimination efficiency improved when including the Bp signature and clinical factors [i.e., the individual prediction model (AUC, 0.93)]. ConclusionThe Bp signature, based on bp-MRI, performed better than each single imaging modality. The individual prediction model including the radiomics signatures and clinical factors showed better preoperative diagnostic performance, which could contribute to clinical individualized treatment.

MpMRI of the prostate: is there a role for semi-quantitative analysis of DCE-MRI and late gadolinium enhancement in the characterisation of prostate cancer?

To assess whether there is a significant difference in perfusion parameters between benign and malignant prostatic lesions, focusing on semi-quantitative analysis of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and presence of late gadolinium enhancement (LGE). Three hundred and thirteen patients who underwent multiparametric MRI (mpMRI) of the prostate and with available corresponding histology (prostatectomy or biopsy) were selected retrospectively for this study. The MRI protocol consisted of multiplanar T2-and diffusion-weighted imaging, DCE and delayed axial T1 images. Images were reviewed independently by two radiologists for LGE assessment and Prostate Imaging - Reporting and Data System (PI-RADS) scoring. For each lesion, semi-quantitative analysis of DCE-MRI was performed and the following data were evaluated: time to peak, wash-in rate, wash-out rate, brevity of enhancement, and area under the curve. The presence or absence of LGE in delayed axial T1 images was assessed qualitatively. MRI results were compared to histology. The presence of significant prostate cancer was based both on Epstein criteria (SPC) and Gleason score (GS ≥7). SPC and Gleason score ≥7 tumours showed significant lower time to peak and brevity of enhancement (p<0.001) with higher wash-in rate (p=0.001). LGE was observed in 152/313 (49%) cases; among them 103/152 (68%) did not show SPC whereas 49/152 (32%) had SPC (p<0.001). The presence of LGE determined a risk reduction of SPC resulting as an independent predictor at multivariate analysis (logOR=-0.78, SE 0.33, p=0.02). Semi-quantitative perfusion analysis and LGE may help to predict the presence/absence of a significant prostate tumour and represent a promising tool to improve mpMRI diagnostic performance.

Commentary on: mpMRI of the prostate: is there a role for semi-quantitative analysis of DCE-MRI and late gadolinium enhancement in the characterisation of prostate cancer?

Aim To assess whether there is a significant difference in perfusion parameters between benign and malignant prostatic lesions, focusing on semi-quantitative analysis of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and presence of late gadolinium enhancement (LGE). Material and methods Three hundred and thirteen patients who underwent multiparametric MRI (mpMRI) of the prostate and with available corresponding histology (prostatectomy or biopsy) were selected retrospectively for this study. The MRI protocol consisted of multiplanar T2-and diffusion-weighted imaging, DCE and delayed axial T1 images. Images were reviewed independently by two radiologists for LGE assessment and Prostate Imaging – Reporting and Data System (PI-RADS) scoring. For each lesion, semi-quantitative analysis of DCE-MRI was performed and the following data were evaluated: time to peak, wash-in rate, wash-out rate, brevity of enhancement, and area under the curve. The presence or absence of LGE in delayed axial T1 images was assessed qualitatively. MRI results were compared to histology. The presence of significant prostate cancer was based both on Epstein criteria (SPC) and Gleason score (GS ≥7). Results SPC and Gleason score ≥7 tumours showed significant lower time to peak and brevity of enhancement (p Conclusion Semi-quantitative perfusion analysis and LGE may help to predict the presence/absence of a significant prostate tumour and represent a promising tool to improve mpMRI diagnostic performance.

Application evaluation of DCE-MRI combined with quantitative analysis of DWI for the diagnosis of prostate cancer.

The present study aimed to investigate the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with quantitative analysis of diffusion weighted imaging (DWI) for the diagnosis of prostate cancer (PCa). A total of 81 patients with prostatic diseases, including PCa (n=44) and benign prostatic hyperplasia (BPH, n=37), were imaged with T1 weighted imaging (T1WI), T2 weighted imaging (T2WI), DWI and DCE-MRI. The blood vessel permeability parameters volume transfer rate constant (Ktrans), back flow rate constant (Kep), extravascular extracellular space volume fraction (Ve), plasma volume fraction (Vp) and apparent diffusion coefficient (ADC) were measured, and compared between the two groups. The efficiency of these tools for the diagnosis of PCa was analyzed by receiver operating characteristic curve analysis. The efficiency of ADC combined with blood vessel permeability parameters in the diagnosis of PCa was analyzed by logistic regression. The correlation between these parameters and the Gleason score was evaluated by Spearman correlation analysis in the PCa group. The results demonstrated that, compared with the BPH group, Ktrans, Kep, Ve and Vp were higher, and ADC was lower in the PCa group (P<0.05). The combination of Kep and ADC offered the highest diagnosis efficiency [area under the curve (AUC=0.939)]. However, the combination of three parameters did not significantly improve the diagnostic efficiency. A subtle improvement in diagnostic efficiency was observed when four parameters (Ktrans + Kep + Ve + ADC) were combined (AUC=0.940), which was significantly higher than with one parameter. The ADC value of the PCa group was negatively correlated with the primary Gleason pattern, secondary Gleason pattern and the total Gleason score in PCa (r=−0.665, −0.456 and −0.714, respectively; P<0.001). The Vp in the PCa group was slightly negatively correlated with the primary Gleason pattern of PCa (r=−0.385; P<0.05); however, no significant correlation was found with secondary Gleason pattern and the total Gleason score. The present study revealed that the combination of DCE-MRI quantitative analysis and DWI was efficient for PCa diagnosis. This may be because DCE-MRI and DWI can noninvasively detect water motility in tumor tissues and alterations in permeability during tumor neovascularization. The present study demonstrated that Kep and ADC values may be used as predictive parameters for PCa diagnosis, which may help differentiate benign from malignant prostate lesions.

Diagnostic utility of triple antibody (AMACR, HMWCK and P63) stain in prostate neoplasm.

Aims and Objective:In recent period, basal cell markers high molecular weight cytokeratin (HMWCK), P63 and prostate biomarker AMACR have been used as adjuvant to morphology in diagnostically challenging cases with a very high sensitivity and specificity.Materials and Methods:In this prospective study, total of 80 cases including 40 cases of malignant lesions and 40 cases of benign lesions of the prostate were taken. Tumor grade was determined according to Gleason's grading system. AMACR, HMWCK, P63 expressions were determined by immunohistochemical staining.Results:This study showed AMACR had a sensitivity of 90%, specificity of 100%. AMACR was not expressed in any of the 40 cases of benign lesions of the prostate while in malignant lesions of prostate it was expressed in 36 of 40 (90%) cases; 15 of 16 (93%) of well-differentiated carcinoma were positive for AMACR expression; 17 of 19 (89.47%) moderately differentiated and 4 of 5 (80%) cases of poorly differentiated tumors were positive for AMACR. There was statistically significant difference in expression of AMACR between benign and malignant lesions of the prostate (P = 0.001). In benign lesions, HMWCK and P63 were expressed in all the 40 (100%) cases, while in malignant lesions of prostate it was not expressed in any of the (0%) case. AMACR expression was not seen in any of the benign lesion. Out of 40 malignant cases, 4 cases were negative for AMACR, HMWCK and P63, 36 cases were positive only for AMACR, but no case was positive for HMWCK and P63.Conclusions:As an adjunct to biopsy, AMACR, HMWCK and P63 have potential for combating diagnostically challenging cases.

Mast Cell Profile in Benign and Malignant Prostatic Lesions

Introduction: Mast cells have an important role in innate and adaptive immunity. There role in tumour pathology is under investigation due to studies linking them to angiogenesis, tissue remodeling and stromal immunomodulation. Reports suggest that they can exert both pro or anti tumour effects. The role of mast cells may be influenced by its location in the lesion. In the present study, the number and distribution of mast cells in both benign and malignant prostatic lesions were recorded. Methodology: Fifty seven patients of benign prostatic hyperplasia (BPH) and 43 patients of adenocarcinoma (Ca) were the subjects of the study. Inflammatory conditions of prostate like prostatitis and other malignancies of prostate like sarcoma, transitional cell carcinoma etc were excluded from the study. This was a descriptive study with purposive sampling. Histological diagnosis was made by examining sections stained with Haematoxylin and Eosin. Additional sections from the same block were stained for mast cells using Giemsa stains as per standard protocol. Mast cell count was done in minimum 6 random high power microscopy field in four different regions viz., intraglandular, periglandular, stromal and perivascular regions for BPH and intratumoral, peritumoral, stromal and perivascular regions for Ca. Results were analysed statistically. Results: In BPH cases showed a significantly higher number of mast cells in stromal as well as periglandular areas followed by perivascular area. Only few mast cells were observed in intraglandular area. Similar was the observations in adenocarcinoma cases where the maximum number of mast cells were concentrated in the stromal and perilesional area. The number of mast cells in stroma of BPHwas higher as compared to that of adenocarcinoma. In rest of the areas, the numbers were comparable. Conclusion: This study showed no remarkable difference in the number and distribution of mast cells in benign and malignant prostatic lesions. There is paucity of such studies in the literature and the possible utility of mast cell count to differentiate malignant from benign and atypical conditions needs further evaluation.

Prognostic and Clinic-Pathological Significances of SCF and COX-2 Expression in Inflammatory and Malignant Prostatic Lesions.

The initiation of prostatic malignancy has been linked to chronic inflammation. Stem cell factor (SCF) is an inflammatory cytokine that is specific to the c-KIT receptor which is type III receptor tyrosine kinase (RTK). Cyclooxygenases (COXs) are the main enzymes which are responsible for prostaglandins production from arachidonic acid. COX2 is an enzyme which is produced under different pathological conditions. The aim of our study; is to investigate the clinicopathological and the prognostic significance of SCF and COX-2 expression in prostatic adenocarcinoma (PC), chronic prostatitis and nodular prostatic hyperplasia (NPH) in a trial to clarify the role of inflammation as a risk factor for prostatic carcinogenesis and cancer progression. SCF and COX-2 tissue protein expression were evaluated in 50 cases of PC, 20 cases of chronic prostatitis and 10 cases of NPH using immunohistochemistry, patients were followed up for 5years. The relationship between their levels of expressions, clinicopathological, and prognostic criteria were studied. SCF expression in PC was positively correlated with advanced patient age (p = <0.001), high level of PSA (p = 0.010), higher Gleason score (p = 0.011). COX-2 expression in PC was positively correlated with advanced patient age (p = <0.001), high level of PSA (p = 0.016), advanced D'Amico risk group (p = 0.038). High levels of expression of both SCF& COX-2 are associated with higher incidence of tumor relapse, worse disease overall survival and free survival (p < 0.001). SCF and COX-2 are associated with PC progression and associated with poor prognosis in PC patients.

Improving Diagnosis of Primary Prostate Cancer With Combined 68Ga-Prostate-Specific Membrane Antigen-HBED-CC Simultaneous PET and Multiparametric MRI and Clinical Parameters.

The current study was designed to test the diagnostic performance of 68Ga-prostate-specific membrane antigen (PSMA) PET and multiparametric MRI along with clinical parameters in the characterization of prostatic lesions. Eighty-two men with 63 malignant and 21 benign histologically proven prostate lesions who underwent complete clinical workup were included in this retrospective study. All patients underwent simultaneous whole-body 68Ga-PSMA PET/MRI with dedicated multiparametric MRI. Prostate Imaging-Reporting and Data System (PI-RADS) version 2 assessment was used for predicting the likelihood of cancer. Uptake of 68Ga-PSMA was recorded by adopting the copy-and-paste function of ROIs defined on MR images. ROC and combined ROC analyses were performed to test the diagnostic accuracy of individual and combined parameters. Spearman analysis was used to assess the correlations. PSMA uptake (maximum standardized uptake value) was significantly different among tumors with Gleason scores of 7, 8, and 9, with the lowest uptake in tumors with a score of 7 and the highest uptake in tumors with a score of 9. There was a significant difference between early- and delayed-phase PSMA uptake in malignant prostatic lesions (p < 0.01). Significant correlations were observed between delayed and differential PSMA uptake and PI-RADS category (p < 0.01 and < 0.01, respectively), digital rectal examination findings (p = 0.01 and < 0.01, respectively), Gleason score (p = 0.05 and < 0.05, respectively), and prostate-specific antigen levels (p = 0.01 for both). Combined ROC analysis of prostate-specific antigen levels, digital rectal examination findings, multiparametric MRI, and differential PSMA uptake were able to characterize prostatic lesions with a mean (± SD) AUC of 0.94 ± 0.03, compared with their individual AUCs of 0.77, 0.70, 0.82, and 0.88. Gallium-68-PSMA PET combined with multiparametric MRI showed high diagnostic accuracy for prostate cancer diagnosis compared with either multiparametric MRI or PET alone or with clinical factors (e.g., digital rectal examination or prostate-specific antigen level) alone, and the combination further improves characterization of prostatic lesions.

Assessment of Expression of Ki-67 in Benign and Malignant Prostatic Lesions among Sudanese Patients.

BACKGROUND:Prostatic cancer is one of the most common cancers of males in a Sudanese population. The early detection is very important, as it is only curable at an early stage.AIM:The objective of this study was to investigate the expression pattern of Ki-67 in benign and malignant prostatic lesions to improve the diagnosis that may help in better management and prevention of disease.MATERIAL AND METHODS:Fifty-eight formalin fixed paraffin blocks from diagnosed cases of prostatic tumours with different grade, and stages were included in this study. Ki-67 expression was examined immunohistochemically by using monoclonal mouse anti-human Ki67 IS626. The results were correlated with Gleason score and tumour differentiation and stage.RESULTS:The frequency of histological types was as follow: 11 cases of benign prostate, atic hyperplasia (19%) and 47 cases of prostatic cancer (81%). Our results stated that prostatic adenocarcinoma among Sudanese patients was of low grade which means tumours are less aggressive. Furthermore, the findings demonstrate that Ki-67 expression in prostatic carcinoma smears was correlated significantly with the degree of Gleason score (P < 0.05).CONCLUSIONS:We found that the prostatic adenocarcinoma among Sudanese patients was less aggressive. Furthermore, Ki-67 expression was proportional to the grade of a tumour and it was a useful prognostic and diagnostic biomarker.

A Study of Benign and Malignant Lesions of Prostate in a Tertiary Care Hospital

A Study of Benign and Malignant Lesions of Prostate in a Tertiary Care Hospital

Radiomic Machine Learning for Characterization of Prostate Lesions with MRI: Comparison to ADC Values.

Purpose To compare biparametric contrast-free radiomic machine learning (RML), mean apparent diffusion coefficient (ADC), and radiologist assessment for characterization of prostate lesions detected during prospective MRI interpretation. Materials and Methods This single-institution study included 316 men (mean age ± standard deviation, 64.0 years ± 7.8) with an indication for MRI-transrectal US fusion biopsy between May 2015 and September 2016 (training cohort, 183 patients; test cohort, 133 patients). Lesions identified by prospective clinical readings were manually segmented for mean ADC and radiomics analysis. Global and zone-specific random forest RML and mean ADC models for classification of clinically significant prostate cancer (Gleason grade group ≥ 2) were developed on the training set and the fixed models tested on an independent test set. Clinical readings, mean ADC, and radiomics were compared by using the McNemar test and receiver operating characteristic (ROC) analysis. Results In the test set, radiologist interpretation had a per-lesion sensitivity of 88% (53 of 60) and specificity of 50% (79 of 159). Quantitative measurement of the mean ADC (cut-off 732 mm2/sec) significantly reduced false-positive (FP) lesions from 80 to 60 (specificity 62% [99 of 159]) and false-negative (FN) lesions from seven to six (sensitivity 90% [54 of 60]) (P = .048). Radiologist interpretation had a per-patient sensitivity of 89% (40 of 45) and specificity of 43% (38 of 88). Quantitative measurement of the mean ADC reduced the number of patients with FP lesions from 50 to 43 (specificity 51% [45 of 88]) and the number of patients with FN lesions from five to three (sensitivity 93% [42 of 45]) (P = .496). Comparison of the area under the ROC curve (AUC) for the mean ADC (AUCglobal = 0.84; AUCzone-specific ≤ 0.87) vs the RML (AUCglobal = 0.88, P = .176; AUCzone-specific ≤ 0.89, P ≥ .493) showed no significantly different performance. Conclusion Quantitative measurement of the mean apparent diffusion coefficient (ADC) improved differentiation of benign versus malignant prostate lesions, compared with clinical assessment. Radiomic machine learning had comparable but not better performance than mean ADC assessment. © RSNA, 2018 Online supplemental material is available for this article.

Effect of Combined 68Ga-PSMAHBED-CC Uptake Pattern and Multiparametric MRI Derived With Simultaneous PET/MRI in the Diagnosis of Primary Prostate Cancer: Initial Experience.

The purpose of this study is to assess whether temporal changes in 68Ga-prostate-specific membrane antigen (PSMA)-HBED-CC uptake and multiparametric MRI parameters derived using PET/MRI can aid in characterization of benign and malignant prostate lesions. Thirty-five men with 29 malignant and six benign prostate lesions undergoing complete clinical workup including histologic analysis were enrolled for this retrospective study. All had undergone simultaneous whole-body 68Ga-PSMAHBED-CC PET/MRI. Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) assessment was made using a 5-point scale showing the likelihood of cancer with the combination of multiparametric MRI findings. Gallium-68-PSMA uptake was recorded at two time points: early (7 minutes) and delayed (54 minutes), adopting a copy-and-paste function of the ROI defined on MR images. ROC curve analysis was performed to test the diagnostic accuracy of early versus delayed PSMA uptake (measured as maximum standardized uptake value [SUV]). A multiple-ROI analysis was done to obtain ROCs for combined PET SUV and multiparametric MRI datasets. Spearman analysis was performed to assess the correlations. There was a significant difference between early and delayed PSMA uptake in malignant prostatic lesions (p < 0.01), which was able to characterize prostate lesions with an AUC of 0.83 and 0.94. Combined ROC analysis of PI-RADSv2 category derived from multiparametric MRI and differential PSMA uptake in characterizing prostatic lesions improved the AUC to 0.99. Dual-phase PSMA uptake improves accuracy of classifying malignant versus benign prostate lesions and complements multiparametric MRI in the diagnosis of prostate cancer.

Correlation of apparent diffusion coefficient ratio on 3.0 T MRI with prostate cancer Gleason score

IntroductionThe purpose was to investigate the usefulness of ADCratio on Diffusion MRI to discriminate between benign and malignant lesions of Prostate. MethodsImages of patients who underwent in-gantry MRI guided prostate lesion biopsy were retrospectively analyzed. Prostate Cancers with 20% or more Gleason score (GS) pattern 3 + 3 = 6 in each core or any volume of higher Gleason score pattern were included. ADCratio was calculated by two reviewers for each lesion. The ADCratio was calculated for each lesion by dividing the lowest ADC value in a lesion and highest ADC value in normal prostate in peripheral zone (PZ). ADCratio values were compared with the biopsy result. Data was analysed using independent samples T-test, Spearman correlation, intra-class correlation coefficient (ICC) and Receiver operating characteristic (ROC) curve. Results45 lesions in 33 patients were analyzed. 12 lesions were in transitional zone (TZ) and 33 in perpheral zone PZ. All lesions demonstrated an ADCratio of 0.45 or lower. GS demonstrated a negative correlation with both the ADC value and ADCratio. However, ADCratio (p < 0.001) demonstrated a stronger correlation compared to ADC value alone (p = 0.014). There was no significant statistical difference between GS 3 + 4 and GS 4 + 3 mean ADCtumour value (p = 0.167). However when using ADCratio, there was a significant difference (p = 0.032). ROC curve analysis demonstrated an area under the curve of 0.83 using ADCratio and 0.76 when using ADCtumour value when discriminating Gleason 6 from Gleason ≥7 tumours. Inter-observer reliability in the calculation of ADC ratios was excellent, with ICC of 0.964. ConclusionADCratio is a reliable and reproducible tool in quantification of diffusion restriction for clinically significant prostate cancer foci.

Expression of EGF receptors in canine prostate with proliferative inflammatory atrophy and carcinoma

ABSTRACT: Gene expression of ErbB1 and ErbB2, and immunostaining of EGFR (Her1) and Her2 (c-erbB-2) were evaluated in this study to ascertain whether these receptors are involved in the evolution of canine premalignant and malignant prostatic lesions, as proliferative inflammatory atrophy (PIA) and prostatic carcinoma (PC). With regards to the intensity of EGFR immunostaining, there was no difference between normal prostatic tissue and tissues with PIA or PC. In relation to Her2 immunostaining, there were differences between normal prostatic tissue and those with PIA and PC, as also differences between prostates with PIA and PC. There was no correlation between EGFR and Her2 immunostaining. ErbB1 gene product was detected in two normal tissue samples, in one with PIA, and in all samples with PC. ErbB2 mRNA was recorded in two canine samples with PIA, in all with PC, but was not detected in normal prostatic tissue. It was concluded that EGFR and Her2 play roles in canine PIA and PC, suggesting that those receptors may be involved in canine prostatic carcinogenesis.

Analysis of immunohistochemical expression of CD10 in the malignant lesions of prostate

Analysis of immunohistochemical expression of CD10 in the malignant lesions of prostate