Prostate Multiparametric Magnetic Resonance Imaging Research Articles

Long-term follow-up results of multiparametric prostate MRI and the prognostic value of PI-RADS: a single-center retrospective cohort study

We aim to examine the long-term outcomes of patients who underwent multiparametric prostate magnetic resonance imaging (mp-MRI) for suspected prostate cancer (PCa), specifically based on their initial Prostate Imaging Reporting and Data System (PI-RADS) categories and various clinical factors. Our secondary aim is to evaluate the prognostic value of the PI-RADS through the National Comprehensive Cancer Network (NCCN) risk group distribution. This research was conducted as a single-center retrospective cohort study in a tertiary care hospital. A total of 1,359 cases having at least one histopathological examination after the initial mp-MRI and/or adequate clinical/radiological follow-up data were included in the clinically significant PCa (cs-PCa) diagnosis-free survival analysis. Initial mp-MRI dates were accepted as the start of follow-up for the time-to-event analysis. The event was defined as cs-PCa diagnosis (International Society of Urological Pathology ≥2). Patients who were not diagnosed with cs-PCa during follow-up were censored according to predefined literature-based criteria at the end of the maximum follow-up duration with no reasonable suspicion of PCa and no biopsy indication. The impact of various factors on survival was assessed using a log-rank test and multivariable Cox regression. Subsequently, 394 cases diagnosed with PCa during follow-up were evaluated, based on initial PI-RADS categories and NCCN risk groups. Three main risk factors for cs-PCa diagnosis during follow-up were an initial PI-RADS 5 category, initial PI-RADS 4 category, and high MRI-defined PSA density (mPSAD), with average hazard ratios of 29.52, 14.46, and 3.12, respectively. The PI-RADS 3 category, advanced age group, and biopsy-naïve status were identified as additional risk factors (hazard ratios: 2.03, 1.54-1.98, and 1.79, respectively). In the PI-RADS 1-2 cohort, 1, 3, and 5-year cs-PCa diagnosis-free survival rates were 99.1%, 96.5%, and 93.8%, respectively. For the PI-RADS 3 cohort, 1, 3, and 5-year cs-PCa diagnosis-free survival rates were 94.9%, 90.9%, and 89.1%, respectively. For the PI-RADS 4 cohort, 1, 3, and 5-year cs-PCa diagnosis-free survival rates were 56.6%, 55.1%, and 55.1%, respectively. These rates were found to all be 24.2% in the PI-RADS 5 cohort. Considering the 394 cases diagnosed with PCa during follow-up, PI-RADS ≥4 cases were more likely to harbor unfavorable PCa compared to PI-RADS ≤3 cases (P < 0.001). In the PI-RADS 3 subgroup analysis, a low mPSAD (<0.15 ng/mL2) was found to be a protective prognostic factor against unfavorable PCa (P = 0.005). The PI-RADS category has a significant impact on patient management and provides important diagnostic and prognostic information. Higher initial PI-RADS categories are associated with decreased follow-up losses, a shorter time to PCa diagnosis, increased biopsy rates, a higher likelihood of developing cs-PCa during follow-up, and a worse PCa prognosis. Combining mPSAD with PI-RADS categories could enhance diagnostic stratification in the identification of cs-PCa.

3T multiparametric MRI’s accuracy in detecting prostate cancer using Prostate Imaging Reporting and Data System (PIRADS) version 2.1 with prostate biopsy as a reference

BackgroundMultiparametric magnetic resonance imaging (MRI) is valuable in detecting prostate cancer due to its high sensitivity to malignant lesions. It is commonly utilized to improve the identification of clinically significant cancers within the prostate. This study aimed to correlate the findings from 3T multiparametric MRI of the prostate using the updated Prostate Imaging Reporting and Data System version 2.1 (PIRADSv2.1) from 2019 with reference to prostate biopsy results. Additionally, PIRADSv2.1 was used to calculate the sensitivity, specificity, positive predictive value, and negative predictive value of the 3T multiparametric MRI of the prostate.Methods and materialsA retrospective study was conducted at a tertiary center, wherein we identified patients who underwent a prostate biopsy between June 2019 and June 2021 and had a corresponding MRI of the prostate performed at the same institution, evaluated with PIRADSv2.1 criteria.ResultsA total of 50 patients were eligible for final analysis. The prevalence of prostate cancer was 69% (95% confidence interval (CI) 54–81%). Receiver operating characteristic (ROC) curves were generated for 3T multiparametric MRI of the prostate using PIRADSv2.1 to diagnose prostate cancer; the area under the ROC curve was 0.81 (95% CI 0.68–0.95, p < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of the 3T multiparametric prostate MRI using PIRADSv2.1 were 74.0%, 87.0%, 92.9%, and 59.1%, respectively.ConclusionsPIRADSv2.1 exhibited good overall performance in the diagnosis of prostate cancer.

Pearls and Pitfalls in Applying PI-RADS 2.1

AbstractThe use of Prostate Imaging Reporting and Data System (PI-RADS) with multiparametric magnetic resonance imaging (MRI) has significantly improved the detection of clinically significant prostate cancer (csPCa), but there are certain challenges that the reader may face. This review provides an overview of the pitfalls associated with the PI-RADS system for multiparametric prostate MRI (mpMRI), with suggestions/pearls to help overcome these pitfalls.PI-RADS assessment is hindered by several causes of false positives (FPs) and false negatives (FNs). In addition, there is wide variability in the positive predictive value (PPV) of the PI-RADS system across different centers, highlighting the need for improvement. While the negative predictive value (NPV) for csPCa is generally high, variations exist.This review discusses the pitfalls contributing to FNs, including MRI artifacts, such as susceptibility and motion artifacts. Techniques to optimize image acquisition, such as switching the phase encoding direction and reducing bowel peristalsis, are suggested to mitigate these artifacts. Improper b-value selection for diffusion-weighted imaging (DWI) is another pitfall, emphasizing the importance of using high b-values (≥1,400 s/mm2) to optimize neoplasm detection. Similarly, optimizing window settings to visualize csPCa, correctly positioning the endorectal coil, awareness of rare variants like mucinous adenocarcinoma and cribriform adenocarcinoma, and distinguishing central zone tumors from normal central zone are discussed.This article highlights the common pitfalls causing FPs, such as benign pathologies like prostatitis, granulomatous prostatitis, prostatic abscess, stromal BPH nodules, extruded BPH nodules, and prostatic calcifications. It also discusses the pitfalls related to normal anatomical structures, including the central zone, anterior fibromuscular stroma, thickened surgical capsule, neurovascular bundle, and periprostatic venous plexus. Techniques for carefully evaluating these entities' morphology and distribution of signal abnormalities are described to avoid overdiagnosing these as PCa. The article also addresses the pitfalls related to postintervention changes, including postbiopsy hemorrhage and artifacts caused by the UroLift procedure, while providing recommendations for managing these challenges.Finally, the pitfalls that may be encountered during staging, including evaluation for extraprostatic extension, and pelvic nodal and osseous metastases, are highlighted.

Early change in apparent diffusion coefficient as a predictor of response to neoadjuvant androgen deprivation and external beam radiation therapy for intermediate- to high-risk prostate cancer

To determine the role of serial apparent diffusion coefficient (ADC) as a biomarker for response to neoadjuvant androgen deprivation therapy (nADT) followed by external beam radiation therapy (EBRT) in intermediate- to high-risk prostate cancer (PCa) patients. This Health Insurance Portability and Accountability Act (HIPAA)-compliant, institutional review board (IRB)-approved prospective study included 12 patients with intermediate- to high-risk PCa patients prior to nADT and EBRT, who underwent serial serum prostate-specific antigen (PSA) and multiparametric prostate magnetic resonance imaging (mpMRI) at baseline (BL), 8-weeks after nADT initiation (time point [TP]1), 6-weeks into EBRT delivery (TP2), and 6-months after nADT initiation (TP3). Tumour volume (tVOL) and tumour and normal tissue ADC (tADC and nlADC) were determined at all TPs. tADC and nlADC dynamics were correlated with post-treatment PSA using Pearson's correlation coefficient. Paired t-tests compared pre/post-treatment ADC. There was a sequential decrease in PSA at all TPs, reaching their lowest values at TP3 post-treatment completion. Mean tADC increased significantly from baseline to TP1 (917.8±107.7×10-6 versus 1033.8±139.3×10-6 mm2/s; p<0.01), with no subsequent change at TP2 or TP3. Both percentage and absolute change in tADC from BL to TP1 correlated with post-treatment PSA (r=-0.666, r=-0.674; p=0.02). Post-treatment PSA in good responders (<0.1 ng/ml) versus poor responders (≥ 0.1 ng/ml) was associated with a greater increase in tADC from BL to TP1 (169.2±122.4×10-6 versus 22.9±75.5×10-6 mm2/s, p=0.03). This pilot study demonstrates the potential for early ADC metrics as a biomarker of response to nADT and EBRT in intermediate to high-risk PCA.

Utilization trend of prebiopsy multiparametric magnetic resonance imaging and its impact on prostate cancer detection: Real-world insights from a high-volume center in southwest China.

Data on the utilization and effects of prebiopsy prostate multiparametric magnetic resonance imaging (mpMRI) to support its routine use in real-world setting are still scarce. To evaluate the change of clinical practice of prebiopsy mpMRI over time, and assess its diagnostic accuracy. We retrospectively analyzed data from 6168 patients who underwent primary prostate biopsy (PBx) between January 2011 and December 2021 and had prostate-specific antigen (PSA) values ranging from 3 to 100 ng/mL. Prebiopsy MRI at the time of PBx. We performed general linear regression and to elucidate trends in the annual use of prebiopsy mpMRI and conducted multivariable logistic regression to evaluate the potential benefits of incorporating prebiopsy mpMRI for prostate cancer (PCa) detection. The utilization of prebiopsy mpMRI significantly increased from 9.2% in 2011 to 75.0% in 2021 (p < 0.001). In addition, prebiopsy mpMRI significantly reduced negative PBx by 8.6% while improving the detection of clinically significant PCa (csPCa) by 7.0%. Regression analysis showed that the utilization of prebiopsy mpMRI was significantly associated with a 48% (95% confidence interval [CI]: 1.19-1.84) and 36% (95% CI: 1.12-1.66) increased PCa detection rate in the PSA 3-10 ng/mL and 10-20 ng/mL groups, respectively; and a 34% increased csPCa detection rate in the PSA 10-20 ng/mL group (95% CI: 1.09-1.64). The retrospective design and the single center cohort constituted the limitations of this study. Our study demonstrated a notable rise in the utilization of prebiopsy mpMRI in the past decade. The adoption of this imaging technique was significantly associated with an increased probability of detecting prostate cancer. From 2011 to 2021, we demonstrated a steady increase in the utilization of prebiopsy mpMRI among biopsy-naïve men. We also confirmed the positive impact of prebiopsy mpMRI utilization on the detection of prostate cancer.

The importance of periprostatic fat tissue thickness measured by preoperative multiparametric magnetic resonance imaging in upstage prediction after robot-assisted radical prostatectomy.

We analyzed the surgical results of patients who were treated and followed up for prostate cancer in our clinic to predict the relationship between periprostatic adipose tissue and patients with and without pathologically upstaged disease. The study included patients who had undergone robot-assisted radical prostatectomy and preoperative multiparametric prostate magnetic resonance imaging between 18 February 2019 and 1 April 2022. The patients were divided into two groups, and the surgical and transrectal ultrasound-guided biopsy pathology results were compared according to tumor grade and distribution in 124 patients who met the selection criteria. We analyzed the relationships between upgrading/upstaging and periprostatic adipose tissue thickness (PPATT) and subcutaneous adipose tissue thickness (SATT) as measured in magnetic resonance imaging. The median PPATT was 4.03 mm, whereas the median SATT was 36.4 mm. Upgrading was detected in 45 patients (36.3%), and upstaging was detected in 42 patients (33.9%). A receiver operating characteristic regression analysis revealed that a PPATT >3 mm was a predictive factor for upstaging after radical prostatectomy (area under curve=0.623, 95% confidence interval [CI] 0.519-0.727, p=0.025). Multivariate logistic regression analyses revealed that prostate specific antigen density ≥0.15 ng/mL/cm3 (odds ratio [OR] 5.054, 95% CI 2.008-12.724, p=0.001), International Society of Urological Pathology grade ≥4 (OR 9.369, 95% CI 2.109-21.626, p=0.003) and higher PPATT (OR 1.358, 95% CI 1.081-1.707, p=0.009) were independent risk factors for upstaging after radical prostatectomy. We believe that the PPATT may be a predictive indicator for upstaging after robot-assisted laparoscopic radical prostatectomy.

Using an artificial intelligence model to detect and localize visible clinically significant prostate cancer in prostate magnetic resonance imaging: a multicenter external validation study.

An increasing number of patients with suspected clinically significant prostate cancer (csPCa) are undergoing prostate multiparametric magnetic resonance imaging (mpMRI). The role of artificial intelligence (AI) algorithms in interpreting prostate mpMRI needs to be tested with multicenter external data. This study aimed to investigate the diagnostic efficacy of an AI model in detecting and localizing visible csPCa on mpMRI a multicenter external data set. The data of 2,105 patients suspected of having prostate cancer from four hospitals were retrospectively collected to develop an AI model to detect and localize suspicious csPCa. The lesions were annotated based on pathology records by two radiologists. Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values were used as the input for the three-dimensional U-Net framework. Subsequently, the model was validated using an external data set comprising the data of 557 patients from three hospitals. Sensitivity, specificity, and accuracy were employed to evaluate the diagnostic efficacy of the model. At the lesion level, the model had a sensitivity of 0.654. At the overall sextant level, the model had a sensitivity, specificity, and accuracy of 0.846, 0.884, and 0.874, respectively. At the patient level, the model had a sensitivity, specificity, and accuracy of 0.943, 0.776, and 0.849, respectively. The AI-predicted accuracy for the csPCa patients (231/245, 0.943) was significantly higher than that for the non-csPCa patients (242/312, 0.776) (P<0.001). The lesion number and tumor volume were greater in the correctly diagnosed patients than the incorrectly diagnosed patients (both P<0.001). Among the positive patients, those with lower average ADC values had a higher rate of correct diagnosis than those with higher average ADC values (P=0.01). The AI model exhibited acceptable accuracy in detecting and localizing visible csPCa at the patient and sextant levels. However, further improvements need to be made to enhance the sensitivity of the model at the lesion level.

Targeted augmented reality-guided transperineal prostate biopsies study: initial experience.

Transperineal biopsy of magnetic resonance imaging (MRI)-detected prostate lesions is now the established technique used in prostate cancer (CaP) diagnostics. Virtual Surgery Intelligence (VSI) Holomedicine by Apoqlar (Hamburg, Germany) is a mixed reality (MR)/augmented reality (AR) software platform that runs on the HoloLens II system (Microsoft, Redford, USA). Multiparametric prostate MRI images were converted into 3D holograms and added into a MR space, enabling visualization of a 3D hologram and image-assisted prostate biopsy. The Targeted Augmented Reality-GuidEd Transperineal (TARGET) study investigated the feasibility of performing AR-guided prostate biopsies in a MR framework, using the VSI platform in patients with MRI-detected prostate lesions. Ten patients with a clinical suspicion of CaP on MRI (Prostate Imaging-Reporting and Data System, PI-RADS 4/5) were uploaded to the VSI HoloLens system. Two MR/AR-guided prostate biopsies were then acquired using the PrecisionPoint Freehand transperineal biopsy system. Cognitive fusion biopsies were performed as standard of care following the MR/AR-guided prostate biopsies. All 10 patients successfully underwent MR/AR-guided prostate biopsy after 3D MR images were overlaid on the patient's body. Prostatic tissue was obtained in all MR/AR-guided specimens. Seven patients (70%) had matching histology in both the standard and MR/AR-guided biopsies. The remaining three had ISUP (International Society of Urological Pathology) Grade 2 CaP. There were no immediate complications. We believe this is a world first. The initial feasibility data from the TARGET study demonstrated that an MR/AR-guided prostate biopsy utilizing the VSI Holomedicine system is a viable option in CaP diagnostics. The next stage in development is to combine AR images with real-time needle insertion and to provide further data to formally appraise the sensitivity and specificity of the technique.

Predictors of prostate cancer detection in MRI PI-RADS 3 lesions - Reality of a tertiary center.

The Prostate Imaging Reporting and Data System (PI-RADS) score reports the likelihood of a clinically significant prostate cancer (CsPCa) based on various multiparametric prostate magnetic resonance imaging (mpMRI) characteristics. The PI-RADS category 3 is an intermediate status, with an equivocal risk of malignancy. The PSA density (PSAD) has been proposed as a tool to facilitate biopsy decisions on PI-RADS category 3 lesions. The objective of this study is to determine the frequency of CsPCa, assess the diagnostic value of targeted biopsy and identify clinical predictors to improve the CsPCa detection rate in PI-RADS category 3 lesions. Between 1st January 2017 and 31st December 2022, a total of 1661 men underwent a prostate biopsy at our institution. Clinical and mpMRI data of men with PI-RADS 3 lesions was reviewed. The study population was divided into two groups: target group, including those submitted to systematic plus targeted biopsy versus non-target group when only systematic or saturation biopsy were performed. Patients with PI-RADS 3 lesions were divided into three categories based on pathological biopsy results: benign, clinically insignificant disease (score Gleason = 6 or International Society of Urologic Pathologic (ISUP) 1) and clinically significant cancer (score Gleason ≥ 7 (3+4) or ISUP ≥ 2) according to target and non-target group. Univariate and multivariate analyses were performed to identify clinical predictors to improve the CsPCa detection rate in PI-RADS category 3 lesions. A total of 130 men with PIRADS 3 index lesions were identified. Pathologic results were benign in 77 lesions (59.2%), 19 (14.6%) were clinically insignificant (Gleason score 6) and 34 (26.2%) were clinically significant (Gleason score 7 or higher). Eighty-seven of the patients were included in the target group (66.9%) and 43 in the non-target group (33.1%). The CsPCa detection was higher in the non-target group (32.6%, n = 14 vs 23.0%, n = 20 respectively). When systematic and target biopsies were jointly performed, if the results of systematic biopsies are not considered and only the results of target biopsies are taken into account, a CsPCa diagnosis would be missed on 9 patients. The differences of insignificant cancer and CsPCa rates among the target or non-target group were not statistically significant (p = 0.50 and p = 0.24, respectively). on multivariate analysis, the abnormal DRE and lesions localized in Peripheral zone (PZ) were significantly associated with a presence of CsPCa in PI-RADS 3 lesions (oR = 3.61, 95% CI [1.22,10.72], p = 0.02 and oR = 3.31, 95% CI [1.35, 8.11], p = 0.01, respectively). A higher median PSAD significantly predisposed for CsPCa on univariate analyses (p = 0.05), however, was not significant in the multivariate analysis (p = 0.76). In our population, using 0.10 ng/ml/ml as a cut-off to perform biopsy, 41 patients would have avoided biopsy (31.5%), but 5 cases of CsPCa would not have been detected (3.4%). We could not identify any statistical significance between other clinical and imagiological variables and CsPCa detection. PI-RADS 3 lesions were associated with a low likelihood of CsPCa detection. A systematic biopsy associated or not with target biopsy is essential in PI-RADS 3 lesions, and targeted biopsy did not demonstrate to be superior in the detection of CsPCa. The presence of abnormal DRE and lesions localized in PZ potentially predict the presence of CsPCa in biopsied PI-RADS 3 lesions.

The effect of the combination of prostate-specific antigen derivatives with multiparametric prostate magnetic resonance imaging scores on the negative predictive value of it in grey zone patients

ObjectiveTo calculate the negative predictive value (NPV) of negative multiparametric prostate magnetic resonance imaging (mpMRI), accepted as no lesions on images, when combined with prostate-specific antigen density (PSAD) and free/total prostate-specific antigen ratio (f/t PSA) in grey zone patients. Methods191 patients with PSA levels between 4−10 mg/mL and negative mpMRI were analyzed. The NPV of negative mpMRI was calculated according to a PSAD level of <0.15 ng/mL/mL, f/t PSA ratio of >0.15, and a combination of both. Patients were divided into three risk groups according to these two parameters, which were PSAD 0.01−0.07 ng/mL/mL and f/t PSA ratio ≥25 in a low-risk group, PSAD 0.08−0.15 ng/mL/mL, and f/t PSA ratio 0.15−0.24 in an intermediate-risk group and high-risk group, in which PSAD > 0.15 ng/mL/mL and f/t PSA ratio <15. ResultsNPV of negative mpMRI was 92.6% for clinically significant prostate carcinoma (CSPCa). It increased to 97.5% in a low-risk group and decreased to 33.3% for CSPCa in a high-risk group. NPV of negative mpMRI results were so close when combined with PSAD < 0.15 ng/mL/mL and f/t PSA > 15. Conclusionf/t PSA ratio might also be used to increase the NPV of mpMRI, like PSAD. We advise not to avoid prostate biopsy when PSAD is >0.15 ng/mL/mL and the f/t PSA ratio is <0.15. However, we need randomized controlled studies with more patients to confirm our study.

The Role of Multiparametric MRI in the Local Staging of Prostate Cancer.

Prostate cancer ranks as the second most frequently diagnosed cancer globally among men and stands as the fifth leading cause of cancer-related death in males. Hence, an early and precise diagnosis and staging are critical. Traditional staging is based on clinical nomograms but presents a lower performance than prostate multiparametric magnetic resonance imaging (mpMRI). Since tumor staging serves as the basis for risk stratification, prognosis, and treatment decision-making, the primary objective of mpMRI is to distinguish between organ-confined and locally advanced diseases. Therefore, this imaging modality has emerged as the optimal selection for the local staging of prostate cancer, offering incremental value in evaluating pelvic nodal disease and bone involvement, and supplying supplementary insights regarding the precise location and disease extension. As per the Prostate Imaging Reporting & Data System v2.1 guideline, a comprehensive and accurate mpMRI requires several key sequences, which include T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI) for morphological assessment, with T2WI serving as the cornerstone for local staging. Additionally, diffusion-weighted imaging (DWI) and dynamic sequences acquired with intravenous administration of paramagnetic contrast medium (DCE) are crucial components. It is worth noting that while MRI exhibits high specificity, its sensitivity in diagnosing extracapsular extension, seminal vesicle invasion, and lymph node metastases is limited. Moreover, mpMRI has its own constraints and is not as effective in detecting distant metastases or evaluating lymph nodes, for which extended pelvic lymph node dissection remains the gold standard. This review aims to highlight the significance of mpMRI in prostate cancer staging and provide a practical approach to assessing extracapsular extension, seminal vesicle invasions, and the involvement of adjacent organs and lymph nodes.

Evaluación del valor predictivo negativo de la resonancia magnética multiparamétrica de próstata al combinar su puntuación con parámetros del antígeno prostático específico en pacientes con PSA en zona gris

ObjectiveTo calculate the negative predictive value (NPV) of negative multiparametric prostate magnetic resonance imaging (mpMRI), accepted as no lesions on images, when combined with prostate-specific antigen density (PSAD) and free/total prostate-specific antigen ratio (f/t PSA) in grey zone patients. MethodsOne hundred ninety-one patients with PSA levels between 4-10mg/ml and negative mpMRI were analyzed. The NPV of negative mpMRI was calculated according to a PSAD level of <0.15 ng/ml/ml, f/t PSA ratio of >0.15, and a combination of both. Patients were divided into three risk groups according to these two parameters:•PSAD 0.01-0.07 ng/ml/ml and f/t PSA ratio ≥25 in a low-risk group.•PSAD 0.08-0.15 ng/ml/ml, and f/t PSA ratio 0.15-0.24 in an intermediate-risk group and high-risk group.•PSAD>0.15 ng/ml/ml and f/t PSA ratio <15 in high-risk group, ResultsNPV of negative mpMRI was 92.6% for clinically significant prostate carcinoma (CSPCa). It increased to 97.5% in a low-risk group and decreased to 33.3% for CSPCa in a high-risk group. NPV of negative mpMRI results were so close when combined with PSAD <0.15 ng/ml/ml and f/t PSA>15. Conclusionf/t PSA ratio might also be used to increase the NPV of mpMRI, like PSAD. We advise not to avoid prostate biopsy when PSAD is >0.15 ng/ml/ml and the f/t PSA ratio is <0.15. However, we need randomized controlled studies with more patients to confirm our study.

Can the Gleason score be predicted in patients with prostate cancer? A dynamic contrast-enhanced MRI, (68)Ga-PSMA PET/CT, PSA, and PSA-density comparison study.

The present study aims to evaluate whether perfusion parameters in prostate magnetic resonance imaging (MRI), (68)Ga-prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT), prostate-specific antigen (PSA), and PSA density can be used to predict the lesion grade in patients with prostate cancer (PCa). The study included a total of 137 PCa cases in which 12-quadrant transrectal ultrasound-guided prostate biopsy (TRUSBx) was performed, the Gleason score (GS) was determined, and pre-biopsy multiparametric prostate MRI and (68)Ga-PSMA PET/CT examinations were undertaken. The patient population was evaluated in three groups according to the GS: (1) low risk; (2) intermediate risk; (3) high risk. The PSA, PSA density, pre-TRUSBx (68)Ga-PSMA PET/CT maximum standardized uptake value (SUVmax), perfusion MRI parameters [maximum enhancement, maximum relative enhancement, T0 (s), time to peak (s), wash-in rate (s-1), and wash-out rate (s-1)] were retrospectively evaluated. There was no significant difference between the three groups in relation to the PSA, PSA density, and (68)Ga-PSMA PET/CT SUVmax (P > 0.05). However, the values of maximum enhancement, maximum relative enhancement (%), T0 (s), time to peak (s), wash-in rate (s-1), and wash-out rate (s-1) significantly differed among the groups. A moderate positive correlation was found among the prostate volume, PSA (r = 0.490), and (68)Ga-PSMA SUVmax (r = 0.322) in the patients. The wash-out rate (s-1) and wash-in rate (s-1) had the best diagnostic test performance (area under the curve: 89.1% and 78.4%, respectively). No significant correlation was found between the (68)Ga-PSMA PET/CT SUVmax and the GS. The wash-out rate was more successful in estimating the pretreatment GS than the (68)Ga-PSMA PET/CT SUVmax.

Four-quadrant vector mapping of hybrid multidimensional MRI data for the diagnosis of prostate cancer.

The interpretation of prostate multiparametric magnetic resonance imaging (MRI) is subjective in nature, and there is large inter-observer variability among radiologists and up to 30% of clinically significant cancers are missed. This has motivated the development of new MRI techniques and sequences, especially quantitative approaches to improve prostate cancer diagnosis. Using hybrid multidimensional MRI, apparent diffusion coefficient (ADC) and T2 have been shown to change as a function of echo time (TE) and b-values, and that this dependence is different for cancer and benign tissue, which can be exploited for prostate cancer diagnosis. The purpose of this study is to investigate whether four-quadrant vector mapping of hybrid multidimensional MRI (HM-MRI) data can be used to diagnose prostate cancer (PCa) and determine cancer aggressiveness. Twenty-one patients with confirmed PCa underwent preoperative MRI prior to radical prostatectomy. Axial HM-MRI were acquired with all combinations of TE=47, 75, 100ms and b-values of 0, 750, 1500s/mm2 , resulting in a 3×3 data matrix associated with each voxel. Prostate Quadrant (PQ) mapping analysis represents HM-MRI data for each voxel as a color-coded vector in the four-quadrant space of HM-MRI parameters (a 2D matrix of signal values for each combination of b-value and TE) with associated amplitude and angle information representing the change in T2 and ADC as a function of b-value and TE, respectively. Cancers have a higher PQ4 (22.50%±21.27%) and lower PQ2 (69.86%±28.24%) compared to benign tissue: peripheral, transition, and central zone (PQ4=0.13%±0.56%, 5.73%±15.07%, 2.66%±4.05%, and PQ2=98.51%±3.05%, 86.18%±21.75%, 93.38%±9.88%, respectively). Cancers have a higher vector angle (206.5±41.8°) and amplitude (0.017±0.013) compared to benign tissue. PQ metrics showed moderate correlation with Gleason score (|ρ|=0.388-0.609), with more aggressive cancers being associated with increased PQ4 and angle and reduced PQ2 and amplitude. A combination of four-quadrant analysis metrics provided an area under the curve of 0.904 (p<0.001) for the differentiation of prostate cancer from benign prostatic tissue. Four-quadrant vector mapping of HM-MRI data provides effective cancer markers, with cancers associated with high PQ4 and high vector angle and lower PQ2 and vector amplitude.

Prostate Imaging after Focal Ablation (PI-FAB): A Proposal for a Scoring System for Multiparametric MRI of the Prostate After Focal Therapy

At present there is no standardised system for scoring the appearance of the prostate on multiparametric magnetic resonance imaging (MRI) after focal ablation for localised prostate cancer. We propose a novel scoring system, the Prostate Imaging after Focal Ablation (PI-FAB) score, to fill this gap. PI-FAB involves a 3-point scale for rating MRI sequences in sequential order: (1) dynamic contrast-enhanced sequences; (2) diffusion-weighted imaging, split into assessment of the high-b-value sequence first and then the apparent diffusion coefficient map; and (3) T2-weighted imaging. It is essential that the pretreatment scan is also available to help with this assessment. We designed PI-FAB using our experience of reading postablation scans over the past 15 years and include details for four representative patients initially treated with high-intensity focus ultrasound at our institution to demonstrate the scoring system. We propose PI-FAB as a standardised method for evaluating prostate MRI scans after treatment with focal ablation. The next step is to evaluate its performance across multiple experienced readers of MRI after focal therapy in a clinical data set. Patient summaryWe propose a scoring system called PI-FAB for assessing the appearance of magnetic resonance imaging scans of the prostate after focal treatment for localised prostate cancer. This will help clinicians in deciding on further follow-up.

Effect of a dedicated PI-QUAL curriculum on the assessment of prostate MRI quality

PurposeThe Prostate Imaging Quality (PI-QUAL) score is a metric to evaluate the diagnostic quality of multiparametric magnetic resonance imaging (MRI) of the prostate. This study evaluated the impact of a prostate MRI quality training lecture on the participant's ability to assess prostate MRI image quality. MethodsEighteen in-training-radiologists of varying experience in reviewing diagnostic prostate MRI assessed the image quality of ten examinations. Then, they attended a dedicated lecture on MRI quality assessment using the PI-QUAL score. After the lecture, the same participants evaluated the image quality of a new set of ten scans applying the PI-QUAL score. Results were assessed using receiver operating characteristic (ROC) analysis. The reference standard was the PI-QUAL score assessed by a fellowship trained abdominal radiologist with experience in reading prostate MRI. ResultsThere was a significant improvement in the average area under the curve (AUC) for assessment of prostate MRI image quality from baseline (0.82; [0.576 – 0.888]) to post teaching (1.0; [0.954–1]), with an improvement of 0.18 (p < 0.03). When ROC curves were computed for different cohorts stratified based on year of training, difference ranged from 0.48 for second year residents to 0.32 for fourth year residents (p < 0.001–0.01). For abdominal imaging fellows, the pre-teaching AUC was 0.9 [0.557–1] and post teaching AUC was 1 [0.957–1], a difference of 0.1 (p = 0.20). ConclusionsA dedicated lecture on PI-QUAL improved the ability of radiologists-in-training to assess prostate MRI image quality, with variable impact depending on year of training.

MP09-09 CORRELATION BETWEEN PROSTATE MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING AND HIGH-RESOLUTION MICRO-ULTRASOUND

You have accessJournal of UrologyCME1 Apr 2023MP09-09 CORRELATION BETWEEN PROSTATE MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING AND HIGH-RESOLUTION MICRO-ULTRASOUND Nicholas Pickersgill, M. Hassan Alkazemi, Joel Vetter, Adam Ostergar, Nimrod Barashi, Grant Henning, and Arjun Sivaraman Nicholas PickersgillNicholas Pickersgill More articles by this author , M. Hassan AlkazemiM. Hassan Alkazemi More articles by this author , Joel VetterJoel Vetter More articles by this author , Adam OstergarAdam Ostergar More articles by this author , Nimrod BarashiNimrod Barashi More articles by this author , Grant HenningGrant Henning More articles by this author , and Arjun SivaramanArjun Sivaraman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003224.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate multiparametric magnetic resonance imaging (pMRI) has emerged as a valuable tool in the diagnostic pathway for prostate cancer. The recent introduction of high-resolution micro-ultrasound (microUS) guided prostate biopsy aims to further improve the detection of clinically significant prostate cancer (CSCaP). The correlation between these two imaging modalities is poorly understood. We investigated correlation in lesion identification between microUS and pMRI. METHODS: We reviewed our prospectively maintained database of 200 consecutive patients who underwent transperineal microUS-guided biopsy with the ExactVu™platform (Exact Imaging, Markham, Canada) between February 2021 and April 2022. The Prostate Risk Identification using MicroUS (PRI-MUS) protocol was utilized to risk stratify prostate lesions, with PRI-MUS 3-5 defined as positive. pMRI lesions were classified according to PI-RADS version 2. Clinicopathologic outcomes were analyzed. Spearman correlation testing was computed to assess the relationship between PRI-MUS and PI-RADS. Patients with sufficient data for analysis were included. RESULTS: A total of 159 patients met inclusion criteria. Of these, 117 were biopsy-naïve, 19 had a prior negative biopsy and 20 were on active surveillance. Mean±standard deviation (SD) age was 66.6±7.7 years and PSA was 10.1±4.4 ng/mL. A total of 112 patients underwent multiparametric magnetic resonance imaging (mpMRI) prior to biopsy, of which 56 were found to have PIRADS 3-5 lesions. There was a weak positive correlation between PRI-MUS and PI-RADS (r=0.23, p=0.013) (Figure 1). CONCLUSIONS: This preliminary comparison between PRI-MUS and PI-RADS scoring demonstrates a weak positive correlation between the two modalities. This may be attributable to a significant number of patients with negative pMRI who were found to have PRI-MUS 3-5 lesions. Given the rising utilization of micro-US-guided prostate biopsy and widespread use of pMRI, further prospective studies are needed to compare their ability to detect clinically significant prostate cancer. Source of Funding: Midwest Stone Institute © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e107 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Pickersgill More articles by this author M. Hassan Alkazemi More articles by this author Joel Vetter More articles by this author Adam Ostergar More articles by this author Nimrod Barashi More articles by this author Grant Henning More articles by this author Arjun Sivaraman More articles by this author Expand All Advertisement PDF downloadLoading ...

MP12-13 DISPARITIES IN PROSTATE MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGING UTILIZATION IN BIOPSY NAIVE MEN

You have accessJournal of UrologyCME1 Apr 2023MP12-13 DISPARITIES IN PROSTATE MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGING UTILIZATION IN BIOPSY NAIVE MEN Aroh Pandit, Tamir Sholklapper, Johnathan Drevik, and Serge Ginzburg Aroh PanditAroh Pandit More articles by this author , Tamir SholklapperTamir Sholklapper More articles by this author , Johnathan DrevikJohnathan Drevik More articles by this author , and Serge GinzburgSerge Ginzburg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003227.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multi-parametric magnetic resonance imaging (mpMRI) prior to prostate biopsy has been recommended by the American Urologic Society (AUA) since 2019. Studies have shown biopsy naive men in minority groups are less likely to undergo mpMRI. We aimed to evaluate national trends in mpMRI utilization in biopsy naive men. METHODS: The TriNetX US Collaborative Network database of 90,863,999 patients was retrospectively queried using current procedure terminology codes for prostate biopsy and prostate mpMRI with associated dates. One cohort contained men with prostate biopsy without prior mpMRI. A second cohort contained men with biopsy and mpMRI prior. Inclusion was restricted to biopsies performed in 2017 or later. Men were excluded if they had a documented biopsy prior to 2017, or if pre-biopsy prostate specific antigen (PSA) was greater than or equal to 20ng/dL to exclude metastatic disease at presentation. Data was stratified by race, ethnicity, and region. Uni-variable logistic regression modeling was performed to evaluate the likelihood of using mpMRI prior to biopsy, odds ratios (OR) with 95% confidence intervals (CI) not crossing 1 were considered statistically significant. RESULTS: 49,590 men met inclusion for analysis, of which 39% had a pre-biopsy mpMRI. Compared to White men, Black and American Indian or Alaska Native men had a 15% and 39% lower likelihood of using mpMRI, respectively. Compared to non Hispanic men, Hispanic or Latino men had a 45% lower likelihood of using mpMRI. Men in the South and West had a 10% and 48% lower likelihood of using mpMRI, respectively, compared to men in the Northeast. CONCLUSIONS: In this nationwide clinical study, men in minority groups were less likely to undergo pre prostate biopsy mpMRI compared to men in majority groups. Additionally, men in the South and West were less likely to undergo pre prostate biopsy compared to men in the Northeast. Limitations include the retrospective nature and lack of inter-institutional standardization of coding. Further research is warranted to study the causation of these disparities. Source of Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e138 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aroh Pandit More articles by this author Tamir Sholklapper More articles by this author Johnathan Drevik More articles by this author Serge Ginzburg More articles by this author Expand All Advertisement PDF downloadLoading ...

Transrectal vs. transperineal fusion biopsy of the prostate : Time to switch to the perineal technique-comparison of methods and description of the transperineal procedure under local anesthesia

The clinical and histological diagnosis of prostate cancer is acrucial aspect of the routine work of aurologist. The high prevalence of multiresistant microorganisms leads to an increased incidence of sepsis after transrectal prostate biopsy. It requires a switch from the still gold-standard method to the transperineal fusion biopsy procedure after multiparametric prostate magnetic resonance imaging (MRI). This article provides an overview of the most important differences between the two methods and gives adetailed methodological description of transperineal fusion biopsy under local anesthesia.

Bridging the experience gap in prostate multiparametric magnetic resonance imaging using artificial intelligence: A prospective multi-reader comparison study on inter-reader agreement in PI-RADS v2.1, image quality and reporting time between novice and expert readers

PurposeThe aim of the study was to determine the impact of using a semi-automatic commercially available AI-assisted software (Quantib® Prostate) on inter-reader agreement in PI-RADS scoring at different PI-QUAL ratings and grades of reader confidence and on reporting times among novice readers in multiparametric prostate MRI. MethodsA prospective observational study, with a final cohort of 200 patients undergoing mpMRI scans, was performed at our institution. An expert fellowship-trained urogenital radiologist interpreted all 200 scans based on PI-RADS v2.1. The scans were divided into four equal batches of 50 patients. Four independent readers evaluated each batch with and without the use of AI-assisted software, blinded to expert and individual reports. Dedicated training sessions were held before and after each batch. Image quality rated according to PI-QUAL and reporting times were recorded. Readers’ confidence was also evaluated. A final evaluation of the first batch was conducted at the end of the study to assess for any changes in performance. ResultsThe overall kappa coefficient differences in PI-RADS scoring agreement without and with Quantib® were 0.673 to 0.736 for Reader 1, 0.628 to 0.483 for Reader 2, 0.603 to 0.292 for Reader 3 and 0.586 to 0.613 for Reader 4. Using PI-RADS ≥ 4 as cut-off for biopsy, the AUCs with AI ranged from 0.799 (95 % CI: 0.743, 0.856) to 0.820 (95 % CI: 0.765, 0.874). Inter-reader agreements at different PI-QUAL scores were higher with the use of Quantib, particularly for readers 1 and 4, with Kappa coefficient values showing moderate to slight agreement. ConclusionQuantib® Prostate could potentially be useful in improving inter-reader agreement among less experienced to completely novice readers if used as a supplement to PACS.