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Role of multi-parametric MRI of the prostate for screening and staging:Experience with over 1500 cases 被引量:1
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作者 Geoffrey Gaunay Vinay Patel +9 位作者 Paras Shah daniel moreira Simon J.Hall Manish A.Vira Michael Schwartz Jessica Kreshover Eran Ben-Levi Robert Villani Ardeshir Rastinehad Lee Richstone 《Asian Journal of Urology》 2017年第1期68-74,共7页
Objective:Contemporary prostate cancer(PCa)screening modalities such as prostate specific antigen(PSA)and digital rectal examination(DRE)are limited in their ability to predict the detection of clinically significant ... Objective:Contemporary prostate cancer(PCa)screening modalities such as prostate specific antigen(PSA)and digital rectal examination(DRE)are limited in their ability to predict the detection of clinically significant disease.Multi-parametric magnetic resonance imaging(mpMRI)of the prostate has been explored as a staging modality for PCa.Less is known regarding its utility as a primary screening modality.We examined our experience with mpMRI as both a screening and staging instrument.Methods:mpMRI studies performed between 2012 and 2014 in patients without PCa were cross-referenced with transrectal ultrasonography(TRUS)biopsy findings.Statistical analyses were performed to determine association of mpMRI findings with overall cancer diagnoses and clinically significant(Gleason score≥7)disease.Subgroup analyses were then performed on patients with a history of prior negative biopsy and those without a history of TRUS biopsy.mpMRI studies were also cross-referenced with RP specimens.Statistical analyses determined predictive ability of extracapsular extension(ECE),seminal vesicle involvement(SVI),and pathologic evidence of clinically significant disease(Gleason score7).Results:Four hundred biopsy naive or prior negative biopsy patients had positive mpMRI studies.Overall sensitivity,specificity,positive and negative predictive values were 94%,37%,58%,and 87%,respectively and 95%,31%,42%,and 93%,respectively for overall cancer detection and Gleason score≥7 disease.In patients with no prior biopsy history,mpMRI sensitivity,specificity,positive and negative predictive values were 94%,36%,65%,and 82%,for all cancers,and 95%,30%,50%,and 89%for Gleason score7 lesions,respectively.In those with prior negative biopsy sensitivity,specificity,positive and negative predictive values were 94%,37%,52%,and 90% for all cancers,and 96%,32%,36%,and 96% for Gleason score7 lesions,respectively.Seventy-four patients underwent radical prostatectomy(RP)after mpMRI.Lesion size on mpMRI correlated with the presence of Gleason score7 cancers(p Z 0.005).mpMRI sensitivity,specificity,positive and negative predictive values were 84%,39%,81%,and 44% respectively,for Gleason7 cancer.For ECE and SVI,sensitivity and specificity were 58% and 98% and 44% and 97%,respectively.Conclusion:mpMRI is an accurate predictor of TRUS biopsy and RP outcomes.mpMRI has significant potential to change PCa management,particularly in the screening population,in whom a significant proportion may avoid TRUS biopsy.Further studies are necessary to determine how mpMRI should be incorporated into the current PCa screening and staging paradigms. 展开更多
关键词 Prostate cancer Magnetic resonance imaging STAGING Prostatectomy SCREENING MARGINS Gleason score Novel use
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Multi-parametric MRI of the prostate:Factors predicting extracapsular extension at the time of radical prostatectomy 被引量:1
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作者 Geoffrey S.Gaunay Vinay Patel +5 位作者 Paras Shah daniel moreira Ardeshir R.Rastinehad Eran Ben-Levi Robert Villani Manish A.Vira 《Asian Journal of Urology》 2017年第1期31-36,共6页
Objective:Extracapsular extension(ECE)of prostate cancer is a poor prognostic factor associated with progression,recurrence after treatment,and increased prostate cancer-related mortality.Accurate staging prior to rad... Objective:Extracapsular extension(ECE)of prostate cancer is a poor prognostic factor associated with progression,recurrence after treatment,and increased prostate cancer-related mortality.Accurate staging prior to radical prostatectomy is crucial in avoidance of positive margins and when planning nerve-sparing procedures.Multi-parametric magnetic resonance imaging(mpMRI)of the prostate has shown promise in this regard,but is hampered by poor sensitivity.We sought to identify additional clinical variables associated with pathologic ECE and determine our institutional accuracy in the detection of ECE amongst patients who went on to radical prostatectomy.Methods:mpMRI studies performed between the years 2012 and 2014 were cross-referenced with radical prostatectomy specimens.Predictive properties of ECE as well as additional clinical and biochemical variables to identify pathology-proven prostate cancer ECE were analyzed.Results:The prevalence of ECE was 32.4%,and the overall accuracy of mpMRI for ECE was 84.1%.Overall mpMRI sensitivity,specificity,positive predictive value,and negative predictive value for detection of ECE were 58.3%,97.8%,93.3%,and 81.5%,respectively.Specific mpMRI characteristics predictive of pathologic ECE included primary lesion size((20.73±9.09)mm,mean±SD,p<0.001),T2 PIRADS score(p=0.009),overall primary lesion score(p<0.001),overall study suspicion score(p=0.003),and MRI evidence of seminal vesicle invasion(SVI)(p=0.001). 展开更多
关键词 Prostate cancer Magnetic resonance imaging STAGING Prostatectomy Extracapsular extension
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