The Use of MRI and PET Imaging Studies for Prostate Cancer Management: Brief Update, Clinical Recommendations, and Technological Limitations
Abstract
:1. Introduction
2. Multi-Parametric Magnetic Resonance Imaging (mpMRI)
3. Positron Emission Tomography (PET) with Prostate-Specific Membrane Antigen (PSMA) Targeting Ligands
4. Prostate Cancer Diagnosis and Screening
5. Treatment Planning/Primary Staging
6. Active Surveillance
7. Secondary Staging
8. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
- Ferlay, J.; Colombet, M.; Soerjomataram, I.; Mathers, C.; Parkin, D.M.; Pineros, M.; Znaor, A.; Bray, F. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int. J. Cancer J. Int. Du Cancer 2019, 144, 1941–1953. [Google Scholar] [CrossRef] [PubMed]
- D’Amico, A.V. Risk-Based Management of Prostate Cancer. N. Engl. J. Med. 2011, 365, 169–171. [Google Scholar]
- Klotz, L.; Zhang, L.; Lam, A.; Nam, R.; Mamedov, A.; Loblaw, A. Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2010, 28, 126–131. [Google Scholar] [CrossRef] [PubMed]
- Sweeney, C.J.; Chen, Y.-H.; Carducci, M.; Liu, G.; Jarrard, D.F.; Eisenberger, M.; Wong, Y.-N.; Hahn, N.; Kohli, M.; Cooney, M.M.; et al. Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. N. Engl. J. Med. 2015, 373, 737–746. [Google Scholar] [CrossRef] [PubMed]
- James, N.D.; Sydes, M.R.; Clarke, N.W.; Mason, M.D.; Dearnaley, D.P.; Spears, M.R.; Ritchie, A.W.; Parker, C.C.; Russell, J.M.; Attard, G.; et al. Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): Survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. Lancet 2016, 387, 1163–1177. [Google Scholar] [CrossRef]
- Bill-Axelson, A.; Holmberg, L.; Garmo, H.; Taari, K.; Busch, C.; Nordling, S.; Haggman, M.; Andersson, S.-O.; Andren, O.; Steineck, G.; et al. Radical Prostatectomy or Watchful Waiting in Prostate Cancer - 29-Year Follow-up. N. Engl. J. Med. 2018, 379, 2319–2329. [Google Scholar] [CrossRef]
- Hamdy, F.C.; Donovan, J.L.; Lane, J.A.; Mason, M.; Metcalfe, C.; Holding, P.; Davis, M.; Peters, T.J.; Turner, E.L.; Martin, R.M.; et al. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. N. Engl. J. Med. 2016, 375, 1415–1424. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wilt, T.J.; Jones, K.M.; Barry, M.J.; Andriole, G.L.; Culkin, D.; Wheeler, T.; Aronson, W.J.; Brawer, M.K. Follow-up of Prostatectomy versus Observation for Early Prostate Cancer. N. Engl. J. Med. 2017, 377, 132–142. [Google Scholar] [CrossRef] [PubMed]
- Crawford, E.D.; Koo, P.J.; Shore, N.; Slovin, S.F.; Concepcion, R.S.; Freedland, S.J.; Gomella, L.G.; Karsh, L.; Keane, T.E.; Maroni, P. A Clinician’s Guide to Next Generation Imaging in Patients with Advanced Prostate Cancer (RADAR III). J. Urol. 2019, 201, 682–692. [Google Scholar] [CrossRef] [PubMed]
- Schwenck, J.; Rempp, H.; Reischl, G.; Kruck, S.; Stenzl, A.; Nikolaou, K.; Pfannenberg, C.; la Fougere, C. Comparison of (68)Ga-labelled PSMA-11 and (11)C-choline in the detection of prostate cancer metastases by PET/CT. Eur. J. Nucl. Med. Mol. Imaging. 2017, 44, 92–101. [Google Scholar] [CrossRef]
- Sathianathen, N.J.; Butaney, M.; Konety, B.R. The utility of PET-based imaging for prostate cancer biochemical recurrence: A systematic review and meta-analysis. World J. Urol. 2019, 37, 1239–1249. [Google Scholar] [CrossRef] [PubMed]
- Steyn, J.H.; Smith, F.W. Nuclear magnetic resonance imaging of the prostate. Br. J. Urol. 1982, 54, 726–728. [Google Scholar] [CrossRef] [PubMed]
- Barentsz, J.O.; Richenberg, J.; Clements, R.; Choyke, P.; Verma, S.; Villeirs, G.; Rouviere, O.; Logager, V.; Futterer, J.J.; European Society of Urogenital Radiology. ESUR prostate MR guidelines 2012. Eur Radiol. 2012, 22, 746–757. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hoeks, C.M.; Schouten, M.G.; Bomers, J.G.; Hoogendoorn, S.P.; Hulsbergen-van de Kaa, C.A.; Hambrock, T.; Vergunst, H.; Sedelaar, J.P.; Futterer, J.J.; Barentsz, J.O. Three-Tesla magnetic resonance-guided prostate biopsy in men with increased prostate-specific antigen and repeated, negative, random, systematic, transrectal ultrasound biopsies: Detection of clinically significant prostate cancers. Eur. Urol. 2012, 62, 902–909. [Google Scholar] [CrossRef] [PubMed]
- Pokorny, M.R.; de Rooij, M.; Duncan, E.; Schroder, F.H.; Parkinson, R.; Barentsz, J.O.; Thompson, L.C. Prospective study of diagnostic accuracy comparing prostate cancer detection by transrectal ultrasound-guided biopsy versus magnetic resonance (MR) imaging with subsequent MR-guided biopsy in men without previous prostate biopsies. Eur. Urol. 2014, 66, 22–29. [Google Scholar] [CrossRef] [PubMed]
- Israeli, R.S.; Powell, C.T.; Fair, W.R.; Heston, W.D. Molecular cloning of a complementary DNA encoding a prostate-specific membrane antigen. Cancer Res. 1993, 53, 227–320. [Google Scholar] [PubMed]
- Silver, D.A.; Pellicer, I.; Fair, W.R.; Heston, W.D.; Cordon-Cardo, C. Prostate-specific membrane antigen expression in normal and malignant human tissues. Clin. Cancer Res. Off. J. Am. Assoc. Cancer Re. 1997, 3, 81–85. [Google Scholar]
- Troyer, J.K.; Feng, Q.; Beckett, M.L.; Wright, G.L., Jr. Biochemical characterization and mapping of the 7E11-C5.3 epitope of the prostate-specific membrane antigen. Urol. Oncol. 1995, 29–37. [Google Scholar] [CrossRef]
- Wright, G.L., Jr.; Grob, B.M.; Haley, C.; Grossman, K.; Newhall, K.; Petrylak, D.; Troyer, J.; Konchuba, A.; Schellhammer, P.F.; Moriarty, R. Upregulation of prostate-specific membrane antigen after androgen-deprivation therapy. Urology 1996, 48, 326–334. [Google Scholar] [CrossRef]
- Afshar-Oromieh, A.; Haberkorn, U.; Eder, M.; Eisenhut, M.; Zechmann, C.M. [68Ga]Gallium-labelled PSMA ligand as superior PET tracer for the diagnosis of prostate cancer: Comparison with 18F-FECH. Eur. J. Nucl. Med. Mol. Imaging. 2012, 39, 1085–1086. [Google Scholar] [CrossRef] [PubMed]
- Afshar-Oromieh, A.; Avtzi, E.; Giesel, F.L.; Holland-Letz, T.; Linhart, H.G.; Eder, M.; Eisenhut, M.; Boxler, S.; Hadaschik, B.A.; Kratochwil, C.; et al. The diagnostic value of PET/CT imaging with the Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur. J. Nucl. Med. Mol. Imaging. 2014. [Google Scholar] [CrossRef]
- Ahmed, H.U.; El-Shater Bosaily, A.; Brown, L.C.; Gabe, R.; Kaplan, R.; Parmar, M.K.; Collaco-Moraes, Y.; Ward, K.; Hindley, R.G.; Freeman, A.; et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): A Paired Validating Confirmatory Study. Lancet 2017, 389, 815–822. [Google Scholar] [CrossRef]
- Kasivisvanathan, V.; Rannikko, A.S.; Borghi, M.; Panebianco, V.; Mynderse, L.A.; Vaarala, M.H.; Briganti, A.; Budaus, L.; Hellawell, G.; Hindley, R.G.; et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N. Engl. J. Med. 2018, 378, 1767–1777. [Google Scholar] [CrossRef] [PubMed]
- Rouviere, O.; Puech, P.; Renard-Penna, R.; Claudon, M.; Roy, C.; Mege-Lechevallier, F.; Decaussin-Petrucci, M.; Dubreuil-Chambardel, M.; Magaud, L.; Remontet, L.; et al. Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): A prospective, multicentre, paired diagnostic study. Lancet Oncol. 2019, 20, 100–109. [Google Scholar] [CrossRef]
- Sathianathen, N.J.; Butaney, M.; Bongiorno, C.; Konety, B.R.; Bolton, D.M.; Lawrentschuk, N. Accuracy of the magnetic resonance imaging pathway in the detection of prostate cancer: A systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2019, 22, 39–48. [Google Scholar] [CrossRef] [PubMed]
- Rhee, H.; Thomas, P.; Shepherd, B.; Greenslade, S.; Vela, I.; Russell, P.J.; Nelson, C.C.; Chung, E.; Wood, G.; Malone, G.; et al. PSMA PET May Improve the Diagnostic Accuracy of mpMRI in Localised Prostate Cancer as Confirmed by Whole-Mount Histopathology. J. Urol. 2016. [Google Scholar] [CrossRef]
- Perera, M.; Papa, N.; Roberts, M.; Williams, M.; Udovicich, C.; Vela, I.; Christidis, D.; Bolton, D.; Hofman, M.S.; Lawrentschuk, N.; et al. Gallium-68 Prostate-specific Membrane Antigen Positron Emission Tomography in Advanced Prostate Cancer-Updated Diagnostic Utility, Sensitivity, Specificity, and Distribution of Prostate-specific Membrane Antigen-avid Lesions: A Systematic Review and Meta-analysis. Eur. Urol. 2019. [Google Scholar] [CrossRef]
- Wu, H.; Xu, T.; Wang, X.; Yu, Y.B.; Fan, Z.Y.; Li, D.X.; Luo, L.; Yang, X.C.; Jiao, W.; Niu, H.T. Diagnostic Performance of (6)(8)Gallium Labelled Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography and Magnetic Resonance Imaging for Staging the Prostate Cancer with Intermediate or High Risk Prior to Radical Prostatectomy: A Systematic Review and Meta-analysis. World J. Men’s Health 2019. [Google Scholar] [CrossRef]
- van Leeuwen, P.J.; Emmett, L.; Ho, B.; Delprado, W.; Ting, F.; Nguyen, Q.; Stricker, P.D. Prospective evaluation of 68Gallium-prostate-specific membrane antigen positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer. Bju. Int. 2017, 119, 209–215. [Google Scholar] [CrossRef]
- Schwartz, L.H.; Litière, S.; de Vries, E.; Ford, R.; Gwyther, S.; Mandrekar, S.; Shankar, L.; Bogaerts, J.; Chen, A.; Dancey, J.; et al. RECIST 1.1-Update and clarification: From the RECIST committee. Eur. J. Cancer (Oxford, England: 1990) 2016, 62, 132–137. [Google Scholar] [CrossRef]
- Maurer, T.; Gschwend, J.E.; Rauscher, I.; Souvatzoglou, M.; Haller, B.; Weirich, G.; Wester, H.J.; Heck, M.; Kubler, H.; Beer, A.J.; et al. Diagnostic Efficacy of (68)Gallium-PSMA Positron Emission Tomography Compared to Conventional Imaging for Lymph Node Staging of 130 Consecutive Patients with Intermediate to High Risk Prostate Cancer. J. Urol. 2016, 195, 1436–1443. [Google Scholar] [CrossRef] [PubMed]
- McCarthy, M.; Francis, R.; Tang, C.; Watts, J.; Campbell, A. A multicentre prospective clinical trial of (68)Gallium PSMA HBED-CC PET-CT restaging in biochemically relapsed prostate carcinoma: Oligometastatic rate and distribution, compared to standard imaging. Int. J. Radiat. Oncol. Biol. Phys. 2019. [Google Scholar] [CrossRef]
- Zacho, H.D.; Nielsen, J.B.; Haberkorn, U.; Stenholt, L.; Petersen, L.J. (68) Ga-PSMA PET/CT for the detection of bone metastases in prostate cancer: A systematic review of the published literature. Clin. Physiol. Funct. Imaging. 2017. [Google Scholar] [CrossRef] [PubMed]
- de Rooij, M.; Hamoen, E.H.; Witjes, J.A.; Barentsz, J.O.; Rovers, M.M. Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis. Eur. Urol. 2016, 70, 233–245. [Google Scholar] [CrossRef] [PubMed]
- Druskin, S.C.; Liu, J.J.; Young, A.; Feng, Z.; Dianat, S.S.; Ludwig, W.W.; Trock, B.J.; Macura, K.J.; Pavlovich, C.P. Prostate MRI prior to radical prostatectomy: Effects on nerve sparing and pathological margin status. Res. Rep. Urol. 2017, 9, 55–63. [Google Scholar] [CrossRef] [PubMed]
- Fendler, W.P.; Eiber, M.; Beheshti, M.; Bomanji, J.; Ceci, F.; Cho, S.; Giesel, F.; Haberkorn, U.; Hope, T.A.; Kopka, K.; et al. (68)Ga-PSMA PET/CT: Joint EANM and SNMMI procedure guideline for prostate cancer imaging: Version 1.0. Eur. J. Nucl. Med. Mol. Imaging. 2017, 44, 1014–1024. [Google Scholar] [CrossRef] [PubMed]
- Rowe, S.P.; Pienta, K.J.; Pomper, M.G.; Gorin, M.A. PSMA-RADS Version 1.0: A Step Towards Standardizing the Interpretation and Reporting of PSMA-targeted PET Imaging Studies. Eur. Urol. 2018, 73, 485–487. [Google Scholar] [CrossRef] [PubMed]
- Rhee, H.; Ng, K.L.; Tse, B.W.; Yeh, M.C.; Russell, P.J.; Nelson, C.; Thomas, P.; Samaratunga, H.; Vela, I.; Gobe, G.; et al. Using prostate specific membrane antigen (PSMA) expression in clear cell renal cell carcinoma for imaging advanced disease. Pathology 2016. [Google Scholar] [CrossRef] [PubMed]
- Pandit-Taskar, N.; O’Donoghue, J.A.; Divgi, C.R.; Wills, E.A.; Schwartz, L.; Gonen, M.; Smith-Jones, P.; Bander, N.H.; Scher, H.I.; Larson, S.M.; et al. Indium 111-labeled J591 anti-PSMA antibody for vascular targeted imaging in progressive solid tumors. Ejnmmi Res. 2015, 5, 28. [Google Scholar] [CrossRef]
- Klotz, L. Active surveillance: The Canadian experience. Curr. Opin. Urol. 2012, 22, 222–230. [Google Scholar] [CrossRef]
- Stamatakis, L.; Siddiqui, M.M.; Nix, J.W.; Logan, J.; Rais-Bahrami, S.; Walton-Diaz, A.; Hoang, A.N.; Vourganti, S.; Truong, H.; Shuch, B.; et al. Accuracy of multiparametric magnetic resonance imaging in confirming eligibility for active surveillance for men with prostate cancer. Cancer 2013, 119, 3359–3366. [Google Scholar] [CrossRef] [PubMed]
- Klotz, L.; Loblaw, A.; Sugar, L.; Moussa, M.; Berman, D.M.; Van der Kwast, T.; Vesprini, D.; Milot, L.; Kebabdjian, M.; Fleshner, N.; et al. Active Surveillance Magnetic Resonance Imaging Study (ASIST): Results of a Randomized Multicenter Prospective Trial. Eur Urol. 2019, 75, 300–309. [Google Scholar] [CrossRef] [PubMed]
- Olivier, J.; Kasivisvanathan, V.; Drumez, E.; Fantoni, J.C.; Leroy, X.; Puech, P.; Villers, A. Low-risk prostate cancer selected for active surveillance with negative MRI at entry: Can repeat biopsies at 1 year be avoided? A pilot study. World J. Urol. 2019, 37, 253–259. [Google Scholar] [CrossRef] [PubMed]
- Gallagher, K.M.; Christopher, E.; Cameron, A.J.; Little, S.; Innes, A.; Davis, G.; Keanie, J.; Bollina, P.; McNeill, A. Four-year outcomes from a multiparametric magnetic resonance imaging (MRI)-based active surveillance programme: PSA dynamics and serial MRI scans allow omission of protocol biopsies. Bju Int. 2019, 123, 429–438. [Google Scholar] [CrossRef] [PubMed]
- Cantiello, F.; Russo, G.I.; Kaufmann, S.; Cacciamani, G.; Crocerossa, F.; Ferro, M.; De Cobelli, O.; Artibani, W.; Cimino, S.; Morgia, G.; et al. Role of multiparametric magnetic resonance imaging for patients under active surveillance for prostate cancer: A systematic review with diagnostic meta-analysis. Prostate Cancer Prostatic Dis. 2019, 22, 206–220. [Google Scholar] [CrossRef] [PubMed]
- Eineluoto, J.T.; Järvinen, P.; Kenttämies, A.; Kilpeläinen, T.P.; Vasarainen, H.; Sandeman, K.; Erikson, A.; Mirtti, T.; Rannikko, A. Repeat multiparametric MRI in prostate cancer patients on active surveillance. PLoS ONE 2017, 12, e0189272. [Google Scholar] [CrossRef] [PubMed]
- Kane, C.J.; Amling, C.L.; Johnstone, P.A.; Pak, N.; Lance, R.S.; Thrasher, J.B.; Foley, J.P.; Riffenburgh, R.H.; Moul, J.W. Limited value of bone scintigraphy and computed tomography in assessing biochemical failure after radical prostatectomy. Urology 2003, 61, 607–611. [Google Scholar] [CrossRef]
- Carrie, C.; Hasbini, A.; de Laroche, G.; Richaud, P.; Guerif, S.; Latorzeff, I.; Supiot, S.; Bosset, M.; Lagrange, J.L.; Beckendorf, V.; et al. Salvage radiotherapy with or without short-term hormone therapy for rising prostate-specific antigen concentration after radical prostatectomy (GETUG-AFU 16): A randomised, multicentre, open-label phase 3 trial. Lancet Oncol. 2016, 17, 747–756. [Google Scholar] [CrossRef]
- Stephenson, A.J.; Shariat, S.F.; Zelefsky, M.J.; Kattan, M.W.; Butler, E.B.; Teh, B.S.; Klein, E.A.; Kupelian, P.A.; Roehrborn, C.G.; Pistenmaa, D.A.; et al. Salvage Radiotherapy for Recurrent Prostate Cancer after Radical Prostatectomy. JAMA J. Am. Med. Assoc. 2004, 291, 1325–1332. [Google Scholar] [CrossRef]
- Afshar-Oromieh, A.; Zechmann, C.M.; Malcher, A.; Eder, M.; Eisenhut, M.; Linhart, H.G.; Holland-Letz, T.; Hadaschik, B.A.; Giesel, G.L.; Debus, J.; et al. Comparison of PET imaging with a (68)Ga-labelled PSMA ligand and (18)F-choline-based PET/CT for the diagnosis of recurrent prostate cancer. Eur. J. Nucl. Med. Mol. Imaging. 2014, 41, 11–20. [Google Scholar] [CrossRef]
- Afshar-Oromieh, A.; Holland-Letz, T.; Giesel, F.L.; Kratochwil, C.; Mier, W.; Haufe, S.; Debus, N.; Eder, M.; Eisenhut, M.; Schafer, M.; et al. Diagnostic performance of (68)Ga-PSMA-11 (HBED-CC) PET/CT in patients with recurrent prostate cancer: Evaluation in 1007 patients. Eur. J. Nucl. Med. Mol. Imaging. 2017, 44, 1258–1268. [Google Scholar] [CrossRef] [PubMed]
- De Visschere, P.J.L.; Standaert, C.; Futterer, J.J.; Villeirs, G.M.; Panebianco, V.; Walz, J.; Maurer, T.; Hadaschik, B.A.; Lecouvet, F.E.; Giannarini, G.; et al. A Systematic Review on the Role of Imaging in Early Recurrent Prostate Cancer. Eur. Urol. Oncol. 2019, 2, 47–76. [Google Scholar] [CrossRef] [PubMed]
- Calais, J.; Kishan, A.U.; Cao, M.; Fendler, W.P.; Eiber, M.; Herrmann, K.; Ceci, F.; Reiter, R.E.; Rettig, M.B.; Hegde, J.V.; et al. Potential Impact of (68)Ga-PSMA-11 PET/CT on the Planning of Definitive Radiation Therapy for Prostate Cancer. J. Nucl. Med. Off. Publ. Soc. Nuclear Med. 2018, 59, 1714–1721. [Google Scholar]
- Emmett, L.; van Leeuwen, P.J.; Nandurkar, R.; Scheltema, M.J.; Cusick, T.; Hruby, G.; Kneebone, A.; Eade, T.; Fogarty, G.; Jagavkar, R.; et al. Treatment Outcomes from (68)Ga-PSMA PET/CT-Informed Salvage Radiation Treatment in Men with Rising PSA After Radical Prostatectomy: Prognostic Value of a Negative PSMA PET. J. Nucl. Med. Off. Publ. Soc. Nuclear Med. 1972, 58, 1972–1976. [Google Scholar] [CrossRef] [PubMed]
- Herlemann, A.; Kretschmer, A.; Buchner, A.; Karl, A.; Tritschler, S.; El-Malazi, L.; Fendler, W.P.; Wenter, V.; Ilhan, H.; Bartenstein, P.; et al. Salvage lymph node dissection after (68)Ga-PSMA or (18)F-FEC PET/CT for nodal recurrence in prostate cancer patients. Oncotarget 2017, 8, 84180–84192. [Google Scholar] [CrossRef] [PubMed]
- Giesel, F.L.; Will, L.; Lawal, I.; Lengana, T.; Kratochwil, C.; Vorster, M.; Neels, O.; Reyneke, F.; Haberkon, U.; Kopka, K.; et al. Intraindividual Comparison of (18)F-PSMA-1007 and (18)F-DCFPyL PET/CT in the Prospective Evaluation of Patients with Newly Diagnosed Prostate Carcinoma: A Pilot Study. J. Nucl. Med. Off. Publ. Soc. Nuclear Med. 2018, 59, 1076–1080. [Google Scholar] [CrossRef] [PubMed]
- Minner, S.; Wittmer, C.; Graefen, M.; Salomon, G.; Steuber, T.; Haese, A.; Hulland, H.; Bokemeyer, C.; Yekebas, E.; Dierlamm, J.; et al. High level PSMA expression is associated with early PSA recurrence in surgically treated prostate cancer. Prostate 2011, 71, 281–288. [Google Scholar] [CrossRef] [PubMed]
. | PROMIS (22) | PRECISION (23) | MRI-FIRST (24) |
---|---|---|---|
Number (n) | N = 576 | N = 500 MR Pathway n = 252 | N = 251 |
Age (years +/− standard deviation) | 63.4+/−7.6 | 64.4+/−7.5 | 64 (59–68) |
PSA (ng/mL +/− standard deviation or range) | 7.2+/−2.9 | 6.75 (5.16–9.35) | 6.5 (5.6–9.6) |
Clinical Stage (TNM stage) | Less than or equal to cT2c | Less than or equal to cT2c | Less than or equal to cT2c |
Reference | Transperineal biopsy and TRUS biopsy | MR targeted biopsy or TRUS biopsy | Systemic biopsy and MR targeted biopsy |
Definition of csPCa | Gleason grade 4 or greater | Gleason grade 4 or greater | csPCa-A = Gleason grade 4 or greater * |
LESION Scale and Positive Predictive Values (%) | Likert Radiology Reporting Scale | Likert Radiology Reporting Scale | |
1 = 4 | PI-RADS v2 | ||
2 = 12 | |||
3 = 21 | 1 = No biopsy | 1 = No biopsy | |
4 = 58 | 2 = No biopsy | 2 = 6 | |
5 = 81 | 3 = 12 | 3 = 12 | |
(For Gleason score 4 + 3 or greater, or core length equal to or greater than 6mm) | 4 = 60 | 4 = 31 | |
5 = 83 | 5 = 77 | ||
Diagnostic Accuracy of mpMRI (%) | 418 of 576 positive with Likert Score 3–5 | 181 of 252 positive with PI-RADS 3–5 | 198 of 251 positive with Likert score 3–5 |
Sensitivity = 88 (84–91) | |||
Specificity = 45 (39–51) | |||
PPV = 65 (60–69) | PPV = 53 | ||
NPV = 76 (69–82) | PPV = 41 |
mpMRI | PSMA PET | |
---|---|---|
Indications | Active surveillance | |
Loco-regional and distant metastatic disease staging: Primary and Secondary | Loco-regional and distant metastatic disease staging: Primary and Secondary | |
Clarification of indeterminant lesions on conventional imaging | Clarification of indeterminant lesions on conventional imaging | |
Negative TRUS biopsy and clinical suspicious for undetected prostate cancer | Negative TRUS biopsy and/or mpMRI, and clinical suspicious for undetected prostate cancer | |
Assessment of BCR near bladder neck | To determine suitability/treatment response for PSMA targeted theranostic treatment | |
Treatment planning—respectability/risk of positive margin | ||
Contra-Indications or Not Recommended for Interpretation | Aneurysm clip | |
Embolization coil | ||
Implanted cardiac device | ||
Inner ear implant | ||
Intracranial shunt | ||
Metal prosthesis | ||
Neuro/biostimulator | ||
Ocular metallic foreign body | ||
Claustrophobia | ||
Contrast allergy | Contrast allergy | |
Unable to lie down | Unable to lie down | |
Use in Special Circumstances | Contraindicated to prostate biopsy (Coagulopathy, rectal pathology, anterior-perineal resection, immunocompromisation) | Contraindicated to prostate biopsy (Coagulopathy, rectal pathology, anterior-perineal resection, immunocompromisation) Renal impairment |
Limitations to Interpretation of Images | Haemorrhage Prostatitis Fibrosis Atrophy Radiotherapy Hormonal therapy Renal impairment Prosthesis | Local recurrence near bladder neck or a metastatic deposit near bladder. Non-PSMA producing tumour including aggressive tumours such as small cell, neuroendocrine and ductal carcinoma types. Physiological expression in lacrimal or salivary glands, liver, spleen, kidneys, small bowel and ganglia. Benign and malignant tumours with neovascularisation. |
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Mansbridge, M.; Chung, E.; Rhee, H. The Use of MRI and PET Imaging Studies for Prostate Cancer Management: Brief Update, Clinical Recommendations, and Technological Limitations. Med. Sci. 2019, 7, 85. https://doi.org/10.3390/medsci7080085
Mansbridge M, Chung E, Rhee H. The Use of MRI and PET Imaging Studies for Prostate Cancer Management: Brief Update, Clinical Recommendations, and Technological Limitations. Medical Sciences. 2019; 7(8):85. https://doi.org/10.3390/medsci7080085
Chicago/Turabian StyleMansbridge, Margaret, Eric Chung, and Handoo Rhee. 2019. "The Use of MRI and PET Imaging Studies for Prostate Cancer Management: Brief Update, Clinical Recommendations, and Technological Limitations" Medical Sciences 7, no. 8: 85. https://doi.org/10.3390/medsci7080085