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1851 VALUE OF MAGNETIC RESONANCE SPECTROSCOPY IMAGING (MRSI) AND DYNAMIC CONTRAST-ENHANCED IMAGING MR (DCEMR) FOR THE DETECTION OF PROSTATE ADENOCARCINOMA FOCI IN MEN WITH PRIOR NEGATIVE PROSTATE BIOPSY AND ELEVATED PROSTATE SPECIFIC ANTIGEN (PSA) LEVELS
Vol. 183, No. 4, Supplement, Wednesday, June 2, 2010
1851 VALUE OF MAGNETIC RESONANCE SPECTROSCOPY IMAGING (MRSI) AND DYNAMIC CONTRAST-ENHANCED IMAGING MR (DCEMR) FOR THE DETECTION OF PROSTATE ADENOCARCINOMA FOCI IN MEN WITH PRIOR NEGATIVE PROSTATE BIOPSY AND ELEVATED PROSTATE SPECIFIC ANTIGEN (PSA) LEVELS Alessandro Sciarra, Valeria Panebianco*, Stefano Salciccia, Gentilucci Alessandro, Parente Ulderico, Alfarone Andrea, Susanna Cattarino, Roberto Passariello, Vincenzo Gentile, Rome, Italy INTRODUCTION AND OBJECTIVES: To prospectively analyse the role of magnetic resonance spectroscopy imaging (MRSI) and dynamic-contrast enhancement MR (DCEMR) in the detection of prostate tumor foci in patients with persistently elevated PSA levels (in the ´ 4 ng/ml and ⬍ 10 ng/ml) and prior negative random range of ¡Y TRUS-guided biopsy METHODS: This is a prospective randomized single centre study on patients with prior negative random TRUS-guided prostate biopsy and persistent elevated PSA levels. One hundred and eighty eligible cases were included in the study.Patients in Group A were submitted to a second random prostate biopsy, whereas patients in Group B were submitted to a 1H-MRSI-DCEMR examination and samples targeted on suspicious areas were associated to the random biopsy. All examinations were performed on a commercially available 1.5 T scanner RESULTS: At the second biopsy, a prostate adenocarcinoma histological diagnosis was found in 22/90 cases (24.4%) in Group A and in 41/90 cases (45.5%) in Group B (P⫽0.01). On a patient by patient basis, MRSI had a 92.3% sensitivity, 88.2% specificity, 85.7% PPV, 93.7% NPV and 90% accuracy; DCEMR had a 84.6 % sensitivity, 82.3% specificity, 78.5% PPV, 87.5% NPV and 83.3% accuracy and the association MRSI ⫹ DCEMR a 92.6% sensitivity, 88.8% specificity, 88.7% PPV, 92.7% NPV and 90.7% accuracy, for predicting prostate cancer detection CONCLUSIONS: In our population, the combination of MRSI to DCEMR showed the potential to guide biopsy to cancer foci in patients with previously negative TRUS biopsy. Source of Funding: None
1852 ENDORECTAL MAGNETIC RESONANCE IMAGING OF THE PROSTATE. A USEFUL TOOL IN THE DETECTION OF ANTERIOR PROSTATE CANCER. Apostolos P. Labanaris*, Karl Engelhard, Reinhold Nu¨tzel, Robert Smiszek, Reinhard Ku¨hn, Nuremberg, Germany INTRODUCTION AND OBJECTIVES: Although anterior prostate cancer (APC) comprises a significant proportion of prostate cancer (PCa), its diagnosis is troublesome due to its anatomical location and that patients with an APC often require multiple sets of biopsies until diagnosis is made. The objective of this study is to examine if endorectal magnetic resonance imaging (e-MRI) of the prostate could be considered a useful modality in the detection of APC. METHODS: A retrospective review of N⫽386 patients records with a clinical suspicion of PCa (PSA levels ⬎4 ng/ml or a suspicious finding on digital rectal examination) and at least 1 negative prostate biopsy who underwent conventional (e-cMRI) and functional (e-fMRI) e-MRI of the prostate and subsequently prostate biopsy from April 2004 to September 2009 was conducted. e-fMRI included contrast-enhanced e-MRI and diffusion weighted imaging. Interpretation of the images were performed by a highly experienced radiologist (⬎800 interpreted e-cMRI and e-fMRI images) blinded to patient clinical data. N⫽257 (66,5%) patients images were considered to be suspicious for PCa of which N⫽46 (17,8%) cases were considered to be suspicious for APC (defined as the presence of PCa anterior to the urethra). All patients underwent an 18 core transrectal ultrasound (TRUS) guided biopsy of the peripheral zone and an additional 3 core TRUS targeted
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biopsy anterior to the urethra. The clinicopathological parameters of the patients included age, PSA levels, number of prior negative biopsy sets, digital rectal examination (DRE) findings, APC detection rate and e-MRI specificity, sensitivity and accuracy. RESULTS: The median age and median PSA levels of the patients were 68,9 (56-72) years and 12,1 ng/ml (6,4 ng/ml-17,9 ng/ml) respectively. For N⫽16 patients (34,7%) this was their second biopsy, for N⫽21 (45,6%) their third and for N⫽9 (19,7%) their forth prostate biopsy. DRE was only positive in N⫽6 patients (13,1%). The overall PCa detection rate was 84,7%. APC was detected through the targeted cores in N⫽39 patients (84,7%). N⫽6 patients (13,1%) exhibited a PCa of the peripheral zone as well. e-MRI exhibited a specificity of 84,7%, a sensitivity of 86,9% and an accuracy of 85,8%. CONCLUSIONS: APC should always be suspected in patients with a constant increase of PSA levels, negative DRE findings and prior negative sets of prostate biopsy. In such cases, e-MRI of the prostate and subsequently TRUS targeted biopsies of possible suspicious sites of the anterior gland can be considered as a useful modality in the detection of APC. Source of Funding: None
1853 ARE VOIDING SYMPTOMS AS MEASURED BY AUA SYMPTOM SCORE PREDICTIVE OF THE PRESENCE OF HIGH GRADE PROSTATIC MALIGNANCY? Tina Chau, Erin Odom, John M. Corman*, Seattle, WA INTRODUCTION AND OBJECTIVES: Several instruments have been developed to assess the severity of lower urinary tract symptoms secondary to benign prostatic hypertrophy (BPH). The most commonly employed survey is the American Urologic Association Symptom Score (AUASS). While many studies have evaluated the correlation between symptom score and commonly measured parameters of BPH, few analyses have assessed the relationship between voiding symptom scores and the presence and grade of prostatic malignancy. METHODS: We performed a prospective assessment of 1100 consecutive men who underwent an office based (TRUS)-guided prostate needle biopsy. Patients were prospectively enrolled in an IRB approved, HIPAA compliant database. Patients who underwent fewer than a 10 core biopsy set, did not complete their AUASS or had histology that was reviewed outside of our institution were excluded from the analysis. RESULTS: 401 patients had complete data for assessment. Evaluable patients were divided into tertiles based on AUASS (0-10, 11-20, 21⫹). AUASS trended towards being inversely related to the occurrence of prostate cancer, although not statistically significant (p ⫽0.043 Chi square test of correlation). Of those patients with a positive biopsy, an increase in AUASS was significantly correlated with higher likelihood of grade disease (Gleason Grade ⬎/⫽ 8) (p⫽ 0.025). CONCLUSIONS: As suggested in previous studies, a low AUASS may be a predictor of prostatic malignancy in those patients undergoing a “for cause” prostate needle biopsy. In those patients with malignancy, the presence of profound voiding symptoms is associated with a greater risk of higher grade disease.
Source of Funding: None
1851 VALUE OF MAGNETIC RESONANCE SPECTROSCOPY IMAGING (MRSI) AND DYNAMIC CONTRAST-ENHANCED IMAGING MR (DCEMR) FOR THE DETECTION OF PROSTATE ADENOCARCINOMA FOCI IN MEN WITH PRIOR NEGATIVE PROSTATE BIOPSY AND ELEVATED PROSTATE SPECIFIC ANTIGEN (PSA) LEVELS Alessandro Sciarra, Valeria Panebianco*, Stefano Salciccia, Gentilucci Alessandro, Parente Ulderico, Alfarone Andrea, Susanna Cattarino, Roberto Passariello, Vincenzo Gentile, Rome, Italy INTRODUCTION AND OBJECTIVES: To prospectively analyse the role of magnetic resonance spectroscopy imaging (MRSI) and dynamic-contrast enhancement MR (DCEMR) in the detection of prostate tumor foci in patients with persistently elevated PSA levels (in the ´ 4 ng/ml and ⬍ 10 ng/ml) and prior negative random range of ¡Y TRUS-guided biopsy METHODS: This is a prospective randomized single centre study on patients with prior negative random TRUS-guided prostate biopsy and persistent elevated PSA levels. One hundred and eighty eligible cases were included in the study.Patients in Group A were submitted to a second random prostate biopsy, whereas patients in Group B were submitted to a 1H-MRSI-DCEMR examination and samples targeted on suspicious areas were associated to the random biopsy. All examinations were performed on a commercially available 1.5 T scanner RESULTS: At the second biopsy, a prostate adenocarcinoma histological diagnosis was found in 22/90 cases (24.4%) in Group A and in 41/90 cases (45.5%) in Group B (P⫽0.01). On a patient by patient basis, MRSI had a 92.3% sensitivity, 88.2% specificity, 85.7% PPV, 93.7% NPV and 90% accuracy; DCEMR had a 84.6 % sensitivity, 82.3% specificity, 78.5% PPV, 87.5% NPV and 83.3% accuracy and the association MRSI ⫹ DCEMR a 92.6% sensitivity, 88.8% specificity, 88.7% PPV, 92.7% NPV and 90.7% accuracy, for predicting prostate cancer detection CONCLUSIONS: In our population, the combination of MRSI to DCEMR showed the potential to guide biopsy to cancer foci in patients with previously negative TRUS biopsy. Source of Funding: None
1852 ENDORECTAL MAGNETIC RESONANCE IMAGING OF THE PROSTATE. A USEFUL TOOL IN THE DETECTION OF ANTERIOR PROSTATE CANCER. Apostolos P. Labanaris*, Karl Engelhard, Reinhold Nu¨tzel, Robert Smiszek, Reinhard Ku¨hn, Nuremberg, Germany INTRODUCTION AND OBJECTIVES: Although anterior prostate cancer (APC) comprises a significant proportion of prostate cancer (PCa), its diagnosis is troublesome due to its anatomical location and that patients with an APC often require multiple sets of biopsies until diagnosis is made. The objective of this study is to examine if endorectal magnetic resonance imaging (e-MRI) of the prostate could be considered a useful modality in the detection of APC. METHODS: A retrospective review of N⫽386 patients records with a clinical suspicion of PCa (PSA levels ⬎4 ng/ml or a suspicious finding on digital rectal examination) and at least 1 negative prostate biopsy who underwent conventional (e-cMRI) and functional (e-fMRI) e-MRI of the prostate and subsequently prostate biopsy from April 2004 to September 2009 was conducted. e-fMRI included contrast-enhanced e-MRI and diffusion weighted imaging. Interpretation of the images were performed by a highly experienced radiologist (⬎800 interpreted e-cMRI and e-fMRI images) blinded to patient clinical data. N⫽257 (66,5%) patients images were considered to be suspicious for PCa of which N⫽46 (17,8%) cases were considered to be suspicious for APC (defined as the presence of PCa anterior to the urethra). All patients underwent an 18 core transrectal ultrasound (TRUS) guided biopsy of the peripheral zone and an additional 3 core TRUS targeted
THE JOURNAL OF UROLOGY姞
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biopsy anterior to the urethra. The clinicopathological parameters of the patients included age, PSA levels, number of prior negative biopsy sets, digital rectal examination (DRE) findings, APC detection rate and e-MRI specificity, sensitivity and accuracy. RESULTS: The median age and median PSA levels of the patients were 68,9 (56-72) years and 12,1 ng/ml (6,4 ng/ml-17,9 ng/ml) respectively. For N⫽16 patients (34,7%) this was their second biopsy, for N⫽21 (45,6%) their third and for N⫽9 (19,7%) their forth prostate biopsy. DRE was only positive in N⫽6 patients (13,1%). The overall PCa detection rate was 84,7%. APC was detected through the targeted cores in N⫽39 patients (84,7%). N⫽6 patients (13,1%) exhibited a PCa of the peripheral zone as well. e-MRI exhibited a specificity of 84,7%, a sensitivity of 86,9% and an accuracy of 85,8%. CONCLUSIONS: APC should always be suspected in patients with a constant increase of PSA levels, negative DRE findings and prior negative sets of prostate biopsy. In such cases, e-MRI of the prostate and subsequently TRUS targeted biopsies of possible suspicious sites of the anterior gland can be considered as a useful modality in the detection of APC. Source of Funding: None
1853 ARE VOIDING SYMPTOMS AS MEASURED BY AUA SYMPTOM SCORE PREDICTIVE OF THE PRESENCE OF HIGH GRADE PROSTATIC MALIGNANCY? Tina Chau, Erin Odom, John M. Corman*, Seattle, WA INTRODUCTION AND OBJECTIVES: Several instruments have been developed to assess the severity of lower urinary tract symptoms secondary to benign prostatic hypertrophy (BPH). The most commonly employed survey is the American Urologic Association Symptom Score (AUASS). While many studies have evaluated the correlation between symptom score and commonly measured parameters of BPH, few analyses have assessed the relationship between voiding symptom scores and the presence and grade of prostatic malignancy. METHODS: We performed a prospective assessment of 1100 consecutive men who underwent an office based (TRUS)-guided prostate needle biopsy. Patients were prospectively enrolled in an IRB approved, HIPAA compliant database. Patients who underwent fewer than a 10 core biopsy set, did not complete their AUASS or had histology that was reviewed outside of our institution were excluded from the analysis. RESULTS: 401 patients had complete data for assessment. Evaluable patients were divided into tertiles based on AUASS (0-10, 11-20, 21⫹). AUASS trended towards being inversely related to the occurrence of prostate cancer, although not statistically significant (p ⫽0.043 Chi square test of correlation). Of those patients with a positive biopsy, an increase in AUASS was significantly correlated with higher likelihood of grade disease (Gleason Grade ⬎/⫽ 8) (p⫽ 0.025). CONCLUSIONS: As suggested in previous studies, a low AUASS may be a predictor of prostatic malignancy in those patients undergoing a “for cause” prostate needle biopsy. In those patients with malignancy, the presence of profound voiding symptoms is associated with a greater risk of higher grade disease.
Source of Funding: None