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IS THERE A ROLE FOR MAGNETIC RESONANCE IMAGING (MRI) IN THE MANAGEMENT OF T1C CARCINOMA PROSTATE?
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738
A COMPARISON OF PROSTATE CANCER STAGING PERFORMANCE OF GRAY-SCALE TRANSRECTAL ULTRASOUND WITH T2-WEIGHTED 3 TESLA MRI USING A BODY ARRAY AND ENDORECTAL COIL
DIAGNOSTIC ACCURACY OF MAGNETIC RESONANCE IMAGING WITH ENDORECTAL COIL (ER-MRI) IN STAGING EARLY PROSTATE CANCER (EPC) BEFORE RADICAL PROSTATECTOMY (RP)
Heijmink S.1, Fütterer J.1, Van Moerkerk H.2, Langenhuijsen H.2, Hulsbergen-v.d. Kaa C.3, Knipscheer B.2, Witjes F.2, Barentsz J.1
Porcaro A.B.1, Migliorini F.1, Monaco C.1, Balzarro M.1, Montemezzi S.2, Borsato A.2, Gortenuti G.2, Pianon R.1, Longo M.1, Ghimenton C.3, Romano M.4, Comunale L.1 Civil Major Hospital, Urology, Verona, Italy, 2Civil Major Hospital, Radiology, Verona, Italy, Civil Major Hospital, Pathology, Verona, Italy, 4Civil Major Hospital, Radiation Oncology, Verona, Italy
1 1
Radboud University Nijmegen Medical Centre, Radiology, Nijmegen, The Netherlands, 2 Radboud University Nijmegen Medical Centre, Urology, Nijmegen, The Netherlands, 3 Radboud University Nijmegen Medical Centre, Pathology, Nijmegen, The Netherlands INTRODUCTION & OBJECTIVES: With one in three newly diagnosed cancers in men being prostate cancer, the disease burden is considerable. In order to have these patients receive the optimal treatment, accurate staging is important. The goal of this study was to compare the prostate cancer staging performance of gray-scale transrectal ultrasound (TRUS) with 3 tesla T2-weighted body array coil (BAC) and endorectal coil (ERC) magnetic resonance imaging (MRI). MATERIAL & METHODS: Twenty-five consecutive patients with biopsy-proven and clinically localised prostate cancer underwent TRUS and 3 tesla MRI prior to radical prostatectomy. Mean age: 60 years, mean PSA level: 6.34 ng/ml, median biopsy Gleason sum score: 6. Axial gray-scale images were obtained on the Viking® ultrasound machine with a sidefire probe type 8808 (frequency: 10 MHz). T2-weighted MRI in three directions was acquired first with the BAC as sole receiver coil. Subsequently, this was repeated with the ERC only. Two radiologists independently determined the disease stage on a five-point probability scale ranging from definitely stage T2 to definitely stage T3 disease for all anonymized TRUS and MRI sets. Radiologist 1 was most experienced in MRI while radiologist 2 had most experience with TRUS. The order in which the imaging sets were analysed was randomised. Whole-mount section histopathology was the standard of reference. The areas under the receiver operating characteristic curves (AUC) were determined. P<0.05 was considered statistically significant. RESULTS: The AUCs for TRUS, BAC MRI and ERC MRI were 0.61, 0.70 and 0.92, respectively, for radiologist 1, and 0.70, 0.54, and 0.96 for radiologist 2. For radiologist 1 and 2, ERC MRI was significantly better than TRUS and BAC MRI, respectively. CONCLUSIONS: For the radiologist most experienced in MRI, the staging performance of BAC MRI was superior to TRUS. For the radiologist most experienced in TRUS, gray-scale TRUS was superior to that of BAC MRI. However, both radiologists achieved optimal results with ERC MRI.
3
INTRODUCTION & OBJECTIVES: EPC is clinically understaged since 30 to 50% of T2 tumours are P3 at pathological examination of prostatectomy specimens. Assessing EPC for extra capsular extention (ECE) and seminal vescicle involvement (SVI) is a hard task. Tables and nomograms gathering together pathological findings from biopsy cores, PSA and digital rectal examination (DRE) have a good statistic predictive but their individual use for therapeutic decision making is more questionable. ER-MRI has shown to be effective in detecting clinical understaging of EPC thus allowing effective treatment decision making Herein, we investigated the accuracy of ER-MRI in staging EPC for both ECE and SVI. MATERIAL & METHODS: 111 patients with EPC underwent RP. The mean age was 66 years (range 51-77). The mean total PSA serum level was 10,8 ng/mL (range 1-83,57). The mean biopsy Gleason score was 6 (range 4-8). ER-MRI was performed at least 45 days after prostate biopsies by using the Magnetom Symphony 1.5 Tesla. Histological examination was performed according to the Standford protocol. ER-MRI and pathology findings were statistically related to each other in order to assess sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy of ER-MRI. RESULTS: The mean pathologic Gleason score was 6 (range 4-9). Pathology detected 77 out of 111 patients (70%) as P2 prostate cancer and 34 cases (30%) as P3 prostate cancer which was assessed as ECE in 23 patients (21%) and SVI in 11 cases (9%). ER-MRI staged 80 patients (72%) as early prostate cancer and 31 (28%) as locally advanced with ECE in 18 cases (16%) and SVI in 13 (12%). ER-MRI sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy resulted respectively 71%, 99%, 94%, 92% and 93% for ECE; 100%, 98%, 84%, 100% and 98% for detecting SVI. CONCLUSIONS: In our experience, ER-MRI has shown to be effective in detecting both ECE and SVI in patients with EPC. This diagnostic procedure could be effective in staging selected patients with EPC. Indeed, ER-MRI efficacy in assessing prostate cancer ECE can help the surgeon in planning an extended radical prostatectomy dissection without a nerve sparing procedure which will reduce the risk of positive surgical margins. In the future, ER-MRI can be a safe and effective procedure in selecting patients for seminal vesicle sparing radical prostatectomy which will improve both continence and potency.
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740
IS THERE A ROLE FOR MAGNETIC RESONANCE IMAGING (MRI) IN THE MANAGEMENT OF T1C CARCINOMA PROSTATE?
WASH-IN RATE ON THE BASIS OF DYNAMIC CONTRAST-ENHANCED MR IMAGING: USEFULNESS FOR PROSTATE CANCER DETECTION AND LOCALISATION
Qazi H.2, Manikandan R.2, Philip J.2, Mistry R.2, Lamb G.1, Cornford P.2, Woolfenden A.2, Parsons K.2 1
The Royal Liverpool University Hospital, Radiology, Liverpool, United Kingdom, 2 The Royal Liverpool University Hospital, Urology, Liverpool, United Kingdom
INTRODUCTION & OBJECTIVES: To assess the role and implications of magnetic resonance imaging (MRI) in the management of patients with T1c prostate cancer. MATERIAL & METHODS: Data was collected from our oncology database where all new prostate cancers are recorded for a period of 3 years, ending May 2005. Gleason grade, clinical stage, cross–sectional imaging result and subsequent treatment were also recorded. The results of patients with T1c prostate cancer undergoing MRI prior to radical treatment (radical prostatectomy of radical radiotherapy) were analysed to see whether the MRI scans result altered the modality of treatment offered to the patient. RESULTS: A total of 765 patients were diagnosed with prostate cancer. of the 177 patients with T1c disease, 117 were considered eligible for radical treatment and underwent cross-sectional imaging. One hundred and seventeen patients had an MRI scan. of the 117, 111 patients had negative scans that showed no extracapsular invasion while five were equivocal. All the 5 had further investigation either by CT scanning or targeted biopsies, which confirmed the cancer to be localised. In only one case did the MRI upstage T1c disease to T3. The imaging result therefore affected treatment choice in only one patient in that radical surgery was not offered on the basis of the scan findings. CONCLUSIONS: Routine cross sectional imaging is not necessary in patients with T1c prostate cancer because in only 0.8% of patients were the treatment plan influenced by the MRI result.
Lee S.B.1, Kim J.K.2, Park J.1, Yoo C.1, Kim H.S.3, Park J.Y.4, Ahn H.1, Kim C.S.1 1
Asan Medical Center, Urology, Seoul, South Korea, 2Asan Medical Center, Radiology, Seoul, South Korea, 3Chungnam National University Hospital, Urology, Daejeon, South Korea, 4Kangneung Asan Hospital, Urology, Kangneung, South Korea INTRODUCTION & OBJECTIVES: Preliminary studies have shown that prostate cancer tissue enhanced earlier and more intensively than normal tissue on dynamic contrast–enhanced MR imaging. Therefore, the application of the wash–in rate, defined as the maximum slope between the time of onset of contrast inflow and the time of peak intensity, may be helpful in discriminating prostate cancer from normal prostate tissue. We evaluated the usefulness of the wash-in rate based on dynamic contrast-enhanced MR imaging for prostate cancer detection and localisation. MATERIAL & METHODS: 53 patients with both dynamic contrast–enhanced MR imaging and histologic map of prostate cancer after radical retropubic prostatectomy were enrolled in this study. In these patients, the wash-in rate was measured at cancer area and at three normal areas (peripheral zone, inner portion of the transitional zone, outer portion of the transitional zone). On the basis of these data, parametric imaging was generated. On parametric imaging, the value of the wash–in rate was displayed with colour–scale, and then its accuracy for cancer detection and location was evaluated with comparison to that of T2weighted imaging without endorectal coil while dividing the entire prostate into 18 segments. RESULTS: The wash-in rate value was greater at cancer tissue (9.2/s) than at three normal tissues (3.3/s, 6.7/s and 3.2/s) (p<0.001). The sensitivity and specificity were greater on parametric imaging of the wash-in rate than on T2-weighted imaging in the entire prostate (96% and 82% versus 65% and 60%, respectively) and peripheral zone (96% and 97% versus 75% and 53%) (p<0.05). In the transitional zone, the sensitivity was greater on parametric imaging (96%) than on T2-weighted imaging (45%) (p=0.016) but the specificity was similar (51% versus 73%) (p=0.102). CONCLUSIONS: The wash-in rate based on dynamic contrast-enhanced MR imaging is a useful parameter for prostate cancer detection and localisation. Eur Urol Suppl 2006;5(2):207
738
A COMPARISON OF PROSTATE CANCER STAGING PERFORMANCE OF GRAY-SCALE TRANSRECTAL ULTRASOUND WITH T2-WEIGHTED 3 TESLA MRI USING A BODY ARRAY AND ENDORECTAL COIL
DIAGNOSTIC ACCURACY OF MAGNETIC RESONANCE IMAGING WITH ENDORECTAL COIL (ER-MRI) IN STAGING EARLY PROSTATE CANCER (EPC) BEFORE RADICAL PROSTATECTOMY (RP)
Heijmink S.1, Fütterer J.1, Van Moerkerk H.2, Langenhuijsen H.2, Hulsbergen-v.d. Kaa C.3, Knipscheer B.2, Witjes F.2, Barentsz J.1
Porcaro A.B.1, Migliorini F.1, Monaco C.1, Balzarro M.1, Montemezzi S.2, Borsato A.2, Gortenuti G.2, Pianon R.1, Longo M.1, Ghimenton C.3, Romano M.4, Comunale L.1 Civil Major Hospital, Urology, Verona, Italy, 2Civil Major Hospital, Radiology, Verona, Italy, Civil Major Hospital, Pathology, Verona, Italy, 4Civil Major Hospital, Radiation Oncology, Verona, Italy
1 1
Radboud University Nijmegen Medical Centre, Radiology, Nijmegen, The Netherlands, 2 Radboud University Nijmegen Medical Centre, Urology, Nijmegen, The Netherlands, 3 Radboud University Nijmegen Medical Centre, Pathology, Nijmegen, The Netherlands INTRODUCTION & OBJECTIVES: With one in three newly diagnosed cancers in men being prostate cancer, the disease burden is considerable. In order to have these patients receive the optimal treatment, accurate staging is important. The goal of this study was to compare the prostate cancer staging performance of gray-scale transrectal ultrasound (TRUS) with 3 tesla T2-weighted body array coil (BAC) and endorectal coil (ERC) magnetic resonance imaging (MRI). MATERIAL & METHODS: Twenty-five consecutive patients with biopsy-proven and clinically localised prostate cancer underwent TRUS and 3 tesla MRI prior to radical prostatectomy. Mean age: 60 years, mean PSA level: 6.34 ng/ml, median biopsy Gleason sum score: 6. Axial gray-scale images were obtained on the Viking® ultrasound machine with a sidefire probe type 8808 (frequency: 10 MHz). T2-weighted MRI in three directions was acquired first with the BAC as sole receiver coil. Subsequently, this was repeated with the ERC only. Two radiologists independently determined the disease stage on a five-point probability scale ranging from definitely stage T2 to definitely stage T3 disease for all anonymized TRUS and MRI sets. Radiologist 1 was most experienced in MRI while radiologist 2 had most experience with TRUS. The order in which the imaging sets were analysed was randomised. Whole-mount section histopathology was the standard of reference. The areas under the receiver operating characteristic curves (AUC) were determined. P<0.05 was considered statistically significant. RESULTS: The AUCs for TRUS, BAC MRI and ERC MRI were 0.61, 0.70 and 0.92, respectively, for radiologist 1, and 0.70, 0.54, and 0.96 for radiologist 2. For radiologist 1 and 2, ERC MRI was significantly better than TRUS and BAC MRI, respectively. CONCLUSIONS: For the radiologist most experienced in MRI, the staging performance of BAC MRI was superior to TRUS. For the radiologist most experienced in TRUS, gray-scale TRUS was superior to that of BAC MRI. However, both radiologists achieved optimal results with ERC MRI.
3
INTRODUCTION & OBJECTIVES: EPC is clinically understaged since 30 to 50% of T2 tumours are P3 at pathological examination of prostatectomy specimens. Assessing EPC for extra capsular extention (ECE) and seminal vescicle involvement (SVI) is a hard task. Tables and nomograms gathering together pathological findings from biopsy cores, PSA and digital rectal examination (DRE) have a good statistic predictive but their individual use for therapeutic decision making is more questionable. ER-MRI has shown to be effective in detecting clinical understaging of EPC thus allowing effective treatment decision making Herein, we investigated the accuracy of ER-MRI in staging EPC for both ECE and SVI. MATERIAL & METHODS: 111 patients with EPC underwent RP. The mean age was 66 years (range 51-77). The mean total PSA serum level was 10,8 ng/mL (range 1-83,57). The mean biopsy Gleason score was 6 (range 4-8). ER-MRI was performed at least 45 days after prostate biopsies by using the Magnetom Symphony 1.5 Tesla. Histological examination was performed according to the Standford protocol. ER-MRI and pathology findings were statistically related to each other in order to assess sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy of ER-MRI. RESULTS: The mean pathologic Gleason score was 6 (range 4-9). Pathology detected 77 out of 111 patients (70%) as P2 prostate cancer and 34 cases (30%) as P3 prostate cancer which was assessed as ECE in 23 patients (21%) and SVI in 11 cases (9%). ER-MRI staged 80 patients (72%) as early prostate cancer and 31 (28%) as locally advanced with ECE in 18 cases (16%) and SVI in 13 (12%). ER-MRI sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy resulted respectively 71%, 99%, 94%, 92% and 93% for ECE; 100%, 98%, 84%, 100% and 98% for detecting SVI. CONCLUSIONS: In our experience, ER-MRI has shown to be effective in detecting both ECE and SVI in patients with EPC. This diagnostic procedure could be effective in staging selected patients with EPC. Indeed, ER-MRI efficacy in assessing prostate cancer ECE can help the surgeon in planning an extended radical prostatectomy dissection without a nerve sparing procedure which will reduce the risk of positive surgical margins. In the future, ER-MRI can be a safe and effective procedure in selecting patients for seminal vesicle sparing radical prostatectomy which will improve both continence and potency.
739
740
IS THERE A ROLE FOR MAGNETIC RESONANCE IMAGING (MRI) IN THE MANAGEMENT OF T1C CARCINOMA PROSTATE?
WASH-IN RATE ON THE BASIS OF DYNAMIC CONTRAST-ENHANCED MR IMAGING: USEFULNESS FOR PROSTATE CANCER DETECTION AND LOCALISATION
Qazi H.2, Manikandan R.2, Philip J.2, Mistry R.2, Lamb G.1, Cornford P.2, Woolfenden A.2, Parsons K.2 1
The Royal Liverpool University Hospital, Radiology, Liverpool, United Kingdom, 2 The Royal Liverpool University Hospital, Urology, Liverpool, United Kingdom
INTRODUCTION & OBJECTIVES: To assess the role and implications of magnetic resonance imaging (MRI) in the management of patients with T1c prostate cancer. MATERIAL & METHODS: Data was collected from our oncology database where all new prostate cancers are recorded for a period of 3 years, ending May 2005. Gleason grade, clinical stage, cross–sectional imaging result and subsequent treatment were also recorded. The results of patients with T1c prostate cancer undergoing MRI prior to radical treatment (radical prostatectomy of radical radiotherapy) were analysed to see whether the MRI scans result altered the modality of treatment offered to the patient. RESULTS: A total of 765 patients were diagnosed with prostate cancer. of the 177 patients with T1c disease, 117 were considered eligible for radical treatment and underwent cross-sectional imaging. One hundred and seventeen patients had an MRI scan. of the 117, 111 patients had negative scans that showed no extracapsular invasion while five were equivocal. All the 5 had further investigation either by CT scanning or targeted biopsies, which confirmed the cancer to be localised. In only one case did the MRI upstage T1c disease to T3. The imaging result therefore affected treatment choice in only one patient in that radical surgery was not offered on the basis of the scan findings. CONCLUSIONS: Routine cross sectional imaging is not necessary in patients with T1c prostate cancer because in only 0.8% of patients were the treatment plan influenced by the MRI result.
Lee S.B.1, Kim J.K.2, Park J.1, Yoo C.1, Kim H.S.3, Park J.Y.4, Ahn H.1, Kim C.S.1 1
Asan Medical Center, Urology, Seoul, South Korea, 2Asan Medical Center, Radiology, Seoul, South Korea, 3Chungnam National University Hospital, Urology, Daejeon, South Korea, 4Kangneung Asan Hospital, Urology, Kangneung, South Korea INTRODUCTION & OBJECTIVES: Preliminary studies have shown that prostate cancer tissue enhanced earlier and more intensively than normal tissue on dynamic contrast–enhanced MR imaging. Therefore, the application of the wash–in rate, defined as the maximum slope between the time of onset of contrast inflow and the time of peak intensity, may be helpful in discriminating prostate cancer from normal prostate tissue. We evaluated the usefulness of the wash-in rate based on dynamic contrast-enhanced MR imaging for prostate cancer detection and localisation. MATERIAL & METHODS: 53 patients with both dynamic contrast–enhanced MR imaging and histologic map of prostate cancer after radical retropubic prostatectomy were enrolled in this study. In these patients, the wash-in rate was measured at cancer area and at three normal areas (peripheral zone, inner portion of the transitional zone, outer portion of the transitional zone). On the basis of these data, parametric imaging was generated. On parametric imaging, the value of the wash–in rate was displayed with colour–scale, and then its accuracy for cancer detection and location was evaluated with comparison to that of T2weighted imaging without endorectal coil while dividing the entire prostate into 18 segments. RESULTS: The wash-in rate value was greater at cancer tissue (9.2/s) than at three normal tissues (3.3/s, 6.7/s and 3.2/s) (p<0.001). The sensitivity and specificity were greater on parametric imaging of the wash-in rate than on T2-weighted imaging in the entire prostate (96% and 82% versus 65% and 60%, respectively) and peripheral zone (96% and 97% versus 75% and 53%) (p<0.05). In the transitional zone, the sensitivity was greater on parametric imaging (96%) than on T2-weighted imaging (45%) (p=0.016) but the specificity was similar (51% versus 73%) (p=0.102). CONCLUSIONS: The wash-in rate based on dynamic contrast-enhanced MR imaging is a useful parameter for prostate cancer detection and localisation. Eur Urol Suppl 2006;5(2):207