Re: Identification of Bone Metastasis with Routine Prostate MRI: A Study of Patients with Newly Diagnosed Prostate Cancer

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TESTIS CANCER AND ADVANCES IN ONCOLOGIC THERAPY

dihydrotestosterone and prostate specific membrane antigen imaging), initial prostate evaluation, treatment response and recurrence imaging are discussed in detail. Molecular strategies for imaging the prostate are evolving. This article provides an excellent review of what is currently available and future trends in this area. Cary Siegel, MD

Re: Identification of Bone Metastasis with Routine Prostate MRI: A Study of Patients with Newly Diagnosed Prostate Cancer S. Woo, S. Y. Kim, S. H. Kim and J. Y. Cho Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Korea AJR Am J Roentgenol 2016; 206: 1156e1163. doi: 10.2214/AJR.15.15761

Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/27043655 Editorial Comment: In this study 308 patients with newly diagnosed prostate cancer underwent magnetic resonance imaging (MRI). Of these patients 21 had metastatic disease to the bone. It is not surprising that this group with bone metastasis had a higher prostate specific antigen and Gleason score than the group without bone metastasis. Bone lesions were classified as equivocal if smaller than 1 cm. Lesions larger than 1 cm with focal or diffuse abnormal signal in the bone marrow, low signal on the T1-weighted images, immediate to low signal on the T2 images, high signal on the diffusion and brisk enhancement were thought to represent metastatic disease. Only 1 of the 21 patients had a bone metastasis outside the field of view on prostate MRI (thoracic spine). Some radiologists have suggested adding routine whole body axial skeleton sequences to the prostate MRI protocol for a thorough assessment for bone metastasis, while others believe that this step would be cost and time prohibitive. This study shows that the majority of patients with metastatic disease have an identifiable bone metastasis on the standard prostate MRI protocol, which investigates the pelvis and lumbar spine. Multiparametric MRI has been recognized as the most comprehensive initial evaluation for patients with prostate cancer. This method allows tumor localization, local treatment, planning for directed biopsy and determination of which patients may undergo surveillance. Performance of MRI of the prostate to detect bone metastasis is good and may obviate the need for a bone scan in the future. Cary Siegel, MD

Urological Oncology: Testis Cancer and Advances in Oncologic Therapy Re: Cardiovascular Disease Mortality after Chemotherapy or Surgery for Testicular Nonseminoma: A Population-Based Study C. Fung, S. D. Fossa, M. T. Milano, D. M. Sahasrabudhe, D. R. Peterson and L. B. Travis University of Rochester Medical Center, Rochester, New York, and Norwegian Radium Hospital, Oslo, Norway J Clin Oncol 2015; 33: 3105e3115. doi: 10.1200/JCO.2014.60.3654

Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26240226 Editorial Comment: Previous investigations of cardiovascular disease (CVD) mortality were largely restricted to long-term survivors and included patients treated before platinum based therapy. The authors used SEER (Surveillance, Epidemiology and End Results) data to evaluate standardized