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Re: Magnetic Resonance Imaging-Ultrasound Fusion Biopsy during Prostate Cancer Active Surveillance
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then of treatment, given recent observations that men with mutations of DNA repair genes respond favorably to the PARP inhibitor, olaparib. Routine testing of men with metastatic disease in the future may help to guide therapy in this regard. Samir S. Taneja, MD
Suggested Reading Hirata H, Hinoda Y, Kawamoto K et al: Mismatch repair gene MSH3 polymorphism is associated with the risk of sporadic prostate cancer. J Urol 2008; 179: 2020. Chen L, Ambrosone CB, Lee J et al: Association between polymorphisms in the DNA repair genes XRCC1 and APE1, and the risk of prostate cancer in white and black Americans. J Urol 2006; 175: 108. Prtilo A, Leach FS, Markwalder R et al: Tissue microarray analysis of hMSH2 expression predicts outcome in men with prostate cancer. J Urol 2005; 174: 1814.
Re: Magnetic Resonance Imaging-Ultrasound Fusion Biopsy During Prostate Cancer Active Surveillance G. N. Tran, M. S. Leapman, H. G. Nguyen, J. E. Cowan, K. Shinohara, A. C. Westphalen and P. R. Carroll Helen Diller Family Comprehensive Cancer Center, University of California and Departments of Urology, and Radiology and Biomedical Imaging, University of California School of Medicine San Francisco, California Eur Urol 2016; Epub ahead of print. doi: 10.1016/j.eururo.2016.08.023
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/27595378 Editorial Comment: We continue to evaluate the role of multiparametric (mp) magnetic resonance imaging (MRI) and MRI targeted biopsy in clinical practice and to learn about the broad applicability of the tests. One potential role for mpMRI is in the assessment and monitoring of men with low risk prostate cancer on surveillance. Surveillance, as currently practiced without mpMRI, has been demonstrated to achieve excellent cancer specific survival and metastasis-free progression at 15 years of followup, when properly used, although up to 50% of men may need treatment along the way. I have contended that mpMRI cannot improve the oncologic outcomes of surveillance greatly, but it may afford us a tool for better baseline risk stratification, resulting secondarily in better selection of candidates for surveillance, requiring fewer followup biopsies. In this study from a well reported surveillance cohort the use of mpMRI and MRI targeted biopsy appeared to improve the identification of occult high grade disease in men on surveillance. Several critical observations are made and are consistent with the global experience in men with known cancer to date, ie 1) mpMRI targeted biopsy increased the detection of occult high grade disease, 2) systematic biopsy uniquely identified a significant number of men with occult high grade disease not identified by mpMRI targeted biopsy, suggesting a need for both in maximizing biopsy information (this is consistent with our experience and I believe it reflects the high prevalence of small volumes of pattern 4 in this population), and 3) mpMRI suspicion score predicted the likelihood of upgrade, particularly among those with significant upgrade to dominant Gleason pattern 4. The role of mpMRI in surveillance remains to be determined. It is critical to establish its impact, in baseline risk assessment and in monitoring, to justify the substantial cost. Our own experience is that it can be used to reduce the number of biopsies and even to decide who needs biopsy during the monitoring period. My own impression is that the impact correlates with the quality of MRI and experience in interpretation. With time the quality of study and experience will become uniform. However, until that time it must be used with caution. Samir S. Taneja, MD
Suggested Reading Vargas HA, Akin O, Afaq A et al: Magnetic resonance imaging for predicting prostate biopsy findings in patients considered for active surveillance of clinically low risk prostate cancer. J Urol 2012; 188: 1732.
Dochead: Urological Survey
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Margel D, Yap SA, Lawrentschuk N et al: Impact of multiparametric endorectal coil prostate magnetic resonance imaging on disease reclassification among active surveillance candidates: a prospective cohort study. J Urol 2012; 187: 1247. Ouzzane A, Renard-Penna R, Marliere F et al: Magnetic resonance imaging targeted biopsy improves selection of patients considered for active surveillance for clinically low risk prostate cancer based on systematic biopsies. J Urol 2015; 194: 350. Felker ER, Wu J, Natarajan S et al: Serial magnetic resonance imaging in active surveillance of prostate cancer: incremental value. J Urol 2016; 195: 1421. Frye TP, George AK, Kilchevsky A et al: MRI-TRUS guided fusion biopsy to detect progression in patients with existing lesions on active surveillance for low and intermediate risk prostate cancer. J Urol 2016; doi: 10.1016/j.juro.2016.08.109.
Dochead: Urological Survey
LIT 5.4.0 DTD JURO14198_proof 14 November 2016 7:55 pm EO:
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then of treatment, given recent observations that men with mutations of DNA repair genes respond favorably to the PARP inhibitor, olaparib. Routine testing of men with metastatic disease in the future may help to guide therapy in this regard. Samir S. Taneja, MD
Suggested Reading Hirata H, Hinoda Y, Kawamoto K et al: Mismatch repair gene MSH3 polymorphism is associated with the risk of sporadic prostate cancer. J Urol 2008; 179: 2020. Chen L, Ambrosone CB, Lee J et al: Association between polymorphisms in the DNA repair genes XRCC1 and APE1, and the risk of prostate cancer in white and black Americans. J Urol 2006; 175: 108. Prtilo A, Leach FS, Markwalder R et al: Tissue microarray analysis of hMSH2 expression predicts outcome in men with prostate cancer. J Urol 2005; 174: 1814.
Re: Magnetic Resonance Imaging-Ultrasound Fusion Biopsy During Prostate Cancer Active Surveillance G. N. Tran, M. S. Leapman, H. G. Nguyen, J. E. Cowan, K. Shinohara, A. C. Westphalen and P. R. Carroll Helen Diller Family Comprehensive Cancer Center, University of California and Departments of Urology, and Radiology and Biomedical Imaging, University of California School of Medicine San Francisco, California Eur Urol 2016; Epub ahead of print. doi: 10.1016/j.eururo.2016.08.023
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/27595378 Editorial Comment: We continue to evaluate the role of multiparametric (mp) magnetic resonance imaging (MRI) and MRI targeted biopsy in clinical practice and to learn about the broad applicability of the tests. One potential role for mpMRI is in the assessment and monitoring of men with low risk prostate cancer on surveillance. Surveillance, as currently practiced without mpMRI, has been demonstrated to achieve excellent cancer specific survival and metastasis-free progression at 15 years of followup, when properly used, although up to 50% of men may need treatment along the way. I have contended that mpMRI cannot improve the oncologic outcomes of surveillance greatly, but it may afford us a tool for better baseline risk stratification, resulting secondarily in better selection of candidates for surveillance, requiring fewer followup biopsies. In this study from a well reported surveillance cohort the use of mpMRI and MRI targeted biopsy appeared to improve the identification of occult high grade disease in men on surveillance. Several critical observations are made and are consistent with the global experience in men with known cancer to date, ie 1) mpMRI targeted biopsy increased the detection of occult high grade disease, 2) systematic biopsy uniquely identified a significant number of men with occult high grade disease not identified by mpMRI targeted biopsy, suggesting a need for both in maximizing biopsy information (this is consistent with our experience and I believe it reflects the high prevalence of small volumes of pattern 4 in this population), and 3) mpMRI suspicion score predicted the likelihood of upgrade, particularly among those with significant upgrade to dominant Gleason pattern 4. The role of mpMRI in surveillance remains to be determined. It is critical to establish its impact, in baseline risk assessment and in monitoring, to justify the substantial cost. Our own experience is that it can be used to reduce the number of biopsies and even to decide who needs biopsy during the monitoring period. My own impression is that the impact correlates with the quality of MRI and experience in interpretation. With time the quality of study and experience will become uniform. However, until that time it must be used with caution. Samir S. Taneja, MD
Suggested Reading Vargas HA, Akin O, Afaq A et al: Magnetic resonance imaging for predicting prostate biopsy findings in patients considered for active surveillance of clinically low risk prostate cancer. J Urol 2012; 188: 1732.
Dochead: Urological Survey
LIT 5.4.0 DTD JURO14198_proof 14 November 2016 7:55 pm EO:
286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342
PROSTATE CANCER
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Margel D, Yap SA, Lawrentschuk N et al: Impact of multiparametric endorectal coil prostate magnetic resonance imaging on disease reclassification among active surveillance candidates: a prospective cohort study. J Urol 2012; 187: 1247. Ouzzane A, Renard-Penna R, Marliere F et al: Magnetic resonance imaging targeted biopsy improves selection of patients considered for active surveillance for clinically low risk prostate cancer based on systematic biopsies. J Urol 2015; 194: 350. Felker ER, Wu J, Natarajan S et al: Serial magnetic resonance imaging in active surveillance of prostate cancer: incremental value. J Urol 2016; 195: 1421. Frye TP, George AK, Kilchevsky A et al: MRI-TRUS guided fusion biopsy to detect progression in patients with existing lesions on active surveillance for low and intermediate risk prostate cancer. J Urol 2016; doi: 10.1016/j.juro.2016.08.109.
Dochead: Urological Survey
LIT 5.4.0 DTD JURO14198_proof 14 November 2016 7:55 pm EO:
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