Central zone lesions on magnetic resonance imaging: Should we be concerned?

Tan, Wei Phin; Mazzone, Andrew; Shors, Stephanie M.; Antoine, Nency; Ekbal, Shahid; Khare, Narendra; McKiel, Charles F.; Pessis, Dennis; Deane, Leslie A.

doi:10.1016/j.urolonc.2016.08.006

Cited by 5 publications

(3 citation statements)

References 15 publications

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“…In a retrospective review of 73 patients who underwent MRI-fusion biopsy by Tan et al, 26 CZ lesions were graded as PIRADS 3 or greater. Only two (7.7%) of these suspicious lesions harbored PCa ( 34 ). Since evidence suggests PCa arising from the CZ can be more aggressive than peripheral and transitional zone cancers, modification of the PIRADS algorithm may be needed to better characterize CZ lesions ( 35 , 36 ).…”

Section: Resultsmentioning

confidence: 99%

Prostate Cancer Imaging and Biomarkers Guiding Safe Selection of Active Surveillance

et al. 2017

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BackgroundActive surveillance (AS) is a widely adopted strategy to monitor men with low-risk, localized prostate cancer (PCa). Current AS inclusion criteria may misclassify as many as one in four patients. The advent of multiparametric magnetic resonance imaging (mpMRI) and novel PCa biomarkers may offer improved risk stratification. We performed a review of recently published literature to characterize emerging evidence in support of these novel modalities.MethodsAn English literature search was conducted on PubMed for available original investigations on localized PCa, AS, imaging, and biomarkers published within the past 3 years. Our Boolean criteria included the following terms: PCa, AS, imaging, biomarker, genetic, genomic, prospective, retrospective, and comparative. The bibliographies and diagnostic modalities of the identified studies were used to expand our search.ResultsOur review identified 222 original studies. Our expanded search yielded 244 studies. Among these, 70 met our inclusion criteria. Evidence suggests mpMRI offers improved detection of clinically significant PCa, and MRI-fusion technology enhances the sensitivity of surveillance biopsies. Multiple studies demonstrate the promise of commercially available screening assays for prediction of AS failure, and several novel biomarkers show promise in this setting.ConclusionIn the era of AS for men with low-risk PCa, improved strategies for proper stratification are needed. mpMRI has dramatically enhanced the detection of clinically significant PCa. The advent of novel biomarkers for prediction of aggressive disease and AS failure has shown some initial promise, but further validation is warranted.

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Section: Resultsmentioning

confidence: 99%

Prostate Cancer Imaging and Biomarkers Guiding Safe Selection of Active Surveillance

et al. 2017

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“…We performed an Institution Review Board (IRB) approved retrospective analysis of a prospectively collected and maintained database consisting of all patients undergoing mpMRI transrectal ultrasound guided fusion prostate biopsy performed by a single urologist (LAD) for clinical features concerning the presence of prostate cancer. mpMRI of the prostate was performed using a Siemens MAGNETOM 3T machine (Munich, Germany) as previously described (8). Each MRI scan was reviewed and reported by an attending radiologist.…”

Section: Methodsmentioning

confidence: 99%

Lowering positive margin rates at radical prostatectomy by color coding of biopsy specimens to permit individualized preservation of the neurovascular bundles: is it feasible? a pilot investigation

et al. 2018

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Objective: To evaluate whether color-coding of prostate core biopsy specimens aids in preservation of the neurovascular bundles from an oncological perspective. Materials and Methods: MRI guided transrectal ultrasound and biopsy of the prostate were performed in 51 consecutive patients suspected of being at high risk for harboring prostate cancer. Core specimens were labeled with blue dye at the deep aspect and red dye at the superficial peripheral aspect of the core. The distance from the tumor to the end of the dyed specimen was measured to determine if there was an area of normal tissue between the prostate capsule and tumor. Results: Of the 51 patients undergoing prostate biopsy, 30 (58.8%) were found to have cancer of the prostate: grade group 1 in 13.7%, 2 in 25.5%, 3 in 7.8%, 4 in 7.8% and 5 in 3.9% of the cohort. A total of 461 cores were analyzed in the cohort, of which 122 showed cancer. Five patients opted to undergo robotic assisted laparoscopic radical prostatectomy. No patients had a positive surgical margin (PSM) or extra prostatic extension (EPE) on radical prostatectomy if there was a margin of normal prostatic tissue seen between the dye and the tumor on prostate biopsy. Conclusion: Color-coding of prostate biopsy core specimens may assist in tailoring the approach for preservation of the neurovascular bundles without compromising early oncological efficacy. Further study is required to determine whether this simple modification of the prostate biopsy protocol is valuable in larger groups of patients.

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“…In addition, there is concern that central zone (CZ) lesions may not be accurately characterized when using the PIRADS algorithm. In a review of 73 patients who underwent MRI-fusion biopsy, only two (7.7%) of 26 CZ lesions that were designated PIRADS ≥3 actually contained clinically-significant disease ( 42 ). Since there is evidence to suggest PCa originating from the CZ can be more aggressive, relying on the PIRADS score alone may overcall lesions and lead to unnecessary confirmatory biopsy sessions ( 43 , 44 ).…”

Section: Reviewmentioning

confidence: 99%

MRI findings guiding selection of active surveillance for prostate cancer: a review of emerging evidence

Glaser¹,

Porter²,

Thomas³

et al. 2018

Transl. Androl. Urol.

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Active surveillance (AS) for prostate cancer (PCa) is generally considered to be a safe strategy for men with low-risk, localized disease. However, as many as 1 in 4 patients may be incorrectly classified as AS-eligible using traditional inclusion criteria. The use of multiparametric magnetic resonance imaging (mpMRI) may offer improved risk stratification in both the initial diagnostic and disease monitoring setting. We performed a review of recently published studies to evaluate the utility of this imaging modality for this clinical setting. An English literature search was conducted on PubMed for original investigations on localized PCa, AS, and magnetic resonance imaging. Our Boolean criteria included the following terms: PCa, AS, imaging, MRI, mpMRI, prospective, retrospective, and comparative. Our search excluded publication types such as comments, editorials, guidelines, reviews, or interviews. Our literature review identified 71 original investigations. Among these, 52 met our inclusion criteria. Evidence suggests mpMRI improves characterization of clinically significant prostate cancer (csPCa) foci, and the enhanced detection and risk-stratification afforded by this modality may keep men from being inappropriately placed on AS. Use of serial mpMRI may also permit longer intervals between confirmatory biopsies. Multiple studies demonstrate the benefit of MRI-targeted biopsies. The use of mpMRI of the prostate offers improved confidence in risk-stratification for men with clinically low-risk PCa considering AS. While on AS, serial mpMRI and MRI-targeted biopsy aid in the detection of aggressive disease transformation or foci of clinically-significant cancer undetected on prior biopsy sessions.

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Central zone lesions on magnetic resonance imaging: Should we be concerned?

Cited by 5 publications

References 15 publications

Prostate Cancer Imaging and Biomarkers Guiding Safe Selection of Active Surveillance

Prostate Cancer Imaging and Biomarkers Guiding Safe Selection of Active Surveillance

Lowering positive margin rates at radical prostatectomy by color coding of biopsy specimens to permit individualized preservation of the neurovascular bundles: is it feasible? a pilot investigation

MRI findings guiding selection of active surveillance for prostate cancer: a review of emerging evidence

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