Does Magnetic Resonance Imaging of the Spine Have a Role in the Staging of Prostate Cancer?

Venkitaraman, R.; Cook, Gary; Dearnaley, David P.; Parker, Chris; Huddart, Robert; Khoo, Vincent; Eeles, Rosalind; Horwich, A.; Sohaib, S.A.

doi:10.1016/j.clon.2008.09.006

Cited by 24 publications

(8 citation statements)

References 7 publications

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“…17,20,22,23 Our data for equivocal results compare with that of the literature for AS-MRI in high-risk PCa. 21,23,24 Our study of patients with high-risk PCa has confirmed the notion that a PSA > 20 ng/ml, locally advanced disease and Gleason score of ≥4 + 3 are independent predictors of BM which has previously been extensively reported. 25,26 This corroborates with studies, which have shown the importance of Gleason 7 morphology in demonstrating the difference between Gleason 3 + 4 and 4 + 3 in the context of prognosis.…”

Section: Discussionsupporting

confidence: 84%

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Diagnostic and cost‐effectiveness of axial skeleton MRI in staging high‐risk prostate cancer

et al. 2023

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Introduction: Current literature suggests that axial skeleton magnetic resonance imaging (AS-MRI) is more sensitive than Tc 99m bone scintigraphy (BS) for detecting bone metastases (BM) in high-risk prostate cancer (PCa). However, BS is still widely performed. Its diagnostic accuracy has been studied; however, its feasibility and cost implications are yet to be examined. Methods:We reviewed all patients with high risk PCa undergoing AS-MRI over a 5-year period. AS-MRI was performed on patients with histologically confirmed PCa and either PSA > 20 ng/ml, Gleason ≥8, or TNM Stage ≥T3 or N1 disease. All AS-MRI studies were obtained using a 1.5-T AchievaPhilips™MRI scanner. We compared the AS-MRI positivity and equivocal rate with that of BS. Data were analysed according to Gleason score, T-stage and PSA. Multivariate logistic regression analyses were used to quantify the strength of association between positive scans and clinical variables. Feasibility and burden of expenditure was also evaluated.Results: Five hundred three patients with a median age of 72 and a mean PSA of 34.8 ng/ml were analysed. Eighty-eight patients (17.5%) were positive for BM on AS-MRI (mean PSA 99 [95% CI 69.1-129.9]). Comparatively 409 patients (81.3%) were negative for BM on ) (p = 0.007); 1.2% (n = 6) of patients had equivocal results ).There was no significant difference in age (p = 0.122) between this group and patients with a positive scan, but there was a significant difference in PSA (p = 0.028), T stage (p = 0.006) and Gleason score (p = 0.023). In comparison with BS, AS-MRI detection rate was equivalent or higher compared with the literature.Based on NHS tariff calculations, there would be a minimum cost saving of £8406.89. All patients underwent AS-MRI within 14 days. Conclusion:The use of AS-MRI to stage BM in high-risk PCa is both feasible and results in a reduced burden of expenditure.

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Section: Discussionsupporting

confidence: 84%

“…When comparing with BS, our subanalysis revealed that this rate is significantly lower ( p < 0.001) in comparison with BS data which ranges from 6 to 29% 17,20,22,23 . Our data for equivocal results compare with that of the literature for AS‐MRI in high‐risk PCa 21,23,24 …”

Section: Discussioncontrasting

confidence: 40%

Diagnostic and cost‐effectiveness of axial skeleton MRI in staging high‐risk prostate cancer

et al. 2023

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“…SPECT/ CT has been shown to precisely localize abnormalities in the vertebra, particularly in complicated cases, such as multiple collapsed vertebrae of different ages [54]. However, MRI has greater sensitivity and specificity for metastasis in certain locations of the spine [111] and for certain primaries, such as prostate cancer [112].…”

Section: Variant 4: Known Malignancy and New Back Pain Compression Fmentioning

confidence: 99%

ACR Appropriateness Criteria® Management of Vertebral Compression Fractures

Shah

Jennings

Kirsch

et al. 2018

Journal of the American College of Radiology

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Vertebral compression fractures (VCFs) have various causes, including osteoporosis, neoplasms, and acute trauma. As painful VCFs may contribute to general physical deconditioning, management of painful VCFs has the potential for improving quality of life and preventing superimposed medical complications. Various imaging modalities can be used to evaluate a VCF to help determine the etiology and guide intervention. The first-line treatment of painful VCFs has been nonoperative or conservative management as most VCFs show gradual improvement in pain over 2 to 12 weeks, with variable return of function. There is evidence that vertebral augmentation (VA) is associated with better pain relief and improved functional outcomes compared to conservative therapy for osteoporotic VCFs. A multidisciplinary approach is necessary for the management of painful pathologic VCFs, with management strategies including medications to affect bone turnover, radiation therapy, and interventions such as VA and percutaneous thermal ablation to alleviate symptoms.

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“…In recent studies, MRI was better than bone scan for detecting metastatic lesions in a variety of primary cancers 40–43. At least one study also found MRI to be better for detecting bone metastases than PET-CT 44.…”

Section: Detection Of and Monitoring For Bone Metastasesmentioning

confidence: 99%

The Science and Practice of Bone Health in Oncology: Managing Bone Loss and Metastasis in Patients With Solid Tumors

Lipton

Uzzo²,

Amato³

et al. 2009

J Natl Compr Canc Netw

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Cancer and its treatment can compromise bone health, leading to fracture, pain, loss of mobility, and hypercalcemia of malignancy. Bone metastasis occurs frequently in advanced prostate and breast cancers, and bony manifestations are commonplace in multiple myeloma. Osteoporosis and osteopenia may be consequences of androgen-deprivation therapy for prostate cancer, aromatase inhibition for breast cancer, or chemotherapy-induced ovarian failure. Osteoporotic bone loss and bone metastasis ultimately share a pathophysiologic pathway that stimulates bone resorption by increasing the formation and activity of osteoclasts. Important mediators of pathologic bone metabolism include substances produced by osteoblasts, such as RANKL, the receptor activator of nuclear factor kappa B ligand, which spurs osteoclast differentiation from myeloid cells. Available therapies are targeted to various steps in cascade of bone metastasis.

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Does Magnetic Resonance Imaging of the Spine Have a Role in the Staging of Prostate Cancer?

Cited by 24 publications

References 7 publications

Diagnostic and cost‐effectiveness of axial skeleton MRI in staging high‐risk prostate cancer

Diagnostic and cost‐effectiveness of axial skeleton MRI in staging high‐risk prostate cancer

ACR Appropriateness Criteria® Management of Vertebral Compression Fractures

The Science and Practice of Bone Health in Oncology: Managing Bone Loss and Metastasis in Patients With Solid Tumors

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