One‐step TNM staging of high‐risk prostate cancer using magnetic resonance imaging (MRI): Toward an upfront simplified “all‐in‐one” imaging approach?

Abstract

BACKGROUND. Multiparametric magnetic resonance imaging (mpMRI) is the standard for local prostate cancer (PCa) staging. Whole-body MRI (wbMRI) has shown capabilities for metastatic screening. This study assesses the feasibility and value of an all-in-one AJCC TNM staging of PCa during a unique MRI session combining mpMRI and wbMRI. METHODS. Thirty consecutive patients with "high-risk" PCa prospectively underwent mpMRI of the prostate and wbMRI, in addition to 99m Tc bone scan (BS), completed with standard X-rays (AETXR) and contrast enhanced CT for distant staging. For the statistical analysis, a "best valuable comparator" (BVC) combining a panel review of all available baseline and follow-up imaging, biological, and clinical data was used to adjudicate lymph node and bone metastatic status. RESULTS. Prostate mpMRI was analyzed using ESUR guidelines. Sensitivity of BS AE TXR combined with CT and of wbMRI for detecting metastases (bones or nodes) was 85% and 100%, respectively, and specificity was 88% and 100%, respectively. For the overall staging of the patients as being either N0M0 or having disease extension beyond the prostate, wbMRI was superior to the combination of BS and CT (improvement in all ROC characteristics and of AUC by 13.6% (95% CI: þ0.7% to þ26.5%, P ¼ 0.039)). The main limitation is the limited number of patients. CONCLUSIONS. AJCC M and N staging using wbMRI is feasible during the same imaging session as mpMRI performed for T staging, in less then one hour. wbMRI outperforms BS AE TXR and abdomino-pelvic CT work up for discriminating subsets of patients with or

Repeated stereotactic body radiotherapy for oligometastatic prostate cancer recurrence

“…With the addition of computed tomography (CT), 73% of patients is diagnosed with ≤3 metastases with a median PSA of 25 ng/ml [5]. With the introduction of more sensitive and specific imaging modalities such as PET-CT and MRI [10,19], oligometastatic disease is detected even earlier at median PSA levels around 7 ng/ml or lower [6,10]. Consequently, both the time between a PSA rise and the detection of metastatic disease is reducing as well as the number of metastases detected [6].…”

Is there still a role for computed tomography and bone scintigraphy in prostate cancer staging? An analysis from the EUREKA-1 database

“…In particular, BS is deeply influenced by PSA level and Gleason score [7], while the accuracy of CT scan has been shown to be really poor, even in those patients with a very high risk of nodal metastases [8]. Recently, whole-body magnetic resonance imaging (MRI) was shown to be more sensitive and specific than the combination of BS, targeted radiographs and abdomino-pelvic CT [9,10], suggesting an "all-in-one" staging approach. Preoperative clinical models, such as Partin [11] or Briganti nomograms [12], have been adopted in the preoperative risk assessment of PCa for lymph node involvement (LNI), and showed possibly more appropriate and accurate than CT itself to decide for the need of pelvic lymph node dissection (PLND).…”

Imaging for Prostate Cancer

“…Actually, more than 50 publications were about the ''how-to'' or ''the role of'' MRI or on whether it is the ultimate imaging technique for one-stop TNM staging (e.g., [38]). …”