What kind of prostate cancers do we miss on multiparametric magnetic resonance imaging?

Visschere, Pieter J. L. De; Naesens, Leslie; Libbrecht, Louis; Praet, Charles Van; Lumen, Nicolaas; Fonteyne, Valérie; Pattyn, Elise; Villeirs, Geert

doi:10.1007/s00330-015-3894-x

Cited by 70 publications

(47 citation statements)

References 38 publications

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“…Itatani et al [19] reported a NPV of 89.6 % for mpMRI without significant cancer in a 5-year follow-up study. De Visschere et al [20] found a NPV of 68 % for exclusion of any Gleason grade of prostate cancer, but a very high NPV of 95.4 % for high-grade prostate cancer (Gleason score ≥4 + 3 of any size). Arumainayagam et al [21] showed a NPV of up to 95 % for clinically significant cancer, indicating that MRI may be useful at ruling out clinically significant PCa.…”

Section: Discussionmentioning

confidence: 99%

Relationship between non-suspicious MRI and insignificant prostate cancer: results from a monocentric study

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Relationship between non-suspicious MRI and insignificant prostate cancer: results from a monocentric study

et al. 2015

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“…Missed high-grade tumors (primary Gleason ≥4) are predominantly small (66.6% of 18 tumors <1 cm). About 96% of all missed tumors and 83.3% of missed Gleason 4 or greater tumors are organ confined (56). …”

Section: Limitations Of Pretreatment Mpmrimentioning

confidence: 99%

Multi-parametric magnetic resonance imaging as a management decision tool

Johnson¹,

Reiter²

2017

Transl. Androl. Urol.

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The ability to image the prostate accurately and better characterize cancerous lesions makes multiparametric magnetic resonance imaging (mpMRI) an invaluable tool to improve management of localized prostate cancer (PCa). Improved risk stratification is warranted given the evidence of significant overtreatment of indolent PCa. mpMRI can more accurately rule out clinically significant PCa in men deciding between surveillance and definitive treatment to reduce overtreatment. mpMRI improves detection of clinically significant PCa, which helps minimize sampling error, a major limitation of the traditional diagnostic paradigm. Aside from helping determine candidacy for initial surveillance vs. treatment, mpMRI is a useful tool for following men on active surveillance (AS) with the potential to reduce the need for serial biopsies. When definitive treatment is warranted, mpMRI can be used to determine the local extent of disease. This provides information that is useful in the treatment decision, counseling about outcomes, and surgical planning. While mpMRI is a significant step forward in PCa management, it is necessary to understand its limitations. mpMRI and MRI-guided fusion biopsy techniques still do not detect all clinically significant tumors. The utility of current mpMRI techniques is limited by the multifocal nature of PCa with poor detection of non-index lesions, inaccurate estimation of tumor size and geometry, and the need for interpretation by specialized radiologists. The role of mpMRI will continue to expand as improvements in technology and experience help overcome these limitations.

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“…Another group examined 830 biopsy-naive patients with elevated levels of prostate-specific antigen. 5 Of the 391 individuals with a negative baseline MRI examination, 124 (31.7%) were diagnosed with PCa during a 2-year follow-up period. In 85.5% of these patients, the primary Gleason grade was 3 or less, and 96.0% had organ-confined disease.…”

Section: The Significance Of a ''Negative'' Prostate Mrimentioning

confidence: 99%

“…For the exclusion of high-grade PCa (ie, primary Gleason grade 4 or any grade 5), MRI had a negative predictive value of 95.4%. 5 In a similar study of 800 patients who underwent prostate MRI, 125 patients had only low suspicion lesions, which were defined as a maximum of 2 positive findings on T2-weighted images, DWI, DCE, or MR-spectroscopy. 6 In none of these cases, biopsy or radical prostatectomy revealed high-risk cancer (ie, !…”

Section: The Significance Of a ''Negative'' Prostate Mrimentioning

confidence: 99%

“…Reprinted with permission from PLoS One 2014;9:e96619. Within 120 months (x-axis), the likelihood of being diagnosed with PCa (y-axis) was 12.1% for patients with no visible lesions or a low suspicion for significant PCa on MRI (Group score 1-2), 51.7% for patients with equivocal findings (Group score 3), and 89.7% for those with a score of 4 or 5 (Group score [4][5]. Reprinted with permission from PLoS One 2015;10: e0130207.…”

Section: Risk-assessment Of Mri-visible Prostate Lesionsmentioning

confidence: 99%

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Role of MRI in the Risk Assessment of Primary Prostate Cancer

Wibmer

Verma²,

Vargas³

2016

Topics in Magnetic Resonance Imaging

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A successful paradigm shift toward personalized management strategies for patients with prostate cancer (PCa) is heavily dependent on the availability of noninvasive diagnostic tools capable of accurately establishing the true extent of disease at the time of diagnosis and estimating the risk of subsequent disease progression and related mortality. Although there is still considerable scope for improvement in its diagnostic, predictive, and prognostic capabilities, multiparametric prostate magnetic resonance imaging (MRI) is currently regarded as the imaging modality of choice for local staging of PCa. A negative MRI, that is, the absence of any MRI-visible intraprostatic lesion, has a high negative predictive value for the presence of clinically significant PCa and can substantiate the consideration of active surveillance as a preferred initial management approach. MRI-derived quantitative and semi-quantitative parameters can be utilized to noninvasively characterize MRI-visible prostate lesions and identify those patients who are most likely to benefit from radical treatment, and differentiate them from patients with benign or indolent prostate pathology that may also be visible on MRI. This literature review summarizes current strategies how MRI can be used to determine a tailored management strategy for an individual patient.

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What kind of prostate cancers do we miss on multiparametric magnetic resonance imaging?

Abstract: • The majority of missed prostate cancers were low grade and organ-confined. • In patients with a negative mpMRI a biopsy may be postponed. • mpMRI had a negative predictive value of 95.4 % for high-grade prostate cancer.

Cited by 70 publications

References 38 publications

Relationship between non-suspicious MRI and insignificant prostate cancer: results from a monocentric study

Relationship between non-suspicious MRI and insignificant prostate cancer: results from a monocentric study

Multi-parametric magnetic resonance imaging as a management decision tool

Role of MRI in the Risk Assessment of Primary Prostate Cancer

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