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Prostate MRI
Published in Ayman El-Baz, Gyan Pareek, Jasjit S. Suri, Prostate Cancer Imaging, 2018
J. Pereira, Gyan Pareek, D. Grand
Prostate cancer (PCa) is the most prevalent cancer among men in the United States, with an estimated incidence of 180,890 cases in 2016.1 Screening for prostate cancer has traditionally consisted of a digital rectal exam and prostate-specific antigen testing. Following a positive screening evaluation, transrectal ultrasound-guided prostate biopsy is the gold standard for pathologic diagnosis prior to treatment. However, while ultrasound is used to target regions of the prostate, it is unable to reliably identify focal, high-risk nodules.2 Essentially, the prostate remains the last organ that is routinely biopsied “blind.” As such, the incorporation of precise prostate imaging in the evaluation for PCa has become a topic of great interest. First described as a tool for prostate imaging in the 1980s, MRI has been shown to reliably detect and exclude high-risk prostate cancer and can provide targeting of these lesions for transrectal biopsy.3–5 As the use of prostate MRI grew, the Prostate Imaging-Reporting and Data System (PI-RADS) was introduced, which outlines standards for MRI technique, interpretation, and reporting.6,7
Urinary Symptoms and Investigations
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
MRI scanning has a significant role to play, either on its own or as an adjunct to other cross-sectional imaging modalities, in the staging of a number of urological cancers, but it has a central role in the investigation of men suspected of having prostate cancer. Modern MRI techniques in prostate cancer imaging apply the principles of multiparametric MRI (mpMRI), utilising anatomical imaging with standard MRI techniques (T1- and T2-weighted images) and functional imaging such as diffusion-weighted imaging (DWI) (for water molecules motion assessment) and dynamic contrast- enhanced (DCE) imaging (for tissue perfusion assessment after intravenous contrast administration) (Figure75.25). The advantage of mpMRI is that multiple imaging parameters are combined to assign a degree of suspicion that a clinically significant cancer is present. A 5-point scoring system, called PI-RADS (Prostate Imaging-Reporting and Data System), is used to assign a likelihood (from 1: benign to 5: highly suspicious) that prostate cancer is present within the abnormality detected on mpMRI of the prostate.
Breast cancer glycan biomarkers: their link to tumour cell metabolism and their perspectives in clinical practice
Published in Expert Review of Proteomics, 2021
Tomas Bertok, Veronika Pinkova Gajdosova, Aniko Bertokova, Natalia Svecova, Peter Kasak, Jan Tkac
Genetic predispositions to BCa significantly affect not only screening but also follow-up recommendations. Patients with a family history very often exhibit a mutation in genes such as BRCA1, BRCA2, PTEN (85% lifetime risk), PT53, CDH1 and STK1 (highly penetrant) or CHEK2, BRIP1, ATM and PALB2 (moderately penetrant) genes [22]. However, magnetic resonance-imaging is still the most sensitive and accessible procedure used for BCa diagnostics. Similarly to prostate’s MRI PI-RADS system, BI-RADS is being used as a tool to make a decision as to whether to proceed further with a breast biopsy (with BI-RADS 3 and above, biopsy is usually considered, with 5 being the highest score). For different results of biopsy concordant/discordant benign/malignant (i.e. depending on whether the lesion is thought to be benign/malignant prior to the core needle biopsy result), different follow-ups (short-term or annual) are usually needed [23]. If biochemical markers are used for the diagnostics/prognostics of BCa, very often a multiplexed format of analysis is required [24], like one recently published, to achieve high assay accuracy [25].
How to Pick Out the “Unreal” Gleason 3 + 3 Patients: A Nomogram for More Precise Active Surveillance Protocol in Low-Risk Prostate Cancer in a Chinese Population
Published in Journal of Investigative Surgery, 2021
Feng Qi, Kai Zhu, Yifei Cheng, Lixin Hua, Gong Cheng
At present, many studies had formulated their own standards for AS criteria. In 1994, Epstein et al.[25] provided the criteria (“very low-risk”) for “clinically insignificant” PCa which can be safely observed, the included criteria were: GS ≤ 6, clinical T stage T1c, PSAD <0.15, <50% maximum single core involvement and ≤ 2 positive cores. In Soloway’s research [26], the inclusion criteria were: GS ≤ 3 + 3, PSA ≤ 10, clinical T stage ≤ T2c, number of positive cores ≤ 2, maximum% positive in any core ≤ 20. In Welty’s study [27], the inclusion criteria were: GS ≤ 3 + 3, PSA ≤ 10, clinical T stage ≤ T2c, number of positive cores ≤ 33% of total cores, maximum % positive in any core ≤ 20. Compared with those studies, our study adds some imaging factors. PI-RADS v1 were firstly created in 2012 to establish a standardized criterion for prostate MRI interpretation [28] and PI-RADS v2 was set up in 2015 to overcome some of the PI-RADS v1 shortcomings. Furthermore, its prognostic value had been investigated in some studies [24, 29].
Use of multiparametric magnetic resonance imaging (mpMRI) in localized prostate cancer
Published in Expert Review of Medical Devices, 2020
Luke O’Connor, Alex Wang, Stephanie M. Walker, Nitin Yerram, Peter A. Pinto, Baris Turkbey
Prostate MRI has been proven to improve patient care in diagnosis, staging, treatment and follow up of prostate cancer. This imaging technique currently is included in guidelines in many parts of the World including Europe, Australia with resultant common clinical acceptance and use. However, its certain limitations are relatively commonly encountered during daily practice. Among these the most commonly pronounced ones are improper image acquisition, interpretation, which can easily result in unsatisfactory clinical results. Currently available PI-RADS guidelines aim to address these however it is evident that more effort is needed to fix the listed limitations of prostate MRI. Providing more educational opportunities is an important solution to cover this however, it may not be possible and feasible to reach out all radiologists, radiology technologists, and urologists to offer enough education. Artificial intelligence which is an evolving technology in the field of medicine can be utilized for this purpose, however, to be able to develop robust artificial intelligence algorithms to improve limitations of prostate MRI, there is a need for large and well-curated training datasets, which requires a substantial amount of medical research investment.