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Clinically low-risk prostate cancer: evaluation with transrectal doppler ultrasound and functional magnetic resonance imaging.

Novis MI, Baroni RH, Cerri LM, Mattedi RL, Buchpiguel CA - Clinics (Sao Paulo) (2011)

Bottom Line: Seven patients were excluded from the study.Mean patient age was 64.94 years and mean serum PSA was 6.05 ng/ml.Sixteen patients (45.7%) had pathologically proven organ-confined disease, 11 (31.4%) had positive surgical margin, 8 (28.9%) had extracapsular extension, and 3 (8.6%) presented with extracapsular extension and seminal vesicle invasion.

View Article: PubMed Central - PubMed

Affiliation: Faculdade de Medicina da Universidade de São Paulo--Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.

ABSTRACT

Objectives: To evaluate transrectal ultrasound, amplitude Doppler ultrasound, conventional T2-weighted magnetic resonance imaging, spectroscopy and dynamic contrast-enhanced magnetic resonance imaging in localizing and locally staging low-risk prostate cancer.

Introduction: Prostate cancer has been diagnosed at earlier stages and the most accepted classification for low-risk prostate cancer is based on clinical stage T1c or T2a, Gleason score ≤6, and prostate-specific antigen (PSA) ≤10 ng/ml.

Methods: From 2005 to 2006, magnetic resonance imaging was performed in 42 patients, and transrectal ultrasound in 26 of these patients. Seven patients were excluded from the study. Mean patient age was 64.94 years and mean serum PSA was 6.05 ng/ml. The examinations were analyzed for tumor identification and location in prostate sextants, detection of extracapsular extension, and seminal vesicle invasion, using surgical pathology findings as the gold standard.

Results: Sixteen patients (45.7%) had pathologically proven organ-confined disease, 11 (31.4%) had positive surgical margin, 8 (28.9%) had extracapsular extension, and 3 (8.6%) presented with extracapsular extension and seminal vesicle invasion. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy values for localizing low-risk prostate cancer were 53.1%, 48.3%, 63.4%, 37.8% and 51.3% for transrectal ultrasound; 70.4%, 36.2%, 65.1%, 42.0% and 57.7% for amplitude Doppler ultrasound; 71.5%, 58.9%, 76.6%, 52.4% and 67.1% for magnetic resonance imaging; 70.4%, 58.7%, 78.4%, 48.2% and 66.7% for magnetic resonance spectroscopy; 67.2%, 65.7%, 79.3%, 50.6% and 66.7% for dynamic contrast-enhanced magnetic resonance imaging, respectively. Sensitivity, specificity, PPV, NPV and accuracy values for detecting extracapsular extension were 33.3%, 92%, 14.3%, 97.2% and 89.7% for transrectal ultrasound and 50.0%, 77.6%, 13.7%, 95.6% and 75.7% for magnetic resonance imaging, respectively. For detecting seminal vesicle invasion, these values were 66.7%, 85.7%, 22.2%, 97.7% and 84.6% for transrectal ultrasound and 40.0%, 83.1%, 15.4%, 94.7% and 80.0% for magnetic resonance imaging.

Conclusion: Although preliminary, our results suggest that imaging modalities have limited usefulness in localizing and locally staging clinically low-risk prostate cancer.

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Related in: MedlinePlus

64‐year‐old man with prostate cancer (prostate specific antigen (PSA) level 5.2 ng/ml). (a) Transverse transrectal ultrasound (TRUS) demonstrates a hypoechoic nodule in the right mid‐gland peripheral zone, hypervascularized in amplitude Doppler ultrasound (ADUS) (b). Transverse T2‐weighted (T2W) magnetic resonance imaging (MRI) (c) shows a hypointense nodule in the right mid‐gland. This voxel (d) and the corresponding amplitude times frequency spectroscopic graphic (e) shows reduced citrate and increased choline–creatine levels, suspicious for prostate cancer. Transverse T1W DCE‐MRI (f) demonstrates increased vascularization in the nodule (pink region of interest (ROI)) and normal hypovascularized peripheral zone in the left mid‐gland (green ROI), characterized on graphic (g) by washin followed by a decreasing washout curve and continuous enhancement patterns, respectively. Surgically confirmed adenocarcinoma Gleason score 7 (4 + 3) in the right mid‐gland – HE 400× (h).
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f1-cln_66p27: 64‐year‐old man with prostate cancer (prostate specific antigen (PSA) level 5.2 ng/ml). (a) Transverse transrectal ultrasound (TRUS) demonstrates a hypoechoic nodule in the right mid‐gland peripheral zone, hypervascularized in amplitude Doppler ultrasound (ADUS) (b). Transverse T2‐weighted (T2W) magnetic resonance imaging (MRI) (c) shows a hypointense nodule in the right mid‐gland. This voxel (d) and the corresponding amplitude times frequency spectroscopic graphic (e) shows reduced citrate and increased choline–creatine levels, suspicious for prostate cancer. Transverse T1W DCE‐MRI (f) demonstrates increased vascularization in the nodule (pink region of interest (ROI)) and normal hypovascularized peripheral zone in the left mid‐gland (green ROI), characterized on graphic (g) by washin followed by a decreasing washout curve and continuous enhancement patterns, respectively. Surgically confirmed adenocarcinoma Gleason score 7 (4 + 3) in the right mid‐gland – HE 400× (h).

Mentions: The ability to determine the correct cancer location within the prostate and the number of sextants involved has important clinical value, because tumor volume is a relevant prognostic factor and also for considering the actual role of the local therapies. Huge heterogeneity exists in the available MRI literature, strongly affected by methodological and population variables, with cancer detection sensitivity varying between 37% and 90%.13 Although large‐volume cancers can be reasonably well detected by imaging, small lesions have been difficult to identify or measure accurately.3 Also, aggressive tumors with higher Gleason scores present more evident architectural disarray on histology, probably improving their differentiation from the normal gland in imaging studies. In contrast, our difficulty in identifying many lesions in this study may be explained by the lower Gleason grades, represented by more differentiated cells that may be indistinguishable from the normal gland on imaging (Figures 1 and 2).


Clinically low-risk prostate cancer: evaluation with transrectal doppler ultrasound and functional magnetic resonance imaging.

Novis MI, Baroni RH, Cerri LM, Mattedi RL, Buchpiguel CA - Clinics (Sao Paulo) (2011)

64‐year‐old man with prostate cancer (prostate specific antigen (PSA) level 5.2 ng/ml). (a) Transverse transrectal ultrasound (TRUS) demonstrates a hypoechoic nodule in the right mid‐gland peripheral zone, hypervascularized in amplitude Doppler ultrasound (ADUS) (b). Transverse T2‐weighted (T2W) magnetic resonance imaging (MRI) (c) shows a hypointense nodule in the right mid‐gland. This voxel (d) and the corresponding amplitude times frequency spectroscopic graphic (e) shows reduced citrate and increased choline–creatine levels, suspicious for prostate cancer. Transverse T1W DCE‐MRI (f) demonstrates increased vascularization in the nodule (pink region of interest (ROI)) and normal hypovascularized peripheral zone in the left mid‐gland (green ROI), characterized on graphic (g) by washin followed by a decreasing washout curve and continuous enhancement patterns, respectively. Surgically confirmed adenocarcinoma Gleason score 7 (4 + 3) in the right mid‐gland – HE 400× (h).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3044567&req=5

f1-cln_66p27: 64‐year‐old man with prostate cancer (prostate specific antigen (PSA) level 5.2 ng/ml). (a) Transverse transrectal ultrasound (TRUS) demonstrates a hypoechoic nodule in the right mid‐gland peripheral zone, hypervascularized in amplitude Doppler ultrasound (ADUS) (b). Transverse T2‐weighted (T2W) magnetic resonance imaging (MRI) (c) shows a hypointense nodule in the right mid‐gland. This voxel (d) and the corresponding amplitude times frequency spectroscopic graphic (e) shows reduced citrate and increased choline–creatine levels, suspicious for prostate cancer. Transverse T1W DCE‐MRI (f) demonstrates increased vascularization in the nodule (pink region of interest (ROI)) and normal hypovascularized peripheral zone in the left mid‐gland (green ROI), characterized on graphic (g) by washin followed by a decreasing washout curve and continuous enhancement patterns, respectively. Surgically confirmed adenocarcinoma Gleason score 7 (4 + 3) in the right mid‐gland – HE 400× (h).
Mentions: The ability to determine the correct cancer location within the prostate and the number of sextants involved has important clinical value, because tumor volume is a relevant prognostic factor and also for considering the actual role of the local therapies. Huge heterogeneity exists in the available MRI literature, strongly affected by methodological and population variables, with cancer detection sensitivity varying between 37% and 90%.13 Although large‐volume cancers can be reasonably well detected by imaging, small lesions have been difficult to identify or measure accurately.3 Also, aggressive tumors with higher Gleason scores present more evident architectural disarray on histology, probably improving their differentiation from the normal gland in imaging studies. In contrast, our difficulty in identifying many lesions in this study may be explained by the lower Gleason grades, represented by more differentiated cells that may be indistinguishable from the normal gland on imaging (Figures 1 and 2).

Bottom Line: Seven patients were excluded from the study.Mean patient age was 64.94 years and mean serum PSA was 6.05 ng/ml.Sixteen patients (45.7%) had pathologically proven organ-confined disease, 11 (31.4%) had positive surgical margin, 8 (28.9%) had extracapsular extension, and 3 (8.6%) presented with extracapsular extension and seminal vesicle invasion.

View Article: PubMed Central - PubMed

Affiliation: Faculdade de Medicina da Universidade de São Paulo--Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.

ABSTRACT

Objectives: To evaluate transrectal ultrasound, amplitude Doppler ultrasound, conventional T2-weighted magnetic resonance imaging, spectroscopy and dynamic contrast-enhanced magnetic resonance imaging in localizing and locally staging low-risk prostate cancer.

Introduction: Prostate cancer has been diagnosed at earlier stages and the most accepted classification for low-risk prostate cancer is based on clinical stage T1c or T2a, Gleason score ≤6, and prostate-specific antigen (PSA) ≤10 ng/ml.

Methods: From 2005 to 2006, magnetic resonance imaging was performed in 42 patients, and transrectal ultrasound in 26 of these patients. Seven patients were excluded from the study. Mean patient age was 64.94 years and mean serum PSA was 6.05 ng/ml. The examinations were analyzed for tumor identification and location in prostate sextants, detection of extracapsular extension, and seminal vesicle invasion, using surgical pathology findings as the gold standard.

Results: Sixteen patients (45.7%) had pathologically proven organ-confined disease, 11 (31.4%) had positive surgical margin, 8 (28.9%) had extracapsular extension, and 3 (8.6%) presented with extracapsular extension and seminal vesicle invasion. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy values for localizing low-risk prostate cancer were 53.1%, 48.3%, 63.4%, 37.8% and 51.3% for transrectal ultrasound; 70.4%, 36.2%, 65.1%, 42.0% and 57.7% for amplitude Doppler ultrasound; 71.5%, 58.9%, 76.6%, 52.4% and 67.1% for magnetic resonance imaging; 70.4%, 58.7%, 78.4%, 48.2% and 66.7% for magnetic resonance spectroscopy; 67.2%, 65.7%, 79.3%, 50.6% and 66.7% for dynamic contrast-enhanced magnetic resonance imaging, respectively. Sensitivity, specificity, PPV, NPV and accuracy values for detecting extracapsular extension were 33.3%, 92%, 14.3%, 97.2% and 89.7% for transrectal ultrasound and 50.0%, 77.6%, 13.7%, 95.6% and 75.7% for magnetic resonance imaging, respectively. For detecting seminal vesicle invasion, these values were 66.7%, 85.7%, 22.2%, 97.7% and 84.6% for transrectal ultrasound and 40.0%, 83.1%, 15.4%, 94.7% and 80.0% for magnetic resonance imaging.

Conclusion: Although preliminary, our results suggest that imaging modalities have limited usefulness in localizing and locally staging clinically low-risk prostate cancer.

Show MeSH
Related in: MedlinePlus