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Multiparametric-MRI and Targeted Biopsies in the Management of Prostate Cancer Patients on Active Surveillance.

Sandler K, Patel M, Lynne C, Parekh DJ, Punnen S, Jorda M, Casillas J, Pollack A, Stoyanova R - Front Oncol (2015)

Bottom Line: A multiparametric (MP)-MRI exam revealed a suspicious lesion in the anterior apex of the prostate.The pathology determined Gleason 3 + 4 disease in 30% of the core from this region.MP-MRI was also used to follow the changes from pre- to post-RT.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, University of Miami , Miami, FL , USA.

ABSTRACT
An important key to clinical management of prostate cancer patients is to determine early those who will benefit from primary treatment and are not good candidates for active surveillance (AS). We describe a 67-year-old gentleman with a long history of stable prostate-specific antigen (PSA) levels and a negative biopsy. After slight PSA rise and low volume Gleason score 6 biopsy, the patient was considered for primary treatment or AS. A multiparametric (MP)-MRI exam revealed a suspicious lesion in the anterior apex of the prostate. Biopsies were carried out on a 3D-ultrasound prostate biopsy system with MRI-fusion. The location of the target area was challenging and could have been missed using standard 12-core biopsy template. The pathology determined Gleason 3 + 4 disease in 30% of the core from this region. Consequently, the patient underwent radiotherapy (RT). MP-MRI was also used to follow the changes from pre- to post-RT.

No MeSH data available.


Related in: MedlinePlus

Multiparametric-MRI findings and directed prostate biopsy of the index lesion. (A) T2-weighted MRI and ADC map, with arrows indicating tumor area; (B) DCE-MRI intensity map with the lightest (yellow) part representing the areas of rapid contrast wash-in and gradual washout; and (C) tumor (yellow) and prostate (brown) contours. Both volumes were transferred to Artemis™ for fusion to the real-time ultrasound prior to prostate biopsy; 3D representation of the tumor with biopsy needle path shown.
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Figure 1: Multiparametric-MRI findings and directed prostate biopsy of the index lesion. (A) T2-weighted MRI and ADC map, with arrows indicating tumor area; (B) DCE-MRI intensity map with the lightest (yellow) part representing the areas of rapid contrast wash-in and gradual washout; and (C) tumor (yellow) and prostate (brown) contours. Both volumes were transferred to Artemis™ for fusion to the real-time ultrasound prior to prostate biopsy; 3D representation of the tumor with biopsy needle path shown.

Mentions: We describe a 67-year-old gentleman who presented for evaluation of recently diagnosed cT1N0M0 prostate cancer. After many stable PSAs in the low 4 ng/ml range over 6 years, PSA rose slightly to 4.7 ng/ml a year ago. TRUS biopsy at this time was negative for malignancy, but showed a focus of high grade prostatic intraepithelial neoplasia in the left lateral base. Seven months later, the PSA rose to 6.2 ng/ml and a repeat biopsy was performed, which showed Gleason 3 + 3 = 6 prostatic adenocarcinoma involving two cores with <10% involvement from the left lateral base and left apex. TRUS-estimated prostate volume was 65 cc with a PSA density 0.095 ng/ml. Review of systems was positive for mild daytime urinary frequency and nocturia one to two times per night. DRE revealed a large, smooth prostate with no discrete abnormality. At this time, he was a candidate for either AS or primary treatment. Three months later (PSA = 7.2 ng/ml), the patient underwent multiparametric (MP)-MRI exam. MP-MRI, consisting of T2-weighted, T1 dynamic contrast-enhanced MRI (DCE-MRI), and diffusion-weighted MRI (DWI) with derived apparent diffusion coefficient (ADC) revealed a suspicious lesion in the anterior apex of the prostate. MP-MRI was acquired on a GE Discovery MR750/3 T using standard clinical protocols. Figure 1A shows an area of nodular hypointensity on the axial T2-weighted image marked with an arrow. The same area is associated with low ADC values (mean ± SD: 842 ± 67 μm2/s) relative to the surrounding peripheral zone tissue (mean ± SD: 1858 ± 168μm2/s; p-value < 0.001, Student’s t-test). DCE-MRI was analyzed with in-house developed software (2) and the area indicated in the heat map in Figure 1 was associated with fast contrast uptake and gradual washout. The gadolinium contrast pharmacokinetic parameters for this area: Ktrans [volume transfer constant between plasma and extravascular space (EES)] and kep (rate constant between EES and plasma) are 0.351 and 0.705 min−1, respectively (3). In contrast, the same constants for the surrounding peripheral zone tissue were markedly lower: Ktrans = 0.175 min−1 and kep = 0.292 min−1. Based on these findings, in addition to a PSA of 7.2 ng/ml, the patient underwent MRI-ultrasound-directed prostate biopsies.


Multiparametric-MRI and Targeted Biopsies in the Management of Prostate Cancer Patients on Active Surveillance.

Sandler K, Patel M, Lynne C, Parekh DJ, Punnen S, Jorda M, Casillas J, Pollack A, Stoyanova R - Front Oncol (2015)

Multiparametric-MRI findings and directed prostate biopsy of the index lesion. (A) T2-weighted MRI and ADC map, with arrows indicating tumor area; (B) DCE-MRI intensity map with the lightest (yellow) part representing the areas of rapid contrast wash-in and gradual washout; and (C) tumor (yellow) and prostate (brown) contours. Both volumes were transferred to Artemis™ for fusion to the real-time ultrasound prior to prostate biopsy; 3D representation of the tumor with biopsy needle path shown.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4306300&req=5

Figure 1: Multiparametric-MRI findings and directed prostate biopsy of the index lesion. (A) T2-weighted MRI and ADC map, with arrows indicating tumor area; (B) DCE-MRI intensity map with the lightest (yellow) part representing the areas of rapid contrast wash-in and gradual washout; and (C) tumor (yellow) and prostate (brown) contours. Both volumes were transferred to Artemis™ for fusion to the real-time ultrasound prior to prostate biopsy; 3D representation of the tumor with biopsy needle path shown.
Mentions: We describe a 67-year-old gentleman who presented for evaluation of recently diagnosed cT1N0M0 prostate cancer. After many stable PSAs in the low 4 ng/ml range over 6 years, PSA rose slightly to 4.7 ng/ml a year ago. TRUS biopsy at this time was negative for malignancy, but showed a focus of high grade prostatic intraepithelial neoplasia in the left lateral base. Seven months later, the PSA rose to 6.2 ng/ml and a repeat biopsy was performed, which showed Gleason 3 + 3 = 6 prostatic adenocarcinoma involving two cores with <10% involvement from the left lateral base and left apex. TRUS-estimated prostate volume was 65 cc with a PSA density 0.095 ng/ml. Review of systems was positive for mild daytime urinary frequency and nocturia one to two times per night. DRE revealed a large, smooth prostate with no discrete abnormality. At this time, he was a candidate for either AS or primary treatment. Three months later (PSA = 7.2 ng/ml), the patient underwent multiparametric (MP)-MRI exam. MP-MRI, consisting of T2-weighted, T1 dynamic contrast-enhanced MRI (DCE-MRI), and diffusion-weighted MRI (DWI) with derived apparent diffusion coefficient (ADC) revealed a suspicious lesion in the anterior apex of the prostate. MP-MRI was acquired on a GE Discovery MR750/3 T using standard clinical protocols. Figure 1A shows an area of nodular hypointensity on the axial T2-weighted image marked with an arrow. The same area is associated with low ADC values (mean ± SD: 842 ± 67 μm2/s) relative to the surrounding peripheral zone tissue (mean ± SD: 1858 ± 168μm2/s; p-value < 0.001, Student’s t-test). DCE-MRI was analyzed with in-house developed software (2) and the area indicated in the heat map in Figure 1 was associated with fast contrast uptake and gradual washout. The gadolinium contrast pharmacokinetic parameters for this area: Ktrans [volume transfer constant between plasma and extravascular space (EES)] and kep (rate constant between EES and plasma) are 0.351 and 0.705 min−1, respectively (3). In contrast, the same constants for the surrounding peripheral zone tissue were markedly lower: Ktrans = 0.175 min−1 and kep = 0.292 min−1. Based on these findings, in addition to a PSA of 7.2 ng/ml, the patient underwent MRI-ultrasound-directed prostate biopsies.

Bottom Line: A multiparametric (MP)-MRI exam revealed a suspicious lesion in the anterior apex of the prostate.The pathology determined Gleason 3 + 4 disease in 30% of the core from this region.MP-MRI was also used to follow the changes from pre- to post-RT.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, University of Miami , Miami, FL , USA.

ABSTRACT
An important key to clinical management of prostate cancer patients is to determine early those who will benefit from primary treatment and are not good candidates for active surveillance (AS). We describe a 67-year-old gentleman with a long history of stable prostate-specific antigen (PSA) levels and a negative biopsy. After slight PSA rise and low volume Gleason score 6 biopsy, the patient was considered for primary treatment or AS. A multiparametric (MP)-MRI exam revealed a suspicious lesion in the anterior apex of the prostate. Biopsies were carried out on a 3D-ultrasound prostate biopsy system with MRI-fusion. The location of the target area was challenging and could have been missed using standard 12-core biopsy template. The pathology determined Gleason 3 + 4 disease in 30% of the core from this region. Consequently, the patient underwent radiotherapy (RT). MP-MRI was also used to follow the changes from pre- to post-RT.

No MeSH data available.


Related in: MedlinePlus