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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: 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.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

H&E stain of MP-MRI-ultrasound-directed prostate biopsy. The ink stain indicates that the tumor is located on the tip of the biopsy. The region in the red box is at 20× magnification and shows Gleason score = 3 + 4.
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Figure 2: H&E stain of MP-MRI-ultrasound-directed prostate biopsy. The ink stain indicates that the tumor is located on the tip of the biopsy. The region in the red box is at 20× magnification and shows Gleason score = 3 + 4.

Mentions: The pathology review determined GS 3 + 4 in 30% of the core from the suspicious region (Figure 2). Thus, the patient was not considered as a candidate for AS and he underwent RT. The patient was enrolled in an institutional investigator-initiated RT trial in which higher doses of radiation are delivered to the MP-MRI identified dominant lesion in half of the patients. He was randomized to the standard arm and the entire prostate and proximal seminal vesicles received 80 Gy in 40 fractions. Repeat MP-MRIs were performed 3 months post-RT. In Figure 3, the T2-weighted MRI, ADC map, and contrast-versus-time curves are shown pre- (A) and 3 months post-treatment (B) in two prostate regions. The comparison illustrates the disappearance of the lesion on the post-treatment T2 and ADC images. Post-treatment ADC values for the lesion (blue) were 1576 ± 80 μm2/s and for normal prostate (red) were 1467 ± 146 μm2/s. While quite distinct pre-treatment, the contrast-versus-time curves post-RT were similar with a temporal pattern characteristic for normal prostate.


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)

H&E stain of MP-MRI-ultrasound-directed prostate biopsy. The ink stain indicates that the tumor is located on the tip of the biopsy. The region in the red box is at 20× magnification and shows Gleason score = 3 + 4.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: H&E stain of MP-MRI-ultrasound-directed prostate biopsy. The ink stain indicates that the tumor is located on the tip of the biopsy. The region in the red box is at 20× magnification and shows Gleason score = 3 + 4.
Mentions: The pathology review determined GS 3 + 4 in 30% of the core from the suspicious region (Figure 2). Thus, the patient was not considered as a candidate for AS and he underwent RT. The patient was enrolled in an institutional investigator-initiated RT trial in which higher doses of radiation are delivered to the MP-MRI identified dominant lesion in half of the patients. He was randomized to the standard arm and the entire prostate and proximal seminal vesicles received 80 Gy in 40 fractions. Repeat MP-MRIs were performed 3 months post-RT. In Figure 3, the T2-weighted MRI, ADC map, and contrast-versus-time curves are shown pre- (A) and 3 months post-treatment (B) in two prostate regions. The comparison illustrates the disappearance of the lesion on the post-treatment T2 and ADC images. Post-treatment ADC values for the lesion (blue) were 1576 ± 80 μm2/s and for normal prostate (red) were 1467 ± 146 μm2/s. While quite distinct pre-treatment, the contrast-versus-time curves post-RT were similar with a temporal pattern characteristic for normal prostate.

Bottom Line: 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.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