Endorectal Magnetic Resonance Imaging and Spectroscopy Are Useful for Selecting Candidates for Biopsy among Patients with Persistently Elevated Prostate Specific Antigen — Oak Academic Publishing
Research ArticleOpen AccessGoogle Scholar indexed
Endorectal Magnetic Resonance Imaging and Spectroscopy Are Useful for Selecting Candidates for Biopsy among Patients with Persistently Elevated Prostate Specific Antigen
Urology Department, Hospital Dr. Josep Trueta, Catalonia, Spain
,
Department of Computer Science and Applied Mathematics, University of Girona, Catalonia, Spain
,
Ressonància Girona, Catalonia, Spain
,
Urology Department, Hospital Dr. Josep Trueta, Catalonia, Spain
,
Radiology Department, Hospital Dr. Josep Trueta, Catalonia, Spain
Objective: To evaluate the efficacy of endorectal Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spetroscopic Imaging (MRSI) combined with total prostate-specific antigen (tPSA) and free prostate-specific antigen (fPSA) in selecting candidates for biopsy. Subjects and Methods: 246 patients with elevated tPSA (median: 7.81 ng/ml) underwent endorectal MRI and MRSI before Transrectal Ultrasound (TRUS) biopsy (10 peripheral + 2 central cores); patients with positive biopsies were treated with radical intention; those with negative biopsies were followed up and underwent MRSI before each additional biopsy if tPSA rose persistently. Mean follow-up: 27.6 months. We compared MRI, MRSI, tPSA, and fPSA with histopathology by sextant and determined the association between the Gleason score and MRI and MRSI. We determined the most accurate combination to detect prostate cancer (PCa) using receiver operating curves; we estimated the odds ratios (OR) and calculated sensitivity, specificity, and positive and negative predictive values. Results: No difference in tPSA was found between patients with and without PCa (p = 0.551). In the peripheral zone, the risk of PCa increased with MRSI grade; patients with high-grade MRSI had the greatest risk of PCa over time (OR = 328.6); the model including MRI, MRSI, tPSA, and fPSA was more accurate (Area under Curve: AUC = 95.7%) than MRI alone (AUC = 85.1%) or fPSA alone (AUC = 78.1%), but not than MRSI alone (94.5%). In the transitional zone, the model was less accurate (AUC = 84.4%). The association (p = 0.005) between MRSI and Gleason score was significant in both zones. Conclusions: MRSI is useful in patients with elevated tPSA. High-grade MRSI lesions call for repeated biopsies. Men with negative MRSI may forgo further biopsies because a significantly high Gleason lesion is very unlikely.
KeywordsEndorectal MRISpectroscopyProstate CancerDiagnosisProstate Specific Antigen (PSA)Free to Total PSA Ratio (F/T PSA)
I. M. Thompson, D. K. Pauler and P. J. Goodman, “Prevalence of Prostate Cancer among Men with a Prostate-Specific Antigen Level < or =4.0 ng per Milliliter,” The New England Journal of Medicine, Vol. 350, No. 22, 2004, pp. 2239-2246.
C. G. Arcangeli, D. K. Ornstein and D. W. Keetch, “Prostate-Specific Antigen as a Screening Test for Prostate Cancer. The United States Experience,” Urologic Clinics of North America, Vol. 24, No. 2, 1997, pp. 299-306.
G. L. Andriole and W. J. Catalona, “Using PSA to Screen for Prostate Cancer. The Washington University Experience,” Urologic Clinics of North America, Vol. 20, No. 4, 1993, pp. 647-651.
J. B. Shah, A. C. Reese and J. M. McKiernan, “PSA Up-dated: Still Relevant in the New Millennium?” European Urology, Vol. 47, No. 4, 2005, pp. 427-432.
A. W. Roddam, M. J. Duffy and F. C. Hamdy, “Use of Prostate-Specific Antigen (PSA) Isoforms for the Detection of Prostate Cancer in Men with a PSA Level of 2-10ng/ml: Systematic Review and Meta-Analysis,” European Urology, Vol. 48, No. 3, 2005, pp. 386-399.
J. Scheidler, H. Hricak and D. B. Vigneron, “Prostate Cancer: Localization with Three-Dimensional Proton MR Spectroscopic Imaging—Clinicopathologic Study,” Radiology, Vol. 213, No. 2, 1999, pp. 473-480.
A. E. Wefer, H. Hricak and D. B. Vigneron, “Sextant Localization of Prostate Cancer: Comparison of Sextant Biopsy, Magnetic Resonance Imaging and Magnetic Resonance Spectroscopic Imaging with Step Section Histology,” Journal of Urology, Vol. 164, No. 2, 2000, pp. 400-404.
J. Kurhanewicz, D. B. Vigneron and H. Hricak, “Three Dimensional H-1 MR Spectroscopic Imaging of the in Situ Human Prostate with High (0.24 - 0.7 cm3) Spatial Resolution,” Radiology, Vol. 198, No. 3, 1996, pp. 795-805.
K. Okamura, H. Takaba and O. Kamihira, “Determination of the Relative Probability for Prostate Cancer to Avoid Unnecessary Biopsies,” International Journal of Urology, Vol. 12, No. 4, 2005, pp. 346-352.
J. Nakashima, A. Tanimoto and Y. Imai, “Endorectal MRI for Prediction of Tumour Site, Tumour Size, and Local Extension of Prostate Cancer,” Journal of Urology, Vol. 64, No. 1, 2004, pp. 101-105.
M. Umberh, L. M. Bachmann and U. Held, “Combined Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy Imaging in the Diagnosis of Prostate Cancer: A Systematic Review and Meta-Analysis,” European Urology, Vol. 55, No. 3, 2009, pp. 575-591.
J. S. P Yuen, C. H. Thng and P. H. Tan, “Endorectal Magnetic Resonance Imaging and Spectroscopy for the Detection of Tumor Foci in Men with Prior Negative Transrectal Ultrasound Prostate Biopsy,” Journal of Urology, Vol. 171, No. 4, 2004, pp. 1482-1486.
D. Amsellem-Ouazana, P. Younes and S. Conquy, “Negative Prostatic Biopsies in Patients with a High Risk of Prostate Cancer. Is the Combination of Endorectal MRI and Magnetic Resonance Spectroscopic Imaging (MRSI) a Useful Tool? A Preliminary Study,” European Urology, Vol. 47, No. 5, 2005, pp. 582-586.
A. Shukla-Dave, H. Hricak and N. Ishill, “Correlation of MR Imaging and MR Spectroscopic Imaging Findings with Ki-67, Phospho-Akt, and Androgen Receptor Expression in Prostate Cancer,” Radiology, Vol. 250, No. 3, 2009, pp. 803-807.
S. Ikonen, P. K?rkkainen and L. Kivisaar, “Magnetic Resonance Imaging of Prostatic Cancer: Does Detection Vary between High and Low Gleason Score Tumors?” Prostate, Vol. 43, No. 1, 2000, pp. 43-48.
Y. Kubota, S. Kamei and M. Nakano, “The Potential Role of Prebiopsy Magnetic Resonance Imaging Combined with Prostate Specific Antigen Density in the Detection of Prostate Cancer,” International Journal of Urology, Vol. 15, No. 4, 2008, pp. 322-327.
L. Wang, H. Hricak and M. Kattan, “Combined Endorectal and Phased-Array MRI in the Prediction of Pelvic Lymph Node Metastasis in Prostate Cancer,” American Journal of Roentgenology, Vol. 186, No. 3, 2006, pp. 743-748.
J. Q. Zhang, K. R. Loughlin and K. H. Zou, “Role of Endorectal Coil Magnetic Resonance Imaging in Treatment of Patients with Prostate Cancer and in Determining Radical Prostatectomy Surgical Margin Status: Report of a Single Surgeon’S Practice,” Journal of Urology, Vol. 69, No. 6, 2007, pp. 1134-1137.
A. P. S. Kirkham, M. Emberton and C. Allen, “How Good Is MRI at Detecting and Characterising Cancer within the Prostate?” European Urology, Vol. 50, No. 6, 2006, pp. 1163-1175.
N. G. Costouros, F. V. Coakley and A. C. Westphalen, “Diagnosis of Prostate Cancer in Patients with an Elevated PSA Level: Role of Endorectal MRI and MR Spectroscopic Imaging,” American Journal of Roentgenology, Vol. 188, No. 3, 2007, pp. 812-816.
A. V. D’Amico, R. Whittington and M. Schnall, “The Impact of the Inclusion of Endorectal Coil Magnetic Resonance Imaging in a Multivariate Analysis to Predict Clinically Unsuspected Extraprostatic Cancer,” Cancer, Vol. 75, No. 9, 1995, pp. 2368-2372.
H. Hricak, L. Wang and D. C. Wei, “The Role of Preoperative Endorectal Magnetic Resonance Imaging in the Decision Regarding Whether to Preserve or Resect Neurovascular Bundles during Radical Retropubic Prostatectomy,” Cancer, Vol. 100, 2004, pp. 2655-2663.
“European Guidelines on Prostate Cancer of the European Association of Urology,” 2012.
“European Guidelines on Prostate Cancer of the European Association of Urology,” 2012.
R. Zigeuner, L. Schips and K. Lipsky, “Detection of Prostate Cancer by TURP or Open Surgery in Patients with Previously Negative Transrectal Prostate Biopsies,” Urology, Vol. 62, No. 5, 2003, pp. 883-887.
A. E. Pelzer, J. Bektic and A. P. Berger, “Are Transition Zone Biopsies Still Necessary to Improve Prostate Cancer Detection? Results from the Tyrol Screening Project,” European Urology, Vol. 48, No. 6, 2005, pp. 916-921.
K. L. Zakian, K. Sircar and H. Hricak, “Correlation of Proton MR Spectroscopic Imaging with Gleason Score Based on Step Section Pathologic Analysis after Radical Prostatectomy,” Radiology, Vol. 234, No. 3, 2005, pp. 804-814.
L. Dickinson, H. U. Ahmed and C. Allen, “Magnetic Resonance Imaging for the Detection, Localization and Characterisation of Prostate Cancer: Recommendations from a European Consensus Meeting,” European Urology, Vol. 59, No. 4, 2011, pp. 477-494.
J. C. Vilanova, C. Barcelo and J. Comet, “Usefulness of Prebiopsy Multifunctional and Morphologic MRI Combined with Free to Total Prostate Specific Antigen Ratio in the Detection of Prostate Cancer,” American Journal of Roentgenology, Vol. 196, No. 6, 2011, pp. 715-722.