Context: Although magnetic resonance imaging (MRI) is broadly implemented into active surveillance (AS) protocols, data on the reliability of serial MRI in order to help guide follow-up biopsy are inconclusive.
Objective: To assess the diagnostic estimates of serial prostate MRI for prostate cancer (PCa) progression during AS.
Evidence Acquisition: We systematically searched PubMed, Scopus, and Web of Science databases to select studies analyzing the association between changes on serial prostate MRI and PCa progression during AS. We included studies that provided data for MRI progression, which allowed us to calculate diagnostic estimates. We compared Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) accuracy with institution-specific definitions.
Evidence Synthesis: We included 15 studies with 2240 patients. Six used PRECISE criteria and nine institution-specific definitions of MRI progression. The pooled PCa progression rate, which included histological progression to Gleason grade ≥2, was 27%. The pooled sensitivity and specificity were 0.59 (95% confidence interval [CI] 0.44-0.73) and 0.75 (95% CI 0.66-0.84) respectively. There was significant heterogeneity between included studies. Depending on PCa progression prevalence, the pooled negative predictive value for serial prostate MRI ranged from 0.81 (95% CI 0.73-0.88) to 0.88 (95% CI 0.83-0.93) and the pooled positive predictive value ranged from 0.37 (95% CI 0.24-0.54) to 0.50 (95% CI 0.36-0.66). There were no significant differences in the pooled sensitivity (p = 0.37) and specificity (p = 0.74) of PRECISE and institution-specific schemes.
Conclusions: Serial MRI still should not be considered a sole factor for excluding PCa progression during AS, and changes on MRI are not accurate enough to indicate PCa progression. There was a nonsignificant trend toward improved diagnostic estimates of PRECISE recommendations. These findings highlight the need to further define the optimal triggers and timing of biopsy during AS, as well as the need for optimizing the quality, interpretation, and reporting of serial prostate MRI.
Patient Summary: Our study suggests that serial prostate magnetic resonance imaging (MRI) alone in patients on active surveillance is not accurate enough to reliably rule out or rule in prostate cancer progression. Other clinical factors and biomarkers along with serial MRI are required to safely tailor the intensity of follow-up biopsies.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1016/j.eururo.2021.05.001 | DOI Listing |
Front Oncol
November 2024
Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States.
Introduction: Prior studies suggest lymphopenia following radiation therapy may impact toxicity and cancer control. Chronic radiation-related lymphopenia (RRL) has been noted in prostate cancer patients treated with conventionally fractionated pelvic radiation therapy. The impact of utilizing hypofractionated high integral dose therapies such as stereotactic body radiation therapy (SBRT) on RRL is less well characterized.
View Article and Find Full Text PDFAn Acad Bras Cienc
November 2024
Paulista University, Graduate Program in Environmental and Experimental Pathology, R. Dr. Bacelar, 1212, 04026-002 São Paulo, SP, Brazil.
Cell Rep Med
November 2024
Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA; Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, Los Angeles, CA, USA. Electronic address:
Small cell neuroendocrine cancers share biologic similarities across tissue types, including transient response to platinum-based chemotherapy with rapid progression of disease. We report a phase 1b study of pembrolizumab in combination with platinum-based chemotherapy in 15 patients with stage III-IV small cell bladder (cohort 1) or small cell/neuroendocrine prostate cancers (cohort 2). Overall response rate (ORR) is 43% with two-year overall survival (OS) rate of 86% (95% confidence interval [CI]: 0.
View Article and Find Full Text PDFEur Urol Focus
July 2024
Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address:
Background: Inflammation has been linked to the development of benign prostatic hyperplasia (BPH). SRD5A2 is a pivotal enzyme in the development and growth of the prostate gland and a critical target for BPH therapy. TNF-α regulates epigenetic changes in SRD5A2, leading to suppression of SRD5A2 gene and protein expression.
View Article and Find Full Text PDFBMC Cancer
October 2024
Interdisciplinary Research Unit for Cancer Prevention and Treatment, Federative Structure 4207 'Normandie Oncologie', F. Baclesse, Université of Caen Normandie, Inserm U1086 ANTICIPE, Caen, France.
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!