ACR Appropriateness Criteria Posttreatment Follow-up of Prostate Cancer

Although prostate cancer can be effectively treated, recurrent or residual disease after therapy is not uncommon and is usually detected by a rise in prostate-specific antigen. Patients with biochemical prostate-specific antigen relapse should undergo a prompt search for the presence of local recurrence or distant metastatic disease, each requiring different forms of therapy. Various imaging modalities and image-guided procedures may be used in the evaluation of these patients. Literature on the indications and usefulness of these radiologic studies and procedures in specific clinical settings is reviewed. The ACR Appropriateness Criteria(?) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.     

前列腺癌内分泌治疗后复发的MRI研究

目的探讨前列腺癌内分泌治疗后复发的MR I征象。方法10例经临床诊断证实的前列腺癌内分泌治疗后复发的病人,在内分泌治疗过程中肿瘤复发前后都进行了MR I检查。对2次MR I图像中前列腺T2信号、体积变化、对周围组织侵犯、扫描范围内的骨转移和淋巴结转移等情况进行对比分析。结果与复发前对比,前列腺体积增大的有7例,体积未见明显变化的有3例。复发后新出现的周围组织侵犯包括精囊腺(3例)、膀胱(2例)、直肠(1例)、盆底肌(1例)。复发后扫描范围内(骨盆至髂血管分叉水平)原有骨转移病灶进展的有3例,新出现转移灶的有4例。新出现髂血管旁肿大淋巴结的有4例,腹股沟肿大淋巴结的有2例。结论MR I检查能提供有助于诊断内分泌治疗后肿瘤复发的多方面影像信息。     

Granulomatous Prostatitis Mimicking Invasive Prostate Cancer

Teaching Point: Benign granulomatous prostatitis mimics prostate cancer on MRI. Peculiar urological history of a patient undergoing prostate MRI helps sorting out that differential, such as a treatment with topic Bacilli Calmette-Guerin instillations.     

Radiologists’ Contribution to Variation in Detecting Clinically Significant Prostate Cancer in Men With Prostate MRI

ObjectiveAssess radiologists’ contribution to variation in clinically significant prostate cancer (csPCa) detection in patients with elevated prostate-specific antigen (PSA) and multiparametric MRI (mpMRI).MethodsThis institutional review board–approved, retrospective cohort study was performed at a tertiary, academic, National Cancer Institute–designated Comprehensive Cancer Center with a multidisciplinary prostate cancer program. Men undergoing mpMRI examinations from January 1, 2015, to December 31, 2019, with elevated PSA (≥4 ng/mL) and biopsy within 6 months pre- or post-MRI or prostatectomy within 6 months post-mpMRI were included. Univariate and multivariable hierarchical logistic regression assessed impact of patient, provider, mpMRI examination, mpMRI report, and pathology factors on the diagnosis of Grade Group ≥ 2 csPCa.ResultsStudy cohort included 960 MRIs in 928 men, mean age 64.0 years (SD ± 7.4), and 59.8% (555 of 928) had csPCa. Interpreting radiologist was not significant individually (P > .999) or combined with mpMRI ordering physician and physician performing biopsy or prostatectomy (P = .41). Prostate Imaging Reporting and Data System (PI-RADS) category 2 (odds ratio [OR] 0.18, P = .04), PI-RADS category 4 (OR 2.52, P < .001), and PI-RADS category 5 (OR 4.99, P < .001) assessment compared with no focal lesion; PSA density of 0.1 to 0.15 ng/mL/cc (OR 2.46, P < .001), 0.15 to 0.2 ng/mL/cc (OR 2.77, P < .001), or ≥0.2 ng/mL/cc (OR 4.52, P < .001); private insurance (reference = Medicare, OR 0.52, P = .001), and unambiguous extraprostatic extension on mpMRI (OR 2.94, P = .01) were independently associated with csPCa. PI-RADS 3 assessment (OR 1.18, P = .56), age (OR 0.99, P = .39), and African American race (OR 0.90, P = .75) were not.DiscussionAlthough there is known in-practice variation in radiologists’ interpretation of mpMRI, in our multidisciplinary prostate cancer program we found no significant radiologist-attributable variation in csPCa detection.     

经直肠彩色多普勒超声对前列腺癌的诊断价值

目的　探讨经直肠彩色多普勒超声检查法对前列腺癌的诊断价值。方法　对 13 5例临床疑有前列腺癌的病人行经直肠灰阶超声及彩色多普勒超声检查 ,利用彩色直方图计算软件测得前列腺内异常血流增多区域的彩色血流面积占所选区域面积的百分比(theblackandwhitecolorratio ,BCR) ,并与其整个前列腺内血流BCR比较。每例患者均行经直肠超声引导下前列腺穿刺活检。结果　13 5例病人经前列腺穿刺病理证实前列腺癌 73例 ,前列腺增生症 5 0例 ,前列腺炎 12例。经直肠灰阶超声检查发现异常回声 84例 ,前列腺癌 5 1例 ,前列腺增生症 2 6例 ,前列腺炎 7例。经直肠彩色多普勒超声检查发现异常血流增多的 73例 ,前列腺癌 5 6例 ,其中 12例为灰阶超声无异常发现的位于内腺的前列腺癌。前列腺增生症 11例 ,前列腺炎 6例。经直肠灰阶超声及彩色多普勒超声检查对诊断前列腺癌的敏感性、特异性、阳性预测值分别为 70 .0 % ,46.8% ,60 .7%和 76.7% ,72 .6% ,76.7%。结论　经直肠彩色多普勒超声检查应列为前列腺癌的常规检查 ,这对提高前列腺癌的检出率 ,特别对位于内腺的前列腺癌有重要意义     

经直肠超声引导下前列腺穿刺活检诊断前列腺癌

目的:探讨经直肠彩色多普勒超声引导下前列腺穿刺活检诊断前列腺癌的价值。材料和方法:对36例临床肛门指检、前列腺特异抗原及经直肠超声三项检查之一异常者行经直肠超声检查,并行超声引导下穿刺活检。穿刺部位选择在可疑的前列腺癌结节,再结合6点穿刺法对其它部位进行穿刺。结果:19例前列腺癌,超声发现结节11例,9例位于外腺或内外腺交界处;17例前列腺增生,超声发现结节9例,7例结节位于内腺。结论:对可疑前列腺癌病例行经直肠超声引导下穿刺活检是一种快速有效的诊断技术。     

TURP手术对前列腺癌组织和非肿瘤组织血供影响的MRI评价

目的　应用动态增强MRI两室药物代谢动力学模型评价TURP手术对前列腺癌、前列腺良性增生和正常前列腺周围带血液供应的影响。方法　对 78例经病理组织学证实的前列腺癌 ,其中TURP手术组 2 4例 ,对照组 5 4例 ,使用GE 1.5T超导磁共振成像仪 ,采用FSPGR序列针对前列腺 ( 4层或 5层 )进行动态增强扫描 ,层厚 7mm ,层间间隔 2mm ,连续扫描采样 35次。应用两室药物代谢动力学模型进行分析 ,分别计算出前列腺癌、前列腺良性增生和正常前列腺周围带的最大增强指数、对造影剂的吸收幅度、造影剂的交换率和造影剂分布指数。结果　TURP组和对照组之间年龄、病理学分级、PSA和肿瘤的分期、大小均未见明显差异 (Ρ >0 .0 5 )。在TURP组中肿瘤区最大增强指数、造影剂分布指数和正常前列腺周围带的最大增强指数明显高于对照组 ,之间存在显著统计学差异 (Ρ <0 .0 5 )。结论　MRI药物代谢动力学模型 ,特别是最大增强指数和造影剂分布指数能够更准确地反映TURP手术对前列腺癌组织和非肿瘤组织的血液供应变化     

前列腺良恶性疾病MR表观扩散系数与细胞增殖的相关性研究

目的 通过表观扩散系数(ADC)与细胞密度、增殖细胞核抗原(PCNA)表达相关性分析,探讨扩散加权成像(DWI)评价良性前列腺增生(benign prostate hyperplasia,BPH)、前列腺癌(prostate cancer,PCa)细胞增殖状态的价值. 资料与方法 71例行DWI检查的前列腺疾病患者,其中PCa 38例,BPH 33例.根据常规HE染色和免疫组织化学记录PCa细胞密度及PCNA表达情况.对ADC值与细胞密度及PCNA表达水平进行相关性分析. 结果 PCa、BPH和正常外周带的平均ADC值分别为(49.32±12.68)×10-5 mm2/s、(86.73±26.75)×10-5 mm2/s和(126.25±27.21)×10-5 mm2/s,差异有统计学意义(P＜0.05).PCa的细胞密度及PCNA表达平均值分别为12.9%和72.1%,高于BPH的细胞密度(8.6%)及PCNA表达(55.7%)(P＜0.05).PCa的ADC值与细胞密度及PCNA表达存在负相关性(r=-0.646、-0.446,P＜0.05). 结论 细胞密度是影响ADC值的重要因素,ADC值能对PCa细胞增殖状态进行评估.     

Dose to Bone Marrow Using IMRT Techniques in Prostate Cancer Patients

Purpose: To investigate the dose distribution in active bone marrow of patients undergoing intensity-modulated radiotherapy (IMRT) for prostate cancer and compare it to the distribution in the same patients, if they had been treated using conformal plans, in order to develop criteria for optimization to minimize the estimated risk of secondary leukemia. Patients and Methods: Mean bone marrow doses were calculated for ten patients with localized prostate cancer who underwent whole-pelvis IMRT and compared to three-dimensional conformal (3-D CRT) plans prepared for the same patients. Also for comparison, the IMRT and 3-D CRT plans were produced to simulate the treatment of the prostate gland only. To measure the dose to extrapelvic bone marrow, three thermoluminescent diode (TLD) chips were placed in the middle of the sternum region inside the Rando phantom. Results: For both the pelvic and prostate-only volumes, the IMRT plans were superior to 3-D CRT plans in reducing the high dose volume to the rectum, the bladder and the small bowel while maintaining acceptable coverage of the planning target volume (PTV). For the pelvic treatment group the IMRT plans, compared to 3-D CRT, reduced the high dose volume (> 20 Gy) to os coxae, which is the main contributor of dose to pelvic bone marrow, but increased the middle dose volume (10–20 Gy). No statistically significant differences were observed for lower dose volumes (< 5 Gy). For the prostate-only treatment the IMRT plan increased the high dose volume and slightly decreased the low dose volume of pelvic bone marrow. However, for both treatments the leakage dose to extrapelvic sites was higher by a factor of 2 in IMRT plans. Conclusion: There are significant differences in the dose-volume histograms of bone marrow doses from 3-D CRT and from IMRT. Pronounced dose inhomogeneity reduces the risk of leukemia compared to homogeneous radiation exposure of the bone marrow. The mean bone marrow dose is therefore not a useful criterion to judge plan quality, since scattered low doses to distant sites may be more critical than the high dose volumes receiving > 10 Gy. The number of monitor units needed to deliver an IMRT plan affects leakage dose and their incorporation into planning constraints should be considered.     

E-cadherin蛋白在前列腺癌组织中的表达及临床意义

目的　探讨上皮细胞钙粘素 (E cadherin ,E Cad)在前列腺癌组织中的表达及其临床意义。方法　应用免疫组织化学 (SP)方法测定 42例前列腺癌及 3例正常和 7例良性前列腺增生组织中E Cad蛋白的表达。结果　 42例前列腺癌组织中 2 1例E Cad蛋白表达阳性 ( 5 0 %)。随肿瘤细胞病理分级、临床分期程度的增高 ,癌细胞表达E Cad蛋白阳性率降低 ,高、中分化组 2 2例前列腺癌中 19例E Cad蛋白表达阳性( 86%) ,与低分化组 2 0例中 2例 ( 10 %)阳性表达 ;A +B期和C +D期前列腺癌组织中的阳性表达率分别为 65 5 %( 19/ 2 9)和 15 3 %( 2 / 13 ) ,各组间比较有显著性差异 ( χ2 =2 4 43 ,P <0 0 0 5 ;χ2 =9 0 3 ,P <0 0 0 5 )。而正常和良性前列腺增生组E Cad蛋白均呈阳性免疫反应。结论　E Cad蛋白异常表达在前列腺癌的恶性进展中起重要作用 ,检测E Cad蛋白的表达有利于判断病期及预后。     

前列腺癌骨转移的临床诊断:MRI与同位素骨扫描的比较

目的比较盆腔MRI和全身骨扫描对前列腺癌骨转移的临床诊断效能。方法收集183例前列腺疾病患者的资料,包括盆腔MRI和全身骨扫描检查结果。根据临床综合诊断结果,将所有患者分为骨转移组和非骨转移组。对获得的资料进行统计学分析。结果①183例患者中,37例确诊临床骨转移,146例无临床骨转移。37例骨转移患者的转移灶位置,5例位于盆腔内,3例位于盆腔外,29例位于盆腔内外。②盆腔MRI检查诊断24例骨转移,均经临床综合评价确诊为骨转移(100%,24/24)。全身骨扫描诊断27例骨转移,96.4%(27/28)经临床综合评价确诊为骨转移。其它骨转移的确诊均经临床综合诊断。③将盆腔MRI和同位素骨扫描的结果进行比较,盆腔MRI检查未见明确骨转移灶的患者共159例,其中仅有4例患者(4/159,2.52%)全身骨扫描可明确诊断骨转移。④评价2种影像检查方法对全身骨转移的预测和诊断效果,盆腔MRI对全身骨转移预测的敏感性、特异性和准确性分别为78.38%、87.0%和85.25%;全身骨扫描对骨转移的诊断敏感性、特异性和准确性分别为94.59%、62.33%和68.85%。MRI的特异性和准确性高于同位素骨扫描(χ2=23.458,P=0.000;χ2=13.906,P=0.000),同位素骨扫描的敏感性高于MRI(χ2=4.163,P=0.041)。结论盆腔MRI也可用作前列腺癌全身骨转移的诊断。当盆腔MRI检查未见骨转移灶时,发生全身骨转移的机会较低。     

Patient-Centered Outcomes From Multiparametric MRI and MRI-Guided Biopsy for Prostate Cancer: A Systematic Review

ObjectiveTo identify and characterize patient-centered outcomes (PCOs) relating to multiparametric MRI (mpMRI) and MRI-guided biopsy as diagnostic tests for possible prostate cancer.MethodsMedline via OVID, EMBASE, PsycInfo, and the Cochrane Central register of Controlled Trials (CENTRAL) were searched for relevant articles. Hand searching of reference lists and snowballing techniques were performed. Studies of mpMRI and MRI-guided biopsy that measured any PCO were included. There were no restrictions placed on year of publication, language, or country for study inclusion. All database search hits were screened independently by two reviewers, and data were extracted using a standardized form.ResultsOverall, 2,762 database search hits were screened based on title and abstract. Of these, 222 full-text articles were assessed, and 10 studies met the inclusion criteria. There were 2,192 participants featured in the included studies, all of which were conducted in high-income countries. Nineteen different PCOs were measured, with a median of four PCOs per study (range 1-11). Urethral bleeding, pain, and urinary tract infection were the most common outcomes measured. In the four studies that compared mpMRI or MRI-guided biopsy to transrectal ultrasound biopsy, most adverse outcomes occurred less frequently in MRI-related tests. These four studies were assessed as having a low risk of bias.DiscussionPCOs measured in studies of mpMRI or MRI-guided biopsy thus far have mostly been physical outcomes, with some evidence that MRI tests are associated with less frequent adverse outcomes compared with transrectal ultrasound biopsy. There was very little evidence for the effect of mpMRI and MRI-guided biopsy on emotional, cognitive, social, or behavioral outcomes.