Integrated CT-perfusion shows no meaningful correlation with PSA and presurgical Gleason score in patients with early prostate cancer

ObjectivesTo analyze the correlation of computed tomography (CT) perfusion parameters blood flow (BF), blood volume (BV), and mean transit time (MTT) with presurgical prostate cancer data.MethodsNinety-eight patients with biopsy-proven prostate cancer underwent a CT-perfusion scan of the prostate. MTT, BF, and BV were determined and correlated with prostate-specific antigen (PSA) level, tumor load and Gleason score of transrectal ultrasonography-guided biopsy specimens.ResultsMean BF was 41.3 ml/100 ml*min^- 1, BV 5.2 ml/100 ml, MTT 8.7 s. Moderate correlations were observed between Gleason score and BF (0.35) and between PSA and BF (0.33) and BV (0.30).ConclusionsCT-perfusion shows no valuable correlation with presurgical prostate cancer data.     

前列腺癌的MR波谱特征与Gleason评分的关系

目的以MR波谱分析(MRS)方法定量分析前列腺癌(PCa)的代谢特征与Gleason评分的关系。方法经手术病理或穿刺活检证实的PCa21例以6分区的方法(将前列腺分为左、右侧的底部、中部、尖部)进行MRS定量分析。在MRS代谢图上标记出手术病理或穿刺活检取材位置归入相应的分区,测量其(胆碱+肌酸)/枸椽酸盐(CC/C)的比值。将PCa的MRS代谢结果与其Gleason评分进行对照。结果21例患者74分区有癌,其CC/C均值为2.13±0.82;52分区无癌,其CC/C均值为0.59±0.20。二者间的差异有统计学意义(t=7.72,P=0.00)。PCa的CC/C比值与Gleason评分相关(r=0.66,P=0.01)。Gleason评分≥7组和<7组的CC/C比值分别为2.61±0.79和1.69±0.59,差异有统计学意义(t=3.06,P=0.01)。结论CC/C与Gleason评分有相关性,MRS有可能无创地评价PCa的病理分级。     

IVIM-DWI在前列腺癌与前列腺增生鉴别诊断中的应用价值及其与Gleason评分的相关性

目的:探讨体素内不相干运动磁共振扩散加权成像(IVIM-DWI)定量参数测量在列腺癌和前列腺增生鉴别诊断中的价值及其与Gleason评分的相关性.方法:回顾性分析经临床病理学证实的50例前列腺疾病患者的影像学资料,其中前列腺癌(PCa)24例,前列腺增生(BPH)26例.所有患者均行常规MRI和IVIM-DWI检查,IVIM-DWI采用10个b值(10、20、30、50、80、100、200、400、1000和1500s/mm2),对不同b值的DWI数据进行后处理,使用双指数模型拟合算法获得病变组织的纯水分子扩散系数D值和灌注分数f值,比较二者在前列腺癌和前列腺增生组间的差异,及其与Gl-eason评分的相关性.结果:前列腺癌组的D值明显低于前列腺增生组,组间差异有统计学意义(P＜0.05);前列腺癌组的f值高于前列腺增生组,组间差异有统计学意义(P＜0.05).前列腺癌组的D值和f值与Gleason评分的相关性无统计学意义(P＞0.05).结论:IVIM-DWI定量分析在前列腺癌和前列腺增生的诊断及鉴别诊断中有较高价值,前列腺癌的D值和f值与Gleason评分无相关性.     

Relative influence of Gleason score and pretreatment PSA in predicting survival following brachytherapy for prostate cancer

PURPOSE: To evaluate 10-year survival rates after prostate brachytherapy and to assess the relative importance of pretreatment prostate-specific antigen (PSA) and Gleason score in predicting cancer death. MATERIALS AND METHODS: A retrospective review was performed on all patients treated with permanent brachytherapy for stage T1 or T2 primary prostate cancer at a single institution from December 1988 through June 30, 1998. The study cohort consisted of 1266 patients with a median follow-up of 4.1 years and a maximum of 12.6 years. Actuarial survival and cause-specific survival rates were calculated as the primary endpoints, and compared at 5 and 10 years. Groups studied consist of PSAor=10 as well as Gleason 2-4, 5-6, and 7-10. Multivariate and univariate analysis were performed looking at stage, grade, PSA, and risk group as variables. RESULTS: The median age at the time of treatment was 73 years and at the time of analysis 603 patients were known to be alive. Overall survival is 38% at 10 years, however most deaths were unrelated to prostate cancer. Cause specific survival at 5 and 10 years is 98% and 87%. Both grade (>or=Gleason 7) and PSA (>or=10 ng/ml) predict adversely for cancer death within 10 years. Patients with low grade or PSA at presentation reveal prostate cancer-specific survival of 91% and 98%, respectively. By contrast, men with high grade or high PSA presentation have survival of 66% and 69% at 10 years. In multivariate analysis, the presence of one of these adverse features carries a hazard ratio of cancer death of 4.7 and 6.4, while the presence of multiple risk factors places patients in an unfavorable risk group with a hazard ratio of 27. CONCLUSIONS: Biochemical disease-free survival is a useful tool to assess prostate cancer treatments and is predicted based on established pretreatment risk groups. Long-term cancer-specific survival is ultimately a more important endpoint. Brachytherapy is reported here to be an excellent therapeutic alternative for selected early stage patients with prostate cancer. This is based on 10-year cause specific survival, which may also be predicted by stage, grade, PSA, and risk group. Of these, the risk group remains the most powerful parameter to identify those patients at highest risk of biochemical failure and death from prostate cancer.     

前列腺癌ADC值与Gleason评分、临床分期及PSA的相关性研究

目的：探讨前列腺癌（Pca）的表观弥散系数值（ADC-value）与前列腺癌Gleason评分、临床分期及PSA的相关性。方法：分析经穿刺活检、手术组织病理学证实的Pca患者45例,记录患者的临床资料。使用GE公司Twin-speedHD和HDe1．5T超导磁共振成像仪,体线圈为射频发射和接受线圈进行扩散加权成像。通过GE高级工作站4．3进行数据处理,计算得到的Pea感兴趣区的平均ADC值,分析Pca癌灶ADC值与Gleason评分、临床分期及PSA的相关性。结果：45例Pca癌灶ADC的平均值为（0．914±0．066）×10^-3mm^2／s,Pca的ADC值与Gleason评分、临床分期及PSA水平存在负相关关系,r值分别为-0．403、-0．497、-0．437,P值均〈0．05。结论：Pca病灶的ADC值与Gleason分级、临床分期及PSA存在相关性,根据ADC值可对Pea的生物学特性进行初步评估,对临床制定合适的治疗方案有一定帮助。     

DWI 双指数模型参数与前列腺癌 Gleason 评分及临床侵袭性相关性研究

目的：研究多 b值DWI双指数模型参数预测前列腺癌恶性程度的应用价值。方法回顾性分析57例经穿刺或手术证实为前列腺癌患者的多 b 值 DWI(b 值0~800 s/ mm2)图像,逐层勾画全肿瘤感兴趣区,利用体素不相干运动(IVIM)计算肿瘤扩散系数 Dt、灌注系数 Dp 及灌注分数 f。根据 Gleason 评分(GS)及 D’Amico 分级分组,采用 ANOVA 方差分析及 Spearman 相关分析,低侵袭及中-高侵袭组间行受试者工作特征(ROC)分析。结果癌灶 Dt 在 GS 及 D’Amico 组间存在显著差异且呈负相关。Dp及 f 组间无统计学意义。对 Dt 进行 ROC 分析,敏感性、特异性分别为82.2%,100%;85.1%,90.0%;AUC=0.928,0.838;界值分别为1.073×10-3 mm2/s,1.117×10-3 mm2/s。结论Dt 可预测前列腺癌恶性程度。Dp 及 f 与前列腺癌恶性度无相关性。     

Magnetic resonance spectroscopy in patients with locally confined prostate cancer: association of prostatic citrate and metabolic atrophy with time on hormone deprivation therapy, PSA level, and biopsy Gleason score

This study was undertaken to determine respective associations between prostatic citrate or metabolic atrophy (no detectable citrate, choline, and creatine) at magnetic resonance spectroscopy (MRS) and time on hormone-deprivation therapy, serum PSA, and biopsy Gleason score. Clinical data, histopathology reports and PSA levels of 36 patients on hormone-deprivation therapy (age, 64±9 years, pre-therapeutic biopsy Gleason sum, median 6, range 3–8, antiandrogens only, n=3, LHRH-analogues only, n=4, combined hormone-deprivation therapy, n=29, duration, 27±19 weeks) for locally confined prostate cancer (PCA) were retrospectively correlated with findings in the peripheral zone of the prostate at 3D-MRS (endorectal coil, PRESS, TR 1,000 ms, TE 130 ms). The results show that citrate was usually detected after 13 weeks or less of hormone-deprivation therapy (10/12 vs. 6/24 patients, chi-square-test, p=0.002). All patients with PSA levels exceeding 0.20 ng/ml had detectable metabolites (citrate, n=12, choline without citrate, n=6), while 9/18 patients with PSA 0.20 ng/ml or less showed metabolic atrophy (Fisher-exact-test, p=0.001). There were no significant associations between citrate, metabolic atrophy, pre-therapeutic PSA, and biopsy Gleason sum, respectively. It has been concluded that hormone-deprivation therapy for locally confined PCA has not reached its full deprivation potential after 13 weeks. MRS detects prostate metabolism in patients with PSA exceeding 0.20 ng/ml after hormone-deprivation therapy.     

Prostate specific antigen level and Gleason score in predicting the stage of newly diagnosed prostate cancer.

The purpose of this study was to determine the utility of prostate specific antigen (PSA) level and Gleason score in the prediction of disease stage in men with newly diagnosed prostate cancer. 102 consecutive men, newly diagnosed with prostate cancer and candidates for radical therapy, underwent contrast enhanced pelvic CT and skeletal scintigraphy. Staging examinations used the TNM classification and were reported prospectively with the radiologist blinded to the patient's Gleason score and level of PSA. Lymph node metastasis was confirmed by CT guided biopsy, lymphadenectomy or response to therapy in some cases of massive disease. There were significant differences between the mean PSA values of 18 men with and 84 men without skeletal metastases (p = 0.01) and between men with locally confined and non-confined disease (p = 0.02). There was no difference between PSA values of 13 men with and 89 men without lymph node metastasis (p = 0.9). Only one man with CT evidence of nodal metastasis (N + ve) had a PSA value below 20 ng ml-1. Two men with Gleason scores below 6 were N + ve and both had PSA values over 20 ng ml-1. One man with skeletal metastasis had a PSA value below 20 ng ml-1 but had bone pain. For this study group if only those men with PSA values over 20 ng ml-1 had been examined, sensitivity for lymphatic and skeletal metastasis would have been 92%. Using this threshold about one-third would have been spared imaging investigation. In conclusion, pelvic CT and skeletal scintigraphy are unlikely to show metastatic disease in a man newly diagnosed with prostate cancer who has no suggestive clinical features, a PSA level below 20 ng ml-1 and a Gleason score below 6.     

Relationships between serum PSA levels,Gleason scores and results of 68Ga-PSMAPET/CT in patients with recurrent prostate cancer

Aim

To investigate the relationship between serum PSA level, Gleason score of PCa and the outcomes of Ga⁶⁸-PSMA PET/CT in patients with recurrent PCa.

Methods

A total of 109 consecutive patients (median age 71 years; range 48–89 years) who had PSA recurrence after RP and/or hormonotherapy and/or radiotherapy were included in this study. Local recurrences, lymph node metastasis (pelvic, abdominal and/or supradiaphragmatic), bone metastases (oligometastatic/multimetastatic) and other metastatic sites (lung, liver, brain, etc) were documented.

Results

In 91(83.4%) patients at least one lesion characteristic for PCa was detected by⁶⁸Ga-PSMA PET/CT. The median serum total PSA (tPSA) was 6.5 (0.2–640) ng/ml.There was a significant difference between ⁶⁸Ga-PSMA PET/CT positive and negative patients in terms of serum total PSA value. No statistical significance was found between positive and negative ⁶⁸Ga-PSMA PET/CT findings in terms of Gleason score. Local recurrence was detected in 56 patients. whereas lymph node metastases were demonstrated in 46 patients. Pelvic nodal disease was the most frequent presentation followed by abdominal and supradiaphragmaticnodal involvement. Bone metastases [oligometastasis, (n?=?20); multimetastasis, (n?=?35)? were also detected in 55 patients. In the ROC analysis for the study cohort, the optimal cut-off value of total serum PSA was determined as 0.67 ng/ml for distinguishing between positive and negative ⁶⁸Ga-PSMA PET/CT images, with an area under curve of 0.952 (95% CI 0.911–0.993).

Conclusions

⁶⁸Ga-PSMA PET/CT was found to be an effective tool for the detection of recurrent PCa. Even though no relationship was detected between the GS and ⁶⁸Ga-PSMA PET/CT findings, serum total PSA values may be used for estimating the likelihood of positive ⁶⁸Ga-PSMA PET/CT results.

     

前列腺外周带癌的MRI 6分区定位诊断研究

目的评价MRI 6分区诊断作为1个独立诊断系统时,对前列腺外周带癌的定位、定性诊断效能。方法不提供任何临床资料,由2名有不同诊断经验的诊断者对80例前列腺外周带480个分区进行独立盲法阅片,针对每个分区做出诊断,分为1是癌、2可能是癌、3不清楚、4可能不是癌、5不是癌5个等级,如果诊断结果是癌,则进一步进行分期。将诊断结果和系统穿刺活检病理结果进行对照研究。结果(1)经病理证实的470个分区中205个分区为癌。诊断界值取2时,MRI 6分区诊断和穿刺病理的一致性较好,Kappa值为0．549-0．560,准确度78．1％-78．3％,敏感度69．3％-76．1％,特异度84．9％-80．0％,阳性预测值78．0％-74．6％,阴性预测值78．1％- 81．2％。(2)不同经验的诊断者的ROC曲线下面积分别为0．829±0．020和0．840±0．019,两者间(U=-0．3988,P>0．05)诊断效能差异无统计学意义。结论MRI可用于前列腺癌的定位、定性诊断,但准确性有待进一步提高。     

DWI对前列腺癌疗效监测及ADC值与PSA相关性研究

目的：探讨前列腺癌（PC）患者治疗前后扩散加权成像（DWI）表现及表观扩散系数（ADC）值与前列腺特异性抗原（PSA）的相关性,从而以ADC值为定量分析指标,将DWI用于PC疗效的监测与评估。方法：48例经病理证实的PC患者均行内分泌治疗,其中12例行去势手术。分别在患者治疗前及治疗后30天行常规MRI及DWI检查,测量其治疗前后的ADC值和血清PSA水平,并对其进行相关性分析。结果：48例PC患者治疗前病灶ADC值为（0．778±0．108）×10^-3mm2／s,PSA值为（28．055±28．880）μg／L;治疗后病灶ADC值显著升高为（1．068±0．187）×10。mm。／S（P〈o．05）,PSA值显著降低为（6．265士13．203）μg／L（P〈0．05）;Pearson相关分析结果显示PC患者治疗前后ADC值与PSA均呈负相关（r=-0．677,P=0．001;r=-0．644,P=0．00）。结论：PC患者内分泌治疗后ADC值升高,与PSA水平呈负相关,DWI有望连续、定量、便捷地监测和评估PC疗效。     

MR spectroscopic imaging and diffusion-weighted imaging of prostate cancer with Gleason scores

Purpose:

To investigate functional changes in prostate cancer patients with three pathologically proven different Gleason scores (GS) (3+3, 3+4, and 4+3) using magnetic resonance spectroscopic imaging (MRSI) and diffusion‐weighted imaging (DWI).

Materials and Methods:

In this study MRSI and DWI data were acquired in 41 prostate cancer patients using a 1.5T MRI scanner with a body matrix combined with an endorectal coil. The metabolite ratios of (Cho+Cr)/Cit were calculated from the peak integrals of total choline (Cho), creatine (Cr), and citrate (Cit) in MRSI. Apparent diffusion coefficient (ADC) values were derived from DWI for three groups of Gleason scores. The sensitivity and specificity of MRSI and DWI in patients were calculated using receiver operating characteristic curve (ROC) analysis.

Results:

The mean and standard deviation of (Cho+Cr)/Cit ratios of GS 3+3, GS 3+4, and GS 4+3 were: 0.44 ± 0.02, 0.56 ± 0.06, and 0.88 ± 0.11, respectively. For the DWI, the mean and standard deviation of ADC values in GS 3+3, GS 3+4, and GS 4+3 were: 1.13 ± 0.11, 0.97 ± 0.10, and 0.83 ± 0.08 mm²/sec, respectively. Statistical significances were observed between the GS and metabolite ratio as well as ADC values and GS.

Conclusion:

Combined MRSI and DWI helps identify the presence and the proportion of aggressive cancer (ie, Gleason grade 4) that might not be apparent on biopsy sampling. This information can guide subsequent rebiopsy management, especially for active surveillance programs. J. Magn. Reson. Imaging 2012;36:697–703. © 2012 Wiley Periodicals, Inc.     

Improved survival for patients with prostate cancer receiving high-dose-rate brachytherapy boost to EBRT compared with EBRT alone

PurposeHigh-dose-rate (HDR) brachytherapy boost is a treatment of intermediate- to high-risk prostate cancer, but long-term clinical outcome data are sparse. We report long-term survival and toxicity data in a cohort of patients treated in a single institution.MethodsBetween 1998 and 2004, 654 patients with localized prostate cancer received either 3-dimensional conformal radiotherapy (median 46 Gy) with an HDR (median 18 Gy in three fractions) boost (“3-D conformal radiotherapy [3DCRT] + HDR”; 215 patients) or 3DCRT alone (“3DCRT”; median 70 Gy; 439 patients) with curative intent. Men with National Comprehensive Cancer Network intermediate risk were offered neoadjuvant androgen deprivation and with high risk were also offered adjuvant androgen deprivation. Data collection included patient-reported outcome measures.ResultsThe 3DCRT + HDR group was older (72.3 vs. 68.9 yrs), had higher presenting PSAs (iPSA) (15.66 and 12.57 ng/mL, respectively), higher proportion of Gleason scores >7 (15.3% vs. 12.4%), and higher proportions of extracapsular disease (29.3% vs. 25.5%). 3DCRT + HDR men had lower proportions of low-risk patients (3.3% vs. 19.4%) and higher proportions of high-risk patients (50.7% vs. 37.4%) than the 3DCRT group. The 5-, 10-, and 15-year overall survival was superior at 92%, 81%, and 67%, respectively, for the 3DCRT + HDR group, compared with 88%, 71%, and 53%, respectively, in the 3DCRT group (p < 0.001). The 5-, 10-, and 15-year cause specific survival also favored the HDR boost group with survival of 96%, 93%, and 87% (3DCRT + HDR) and 95% 88% and 79% (3DCRT), respectively (p < 0.037).ConclusionsHDR brachytherapy boost in conjunction with 3DCRT offered superior overall survival and cause-specific survival in our patient population.