| Prospective assessment of prostate cancer aggressiveness using 3-T diffusion-weighted magnetic resonance imaging-guided biopsies versus a systematic 10-core transrectal ultrasound prostate biopsy cohort. | |
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MedLine Citation:
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PMID: 21924545 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Accurate pretreatment assessment of prostate cancer (PCa) aggressiveness is important in decision making. Gleason grade is a critical predictor of the aggressiveness of PCa. Transrectal ultrasound-guided biopsies (TRUSBxs) show substantial undergrading of Gleason grades found after radical prostatectomy (RP). Diffusion-weighted magnetic resonance imaging (MRI) has been shown to be a biomarker of tumour aggressiveness. OBJECTIVE: To improve pretreatment assessment of PCa aggressiveness, this study prospectively evaluated MRI-guided prostate biopsies (MR-GBs) of abnormalities determined on diffusion-weighted imaging (DWI) apparent diffusion coefficient (ADC) maps. The results were compared with a 10-core TRUSBx cohort. RP findings served as the gold standard. DESIGN, SETTING, AND PARTICIPANTS: A 10-core TRUSBx (n=64) or MR-GB (n=34) was used for PCa diagnosis before RP in 98 patients. MEASUREMENTS: Using multiparametric 3-T MRI: T2-weighted, dynamic contrast-enhanced imaging, and DWI were performed to identify tumour-suspicious regions in patients with a negative TRUSBx. The regions with the highest restriction on ADC maps within the suspicions regions were used to direct MR-GB. A 10-core TRUSBx was used in a matched cohort. Following RP, the highest Gleason grades (HGGs) in biopsies and RP specimens were identified. Biopsy and RP Gleason grade results were evaluated using chi-square analysis. RESULTS AND LIMITATIONS: No significant differences on RP were observed for proportions of patients having a HGG of 3 (35% vs 28%; p=0.50), 4 (32% vs 41%; p=0.51), and 5 (32% vs 31%; p=0.61) for the MR-GB and TRUSBx cohort, respectively. MR-GB showed an exact performance with RP for overall HGG: 88% (30 of 34); for TRUS-GB it was 55% (35 of 64; p=0.001). In the MR-GB cohort, an exact performance with HGG 3 was 100% (12 of 12); for HGG 4, 91% (10 of 11); and for HGG 5, 73% (8 of 11). The corresponding performance rates for TRUSBx were 94% (17 of 18; p=0.41), 46% (12 of 26; p=0.02), and 30% (6 of 20; p=0.01), respectively. CONCLUSIONS: This study shows prospectively that DWI-directed MR-GBs significantly improve pretreatment risk stratification by obtaining biopsies that are representative of true Gleason grade. |
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Authors:
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Thomas Hambrock; Caroline Hoeks; Christina Hulsbergen-van de Kaa; Tom Scheenen; Jurgen Fütterer; Stefan Bouwense; Inge van Oort; Fritz Schröder; Henkjan Huisman; Jelle Barentsz |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't Date: 2011-08-27 |
Journal Detail:
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Title: European urology Volume: 61 ISSN: 1873-7560 ISO Abbreviation: Eur. Urol. Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2011-11-29 Completed Date: 2012-03-30 Revised Date: 2012-05-09 |
Medline Journal Info:
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Nlm Unique ID: 7512719 Medline TA: Eur Urol Country: Switzerland |
Other Details:
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Languages: eng Pagination: 177-84 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved. |
Affiliation:
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Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. t.hambrock@rad.umcn.nl |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Biopsy* Chi-Square Distribution Diffusion Magnetic Resonance Imaging* Humans Magnetic Resonance Imaging, Interventional / methods* Male Middle Aged Neoplasm Grading Neoplasm Staging Netherlands Predictive Value of Tests Prognosis Prospective Studies Prostate-Specific Antigen / blood Prostatic Neoplasms / immunology, pathology* Risk Assessment Risk Factors Tumor Burden Ultrasonography, Interventional* |
| Chemical | |
Reg. No./Substance:
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EC 3.4.21.77/Prostate-Specific Antigen |
| Comments/Corrections | |
Comment In:
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Eur Urol. 2012 May;61(5):e52
[PMID:
22365282
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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