Association between mpMRI detected tumor apparent diffusion coefficient and 5-year biochemical recurrence risk after radical prostatectomy.

PURPOSE: To assess the ability of tumor apparent diffusion coefficient (ADC) values obtained from multiparametric magnetic resonance imaging (mpMRI) to predict the risk of 5-year biochemical recurrence (BCR) after radical prostatectomy (RP). MATERIALS AND METHODS: This retrospective analysis included 1207 peripheral and 232 non-peripheral zone prostate cancer (PCa) patients who underwent mpMRI before RP (2012-2015), with the outcome of interest being 5-year BCR. ADC was evaluated as a continuous variable and as categories: low (< 850 µm2/s), intermediate (850-1100 µm2/s), and high (> 1100 µm2/s). Kaplan-Meier curves with log-rank testing of BCR-free survival, multivariable Cox proportional hazard regression models were formed to estimate the risk of BCR. RESULTS: Among the 1439 males with median age 63 (± 7) years, the median follow-up was 59 months, and 306 (25%) patients experienced BCR. Peripheral zone PCa patients with BCR had lower tumor ADC values than those without BCR (874 versus 1025 µm2/s, p < 0.001). Five-year BCR-free survival rates were 52.3%, 74.4%, and 87% for patients in the low, intermediate, and high ADC value categories, respectively (p < 0.0001). Lower ADC was associated with BCR, both as continuously coded variable (HR: 5.35; p < 0.001) and as ADC categories (intermediate versus high ADC-HR: 1.56, p = 0.017; low vs. high ADC-HR; 2.36, p < 0.001). In the non-peripheral zone PCa patients, no association between ADC and BCR was observed. CONCLUSION: Tumor ADC values and categories were found to be predictive of the 5-year BCR risk after RP in patients with peripheral zone PCa and may serve as a prognostic biomarker.

Multiparametric MRI-based 5-year Risk Prediction Model for Biochemical Recurrence of Prostate Cancer after Radical Prostatectomy.

Background Current predictive tools to estimate the risk of biochemical recurrence (BCR) after treatment of prostate cancer do not consider multiparametric MRI (mpMRI) information. Purpose To develop a risk prediction tool that considers mpMRI findings to assess the risk of 5-year BCR after radical prostatectomy. Materials and Methods In this retrospective single-center analysis in 1459 patients with prostate cancer who underwent mpMRI before radical prostatectomy (in 2012-2015), the outcome of interest was 5-year BCR (two consecutive prostate-specific antigen [PSA] levels > 0.2 ng/mL [0.2 µg/L]). Patients were randomly divided into training (70%) and test (30%) sets. Kaplan-Meier plots were applied to the training set to estimate survival probabilities. Multivariable Cox regression models were used to test the relationship between BCR and different sets of exploratory variables. The C-index of the final model was calculated for the training and test sets and was compared with European Association of Urology, University of California San Francisco Cancer of the Prostate Risk Assessment, Memorial Sloan-Kettering Cancer Center, and Partin risk tools using the partial likelihood ratio test. Five risk categories were created. Results The median duration of follow-up in the whole cohort was 59 months (IQR, 32-81 months); 376 of 1459 (25.8%) patients had BCR. A multivariable Cox regression model (referred to as PIPEN, and composed of PSA density, International Society of Urological Pathology grade group, Prostate Imaging Reporting and Data System category, European Society of Urogenital Radiology extraprostatic extension score, nodes) fitted to the training data yielded a C-index of 0.74, superior to that of other predictive tools (C-index 0.70 for all models; P ≤ .01) and a median higher C-index on 500 test set replications (C-index, 0.73). Five PIPEN risk categories were identified with 5-year BCR-free survival rates of 92%, 84%, 71%, 56%, and 26% in very low-, low-, intermediate-, high-, and very high-risk patients, respectively (all P < .001). Conclusion A five-item model for predicting the risk of 5-year BCR after radical prostatectomy for prostate cancer was developed and internally verified, and five risk categories were identified. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Aguirre and Ortegón in this issue.

The role of MRI in the management of a prostate cancer patient with bone and lymph nodes metastases. A case report.

The use of multiparametric prostate magnetic resonance imaging (mpMRI) is recommended, in the European Association of Urology (EAU) guidelines, for local staging of patients with prostate cancer (PCa). Systemic staging is recommended only for patients with unfavourable intermediate and high-risk disease; with bone and lymph node assessments usually being performed using bone scan (BS) and computed tomography (CT), respectively. Magnetic resonance imaging (MRI) is the imaging technique with the highest sensitivity for the detection of bone metastases and has shown promising results also for lymph node assessments. In this report we illustrate how MRI provided a comprehensive assessment of local disease as well as bone and lymph node metastases in a patient with PCa. (www.actabiomedica.it).

Benign splenosis mimicking peritoneal seeding in a bladder cancer patient: a case report.

INTRODUCTION: Splenosis is a post-traumatic autotrasplantation and proliferation of splenic tissue in ectopic sites. These implants may mimic malignancy in healthy patients or peritoneal metastases in cancer patients. When a previous history of splenic injury is known, the finding of soft tissue nodules in many thoracic and abdominal locations might raise the suspicion of the benign condition of splenosis, in order to avoid unnecessary surgery or chemotherapy. CASE PRESENTATION: A 56-year-old man with history of persistent hematuria from bladder cancer was referred to our Institution for suspected peritoneal carcinosis. For staging purposes he underwent abdominal computed tomography and ultrasound. The integration of patient's history and imaging results led to the diagnosis of peritoneal splenosis. The patient therefore underwent regular Trans Urethral Resection of Bladder for the known malignancy; while no treatment was necessary for splenosis. Two years follow-up was negative for metastases. CONCLUSION: Splenosis is a benign condition after traumatic splenectomy which should be taken into account in the differential diagnosis with peritoneal seeding of malignancy because its appearance may resemble malignancy.

Benign splenosis mimicking peritoneal seeding in a bladder cancer patient: a case report.

INTRODUCTION: Splenosis is a post-traumatic autotrasplantation and proliferation of splenic tissue in ectopic sites. These implants may mimic malignancy in healthy patients or peritoneal metastases in cancer patients. When a previous history of splenic injury is known, the finding of soft tissue nodules in many thoracic and abdominal locations might raise the suspicion of the benign condition of splenosis, in order to avoid unnecessary surgery or chemotherapy. CASE PRESENTATION: A 56-year-old man with history of persistent hematuria from bladder cancer was referred to our Institution for suspected peritoneal carcinosis. For staging purposes he underwent abdominal computed tomography and ultrasound. The integration of patient's history and imaging results led to the diagnosis of peritoneal splenosis. The patient therefore underwent regular Trans Urethral Resection of Bladder for the known malignancy; while no treatment was necessary for splenosis. Two years follow-up was negative for metastases. CONCLUSION: Splenosis is a benign condition after traumatic splenectomy which should be taken into account in the differential diagnosis with peritoneal seeding of malignancy because its appearance may resemble malignancy.