Multiparametric magnetic resonance imaging for prostate cancer-a comparative study including radical prostatectomy specimens.

PURPOSE: To evaluate the diagnostic and staging ability of multiparametric MRI (mpMRI) compared to radical prostatectomy (RP) specimens after dissemination of this technology to several centres. mpMRI is an evolving technique aiming to improve upon the diagnostic sensitivity of prostate biopsy for the diagnosis of prostate cancer. Differences in interpretation, expertise and application of mpMRI are responsible for the range of reported results. METHODS: This retrospective clinical study was conducted with consecutive patients through an electronic database of tertiary hospitals and adjacent private urology practices in Australia. Patients having undergone RP were assessed for the presence of a pre-operative mpMRI performed between 2013 and 2015 which was evaluated against the reference standard of the RP whole-mount specimen. MRI reports were evaluated using the Prostate Imaging Reporting and Data System (PI-RADS). RESULTS: In our cohort of 152 patients, the sensitivity and specificity of mpMRI (PI-RADS ≥ 4) for prostate cancer (Gleason ≥ 4 + 3) detection were 83 and 47%, respectively. For the identification of extraprostatic disease, the sensitivity and specificity were 29 and 94%, respectively. CONCLUSION: These results represent a 'real-world' approach to mpMRI and appear comparable to other single-centre studies. MRI staging information should be interpreted in context with other risk factors for extraprostatic disease. mpMRI has a useful role as an adjunct for prostate cancer diagnosis and directing management towards improving patient outcomes.

Cytoreductive surgery for men with metastatic prostate cancer.

BACKGROUND: Cytoreductive surgery for metastatic prostate cancer is an emerging area of interest with a potential upside that includes local control, delayed initiation of hormone therapy, and possibly improved cancer specific survival. In order for radical prostatectomy to be an effective treatment option for men in this group, the benefits must outweigh the surgical morbidity. The aim of this study was to present a case series and assess the literature feasibility of cytoreductive surgery for men with metastatic prostate cancer. METHODS: A retrospective review of clinical notes was performed to identify men with metastatic prostate cancer who underwent cytoreductive surgery between 2012 and 2014 for a group of urologists at a single institution in Melbourne. Each patient was evaluated with regard to preoperative prostate-specific antigen, grade, stage, adjuvant therapy, and surgical outcomes. RESULTS: Six cases were identified. This included 1 pelvic exenteration and 5 robot-assisted radical prostatectomies. The men who underwent RARP had uncomplicated recoveries, regained continence within 3 months and remained pad-free at follow up. All patients proceeded to additional treatment of sites of metastatic disease with a variable PSA response, however, 3 of 6 men required recommencement of ADT for biochemical progression at follow up. CONCLUSIONS: This data supports recent findings demonstrating that radical prostatectomy for metastatic prostate cancer is feasible. Further studies are needed to explore the role of cytoreductive surgery with regards to the potential oncological benefit.

Current role of multiparametric magnetic resonance imaging in the management of prostate cancer.

The purpose of this review was to evaluate the current role of multiparametric magnetic resonance imaging (mp-MRI) in the management of prostate cancer (PC). The diagnosis of PC remains controversial owing to overdetection of indolent disease, which leads to overtreatment and subsequent patient harm. mp-MRI has the potential to equilibrate the imbalance between detection and treatment. The limitation of the data for analysis with this new technology is problematic, however. This issue has been compounded by a paradigm shift in clinical practice aimed at utilizing this modality, which has been rolled out in an ad hoc fashion often with commercial motivation. Despite a growing body of literature, pertinent clinical questions remain. For example, can mp-MRI be calibrated to reliably detect biologically significant disease? As with any new technology, objective evaluation of the clinical applications of mp-MRI is essential. The focus of this review was on the evaluation of mp-MRI of the prostate with respect to clinical utility.

Magnetic resonance imaging for prostate cancer: Comparative studies including radical prostatectomy specimens and template transperineal biopsy.

PURPOSE: Multiparametric magnetic resonance imaging (mpMRI) is an emerging technique aiming to improve upon the diagnostic sensitivity of prostate biopsy. Because of variance in interpretation and application of techniques, results may vary. There is likely a learning curve to establish consistent reporting of mpMRI. This study aims to review current literature supporting the diagnostic utility of mpMRI when compared with radical prostatectomy (RP) and template transperineal biopsy (TTPB) specimens. METHODS: MEDLINE and PubMed database searches were conducted identifying relevant literature related to comparison of mpMRI with RP or TTPB histology. RESULTS: Data suggest that compared with RP and TTPB specimens, the sensitivity of mpMRI for prostate cancer (PCa) detection is 80-90% and the specificity for suspicious lesions is between 50% and 90%. CONCLUSIONS: mpMRI has an increasing role for PCa diagnosis, staging, and directing management toward improving patient outcomes. Its sensitivity and specificity when compared with RP and TTPB specimens are less than what some expect, possibly reflecting a learning curve for the technique of mpMRI.