Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

MRI helps identify patients with prostate cancer who may benefit from active surveillance

25.09.2012
New study in the Journal of Urology® presents plausible option to reduce overtreatment

PSA screening has resulted in improved prostate cancer survival, but the high rate of diagnosis and treatment side effects raise concerns about overtreatment. In the quest to prevent overtreatment, "active surveillance" has emerged as a plausible option, encouraged for men whose tumors may not need immediate treatment and may never progress to more serious illness.

Appropriate criteria for selecting patients for active surveillance are continuously debated. A group of investigators from Memorial Sloan-Kettering Cancer Center in New York report that adding endorectal magnetic resonance imaging (MRI) to the initial clinical evaluation of men with clinically low prostate cancer risk helps assess eligibility for active surveillance. Their results are published in The Journal of Urology.

"Among patients initially diagnosed with clinically low risk prostate cancer, those with tumors not clearly visualized on MRI were significantly more likely to demonstrate low risk features when a confirmatory biopsy was performed, while patients with tumors clearly visualized on MRI were significantly more likely to have their disease status upgraded on confirmatory biopsy," says lead investigator Hebert Alberto Vargas, MD, Department of Radiology, Memorial Sloan-Kettering Cancer Center.

Researchers evaluated 388 patients who had an initial prostate biopsy performed between 1999 and 2010, had a Gleason score (measures prostate cancer aggressiveness) of 6 or less, and had a biopsy to confirm the assessment within 6 months of initial diagnosis. An endorectal MRI was performed in all patients between the initial and confirmatory biopsies.

MRI studies were interpreted by three radiologists with different levels of experience. One was a fellowship trained radiologist who had read only about 50 prostate MRI examinations before the study (reader 1). The second was a fellow with dedicated training in prostate imaging who had read approximately 500 prostate MRI examinations (reader 2). The third was a fellowship trained radiologist who had interpreted over 5,000 prostate MRI examinations (reader 3). They each assigned a score of 1 to 5 for the presence of tumor on MRI, with 1 being definitely no tumor and 5 being definitely tumor.

On confirmatory biopsy, Gleason scores were upgraded in 79 (20%) cases. Patients with higher MRI scores were more likely to have disease upgraded on confirmatory biopsy. An MRI score of 2 or less was highly associated with low risk features on confirmatory biopsy. Agreement on MRI scores was substantial between readers 2 and 3, but only fair between reader 1 and readers 2 and 3. "These results suggest that MRI of the prostate, if read by radiologists with appropriate training and experience, could help determine active surveillance eligibility and obviate the need for confirmatory biopsy in substantial numbers of patients," notes Dr. Vargas.

Active surveillance allows patients with low grade tumors avoid negative side effects of prostate cancer treatment including erectile dysfunction and bladder problems. The success of active surveillance relies primarily on the accurate identification of patients with low risk disease unlikely to have disease progression. "The fact that clear tumor visualization on MRI was predictive of upgrading on confirmatory prostate biopsy suggests that prostate MRI may contribute to the complex process of assessing patient eligibility for active surveillance," Dr. Vargas concludes.

In an editorial in the same issue of The Journal, Guillaume Ploussard, MD, PhD, of the CHU Saint-Louis, APHP, Paris, France, notes "The primary issue is to reduce the number of clinical settings in which the urologist and the patient face the situation of an increased PSA and an uncertain diagnosis. MRI might help to limit the risk of biopsy under grading. In cases of normal signal in the whole gland, the patient might be reassured and re-biopsy delayed. In cases of a suspicious nodule, re-biopsy would be better justified, and biopsy cores could target specific zones."

Linda Gruner | EurekAlert!
Further information:
http://www.elsevier.com

More articles from Medical Engineering:

nachricht PET identifies which prostate cancer patients can benefit from salvage radiation treatment
05.12.2017 | Society of Nuclear Medicine and Molecular Imaging

nachricht Designing a golden nanopill
01.12.2017 | University of Texas at Austin, Texas Advanced Computing Center

All articles from Medical Engineering >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Long-lived storage of a photonic qubit for worldwide teleportation

MPQ scientists achieve long storage times for photonic quantum bits which break the lower bound for direct teleportation in a global quantum network.

Concerning the development of quantum memories for the realization of global quantum networks, scientists of the Quantum Dynamics Division led by Professor...

Im Focus: Electromagnetic water cloak eliminates drag and wake

Detailed calculations show water cloaks are feasible with today's technology

Researchers have developed a water cloaking concept based on electromagnetic forces that could eliminate an object's wake, greatly reducing its drag while...

Im Focus: Scientists channel graphene to understand filtration and ion transport into cells

Tiny pores at a cell's entryway act as miniature bouncers, letting in some electrically charged atoms--ions--but blocking others. Operating as exquisitely sensitive filters, these "ion channels" play a critical role in biological functions such as muscle contraction and the firing of brain cells.

To rapidly transport the right ions through the cell membrane, the tiny channels rely on a complex interplay between the ions and surrounding molecules,...

Im Focus: Towards data storage at the single molecule level

The miniaturization of the current technology of storage media is hindered by fundamental limits of quantum mechanics. A new approach consists in using so-called spin-crossover molecules as the smallest possible storage unit. Similar to normal hard drives, these special molecules can save information via their magnetic state. A research team from Kiel University has now managed to successfully place a new class of spin-crossover molecules onto a surface and to improve the molecule’s storage capacity. The storage density of conventional hard drives could therefore theoretically be increased by more than one hundred fold. The study has been published in the scientific journal Nano Letters.

Over the past few years, the building blocks of storage media have gotten ever smaller. But further miniaturization of the current technology is hindered by...

Im Focus: Successful Mechanical Testing of Nanowires

With innovative experiments, researchers at the Helmholtz-Zentrums Geesthacht and the Technical University Hamburg unravel why tiny metallic structures are extremely strong

Light-weight and simultaneously strong – porous metallic nanomaterials promise interesting applications as, for instance, for future aeroplanes with enhanced...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

See, understand and experience the work of the future

11.12.2017 | Event News

Innovative strategies to tackle parasitic worms

08.12.2017 | Event News

AKL’18: The opportunities and challenges of digitalization in the laser industry

07.12.2017 | Event News

 
Latest News

A whole-body approach to understanding chemosensory cells

13.12.2017 | Health and Medicine

Water without windows: Capturing water vapor inside an electron microscope

13.12.2017 | Physics and Astronomy

Cellular Self-Digestion Process Triggers Autoimmune Disease

13.12.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>