RESUMO
BACKGROUND: Prostate tuberculosis (TB) is a rare and often underdiagnosed condition due to its nonspecific symptoms and imaging features, which can mimic malignancies on 18F-fluorodeoxyglucose positron emission tomography (PET) scans. This resemblance poses a challenge in differentiating TB from prostate cancer, especially in patients with preexisting tumors such as diffuse large B-cell lymphoma. The purpose of this study is to highlight the importance of considering TB in the differential diagnosis of patients with atypical imaging findings, even in the presence of known malignancies. CASE: We present a case of a 60-year-old man with diffuse large B-cell lymphoma who was initially misdiagnosed with a prostate tumor based on 18F-fluorodeoxyglucose PET/computed tomography scans. The subsequent ultrasound-guided prostate biopsy confirmed the presence of prostate TB, not malignancy. CONCLUSIONS: This case report underscores the critical role of considering TB as a potential diagnosis in patients with hematological tumors and atypical imaging results. It serves as a reminder for clinicians to exercise caution when interpreting PET/computed tomography scans and to incorporate TB into their differential diagnoses, thereby avoiding misdiagnosis and inappropriate treatment.
Assuntos
Fluordesoxiglucose F18 , Linfoma Difuso de Grandes Células B , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Compostos Radiofarmacêuticos , Humanos , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Pessoa de Meia-Idade , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/diagnóstico , Diagnóstico Diferencial , Neoplasias da Próstata/diagnóstico por imagem , Tuberculose dos Genitais Masculinos/diagnóstico por imagem , Tuberculose dos Genitais Masculinos/diagnóstico , Erros de Diagnóstico , Próstata/diagnóstico por imagem , Próstata/patologiaRESUMO
Background: The precision of postoperative prostate cancer radiotherapy is significantly influenced by setup errors and alterations in bladder morphology. Utilizing daily cone beam computed tomography (CBCT) imaging allows for the correction of setup errors. However, this naturally leads to the question of the issue of peripheral dose and workload. Thus, a zero-dose, noninvasive technique to reproduce the bladder volume and improve patient setup accuracy was needed. Purpose: The aim of this study is to investigate if the setup method by combining Optical Surface Management System (OSMS) and BladderScan can improve the accuracy of setup and accurately reproduce the bladder volume during radiotherapy of postoperative prostate cancer and to guide CTV-PTV margins for clinic. Method: The experimental group consisted of 15 postoperative prostate cancer patients who utilized a setup method that combined OSMS and BladderScan. This group recorded 103 setup errors, verified by CBCT. The control group comprised 25 patients, among whom 114 setup errors were recorded using the conventional setup method involving skin markers; additionally, patients in this group also exhibited spontaneous urinary suppression. The errors including lateral (Lat), longitudinal (Lng), vertical directions (Vrt), Pitch, Yaw, and Roll were analyzed between the two methods. The Dice similarity coefficient (DSC) and volume differences of the bladder between CBCT and planning CT were compared as the bladder concordance indicators. Results: The errors in the experimental group at Vrt, Lat, and Lng were 0.17 ± 0.12, 0.22 ± 0.17, and 0.18 ± 0.12 cm, and the control group were 0.25 ± 0.15, 0.31 ± 0.21, 0.34 ± 0.22 cm. The rotation errors of Pitch, Roll, and Yaw in the experimental group were 0.18 ± 0.12°, 0.11 ± 0.1°, and 0.18 ± 0.13°, and in the control group, they were 0.96 ± 0.89°, 1.01 ± 0.86°, and 1.02 ± 0.84°. The DSC and volume differences were 92.52 ± 1.65% and 39.99 ± 28.75 cm3 in the patients with BladderScan, and in the control group, they were 62.98 ± 22.33%, 273.89 ± 190.62 cm3. The P < 0.01 of the above performance indicators indicates that the difference is statistically significant. Conclusion: The accuracy of the setup method by combining OSMS and BladderScan was validated by CBCT in our study. The method in our study can improve the setup accuracy during radiotherapy of postoperative prostate cancer compared to the conventional setup method.
Assuntos
Tomografia Computadorizada de Feixe Cônico , Neoplasias da Próstata , Bexiga Urinária , Humanos , Masculino , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico/métodos , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/efeitos da radiação , Idoso , Planejamento da Radioterapia Assistida por Computador/métodos , Período Pós-Operatório , Pessoa de Meia-Idade , Radioterapia Guiada por Imagem/métodosRESUMO
PURPOSE: The purpose was to evaluate the pathological nature of focal thyroid uptake seen in 11C-Choline PET/CT performed for prostate cancer. MATERIAL AND METHODS: The study was IRB-approved. All 11C-Choline PET/CT exam reports for studies performed between January 01, 2018, and July 30, 2021, in male patients with prostate cancer in our institution were retrospectively reviewed. Exams with "focal thyroid uptake" on their final report were selected. Patients with surgery or ablation in the thyroid prior to the PET/CT, proven parathyroid adenomas or absent thyroid ultrasound were excluded. Repeated PET/CT exams of same patient were excluded. PET images were analyzed visually and semi-quantitatively by measuring the maximum standardized uptake value (SUVmax) of the focal thyroid uptake. Available thyroid ultrasound images, cytology and pathology reports were reviewed. Statistical analyses were performed. RESULTS: Out of 10,047 sequential 11C-Choline PET/CT studies, 318 reports included "focal thyroid uptake." About 128 of these studies were repeat exams and were excluded. Additional 87 patients were excluded, because the uptake was determined to be adjacent, rather than confined to the thyroid gland. Out of the remaining 103 patients, 74 patients had focal thyroid uptake and concurrent thyroid sonographic evaluation. Out of the 74 focal uptakes evaluated with ultrasound, 21 were presumed benign thyroid nodules based on the ultrasound and 53 had further evaluation with biopsy. Sixty three nodules were benign (21 presumed benign on ultrasound and 42 cytology or surgical pathology-proven), 9 nodules were malignant and 2 remained indeterminate. There was no significant difference between the SUVs of the benign and malignant groups (P > .3). CONCLUSION: In this retrospective study of patients with prostate cancer who underwent 11C-Choline PET/CT, we identified a group of patients who underwent thyroid ultrasound for incidental finding of focal 11C-Choline thyroid uptake. Incidence of malignancy in this group was 12%. Therefore, further investigation with ultrasound and possibly ultrasound-guided biopsy may be warranted when a choline avid thyroid nodule is found incidentally on choline PET.
Assuntos
Radioisótopos de Carbono , Colina , Achados Incidentais , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Próstata , Nódulo da Glândula Tireoide , Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Masculino , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/patologia , Colina/farmacocinética , Estudos Retrospectivos , Idoso , Pessoa de Meia-Idade , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Ultrassonografia/métodos , Idoso de 80 Anos ou mais , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Compostos Radiofarmacêuticos/farmacocinéticaRESUMO
We observed at our university-based imaging centers that when prostate-specific membrane antigen (PSMA) PET/CT became available for staging and restaging prostate cancer, the volume of bone scanning on patients with prostate cancer (BS-P) markedly decreased. We aimed to study use patterns of PSMA PET/CT and BS-P at our imaging centers during the 4-y period around U.S. Food and Drug Administration approval of PSMA PET/CT in December 2020. We tested the hypothesis that the rate of decline of BS-P accelerated after U.S. Food and Drug Administration approval, as physicians planned for use of PSMA PET/CT in their patients. Methods: Our clinical report system was searched for BS-P and PSMA PET/CT scans from January 2019 through June 2023. Numbers of scans were tabulated by quarter and year. Quantitative and statistical analyses were performed. Results: Annualized average monthly BS-P peaked at 53.7 scans/mo in 2021 and then decreased over time. There were 552 BS-Ps performed in 2019, 503 in 2020, 614 in 2021, 481 in 2022, and 152 in the first half of 2023. BS-P monthly averages declined by 22% from 2021 to 2022 and by 36% from 2022 to 2023, whereas monthly PSMA PET/CT scan averages increased by 1,416% from 2021 to 2022 and by 69% from 2022 to 2023. There was a significantly greater decline in BS-Ps from 2022 to 2023 than from 2021 to 2022 (36% vs. 22%, P < 0.0001). There were 30 PSMA PET/CT scans performed in 2021, 455 in 2022, and 384 in the first half of 2023. The greatest quarterly increase in these scans (400%) occurred at the outset of PSMA PET/CT implementation in quarter 4 of 2021. In quarter 2 of 2023, the percentage of total studies was higher for PSMA PET/CT than for BS-P (74% vs. 26%, P < 0.0001). Conclusion: At our university-based imaging centers, use of BS-P has declined in correlation with the timing of U.S. Food and Drug Administration approval and implementation of PSMA PET/CT. This study illustrates one instance of workflow changes that occur in the nuclear medicine clinic when new agents are introduced and affect clinical management options.
Assuntos
Antígenos de Superfície , Glutamato Carboxipeptidase II , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Próstata , Humanos , Masculino , Antígenos de Superfície/metabolismo , Osso e Ossos/diagnóstico por imagem , Neoplasias Ósseas/diagnóstico por imagem , Glutamato Carboxipeptidase II/metabolismo , Hospitais Universitários , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Neoplasias da Próstata/diagnóstico por imagemRESUMO
Purpose: This study aims to assess whole-mount Gleason grading (GG) in prostate cancer (PCa) accurately using a multiomics machine learning (ML) model and to compare its performance with biopsy-proven GG (bxGG) assessment. Materials and Methods: A total of 146 patients with PCa recruited in a pilot study of a prospective clinical trial (NCT02659527) were retrospectively included in the side study, all of whom underwent 68Ga-PSMA-11 integrated positron emission tomography (PET) / magnetic resonance (MR) before radical prostatectomy (RP) between May 2014 and April 2020. To establish a multiomics ML model, we quantified PET radiomics features, pathway-level genomics features from whole exome sequencing, and pathomics features derived from immunohistochemical staining of 11 biomarkers. Based on the multiomics dataset, five ML models were established and validated using 100-fold Monte Carlo cross-validation. Results: Among five ML models, the random forest (RF) model performed best in terms of the area under the curve (AUC). Compared to bxGG assessment alone, the RF model was superior in terms of AUC (0.87 vs 0.75), specificity (0.72 vs 0.61), positive predictive value (0.79 vs 0.75), and accuracy (0.78 vs 0.77) and showed slightly decreased sensitivity (0.83 vs 0.89) and negative predictive value (0.80 vs 0.81). Among the feature categories, bxGG was identified as the most important feature, followed by pathomics, clinical, radiomics and genomics features. The three important individual features were bxGG, PSA staining and one intensity-related radiomics feature. Conclusion: The findings demonstrate a superior assessment of the developed multiomics-based ML model in whole-mount GG compared to the current clinical baseline of bxGG. This enables personalized patient management by identifying high-risk PCa patients for RP.
Assuntos
Aprendizado de Máquina , Gradação de Tumores , Prostatectomia , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/genética , Neoplasias da Próstata/diagnóstico por imagem , Prostatectomia/métodos , Idoso , Pessoa de Meia-Idade , Estudos Retrospectivos , Estudos Prospectivos , Projetos Piloto , Tomografia por Emissão de Pósitrons/métodos , Imageamento por Ressonância Magnética/métodos , Genômica/métodos , MultiômicaRESUMO
Erythropoietin-producing hepatocellular receptor A2 (EphA2), is a receptor tyrosine kinase involved in cell-cell interactions. It is known to be overexpressed in various tumors and is associated with poor prognosis. EphA2 has been proposed as a target for theranostic applications. Low molecular weight peptide-based scaffolds with low nanomolar affinities have been shown to be ideal in such applications. Bicyclic peptides have emerged as an alternative to traditional peptides for this purpose, offering affinities comparable to antibodies due to their constrained nature, along with high tissue penetration, and improved stability compared to linear counterparts. This study presents the development and comprehensive in vitro and in vivo preclinical evaluation of BCY18469, a novel EphA2-targeting bicyclic peptide-based radiotheranostic agent. Methods: The EphA2-targeting Bicycle® peptide BCY18469 was identified through phage-display and chemically optimized. BCY18469 was radiolabeled with 68Ga, 177Lu and 111In. The physicochemical properties, binding affinity and internalization as well as specificity of the peptide were evaluated in vitro. In vivo PET/MR and SPECT/CT imaging studies were performed using [68Ga]Ga-BCY18469 and [111In]In-BCY18469, respectively, along with biodistribution of [177Lu]Lu-BCY18469 up to 24 h post injection in HT1080- and PC-3-tumor bearing BALB/c nu/nu EphA2-overexpressing xenograft mouse models. Results: The EphA2-targeting bicyclic peptide BCY18469 showed high binding affinity toward human and mouse EphA2 (1.9 and 3.8 nM, respectively). BCY18469 specifically bound and internalized into EphA2-expressing HT1080 cells. Imaging studies showed high tumor enrichment at early time-points (SUV of 1.7 g/mL at 1 h p.i. and 1.2 g/mL at 2 h p.i. in PET/MRI, HT1080 xenograft) with tumor contrast as early as 5 min p.i. and kidney-mediated clearance. Biodistribution studies revealed high early tumor uptake (19.5 ± 3.5 %ID/g at 1 h p.i., HT1080 xenograft) with SPECT/CT imaging further confirming these findings (5.7 ± 1.5 %ID/g at 1 h p.i., PC-3 xenograft). Conclusion: BCY18469 demonstrated high affinity, specific targeting of EphA2, a favorable biodistribution profile, and clearance through renal pathways. These findings underscore the potentially important role of bicyclic peptides in advancing radiotheranostic approaches and encourage additional translational research.
Assuntos
Receptor EphA2 , Animais , Receptor EphA2/metabolismo , Humanos , Camundongos , Linhagem Celular Tumoral , Distribuição Tecidual , Peptídeos Cíclicos/farmacocinética , Peptídeos Cíclicos/química , Compostos Radiofarmacêuticos/farmacocinética , Compostos Radiofarmacêuticos/química , Masculino , Camundongos Nus , Ensaios Antitumorais Modelo de Xenoenxerto , Camundongos Endogâmicos BALB C , Lutécio/química , Radioisótopos de Índio , Radioisótopos/química , Feminino , Radioisótopos de Gálio , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/metabolismoRESUMO
BACKGROUND: This study aimed to validate a previously published risk model (RM) which combines clinical and multiparametric MRI (mpMRI) parameters to predict extraprostatic extension (EPE) of prostate cancer (PC) prior to radical prostatectomy (RP). MATERIALS AND METHODS: A previously published RM combining clinical with mpMRI parameters including European Society of Urogenital Radiology (ESUR) classification for EPE was retrospectively evaluated in a cohort of two urological university hospitals in Germany. Consecutive patients (n = 205, January 2015 -June 2021) with available preoperative MRI images, clinical information including PSA, prostate volume, ESUR classification for EPE, histopathological results of MRI-fusion biopsy and RP specimen were included. Validation was performed by receiver operating characteristic analysis and calibration plots. The RM's performance was compared to ESUR criteria. RESULTS: Histopathological T3 stage was detected in 43% of the patients (n = 89); 45% at Essen and 42% at Düsseldorf. Discrimination performance between pT2 and pT3 of the RM in the entire cohort was AUC = 0.86 (AUC = 0.88 at site 1 and AUC = 0.85 at site 2). Calibration was good over the entire probability range. The discrimination performance of ESUR classification alone was comparable (AUC = 0.87). CONCLUSIONS: The RM showed good discriminative performance to predict EPE for decision-making for RP as a patient-tailored risk stratification. However, when experienced MRI reading is available, standardized MRI reading with ESUR scoring is comparable regarding information outcome. A main limitation is the potentially limited transferability to other populations because of the high prevalence of EPE in our subgroups.
Assuntos
Imageamento por Ressonância Magnética Multiparamétrica , Invasividade Neoplásica , Prostatectomia , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/diagnóstico por imagem , Estudos Retrospectivos , Medição de Risco , Pessoa de Meia-Idade , Idoso , Prostatectomia/métodos , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodosRESUMO
BACKGROUND: Salvage radiation therapy (sRT) is often the sole curative option in patients with biochemical recurrence after radical prostatectomy. After sRT, we developed and validated a nomogram to predict freedom from biochemical failure. OBJECTIVE: This study aims to evaluate prostate-specific membrane antigen-positron emission tomography (PSMA-PET)-based sRT efficacy for postprostatectomy prostate-specific antigen (PSA) persistence or recurrence. Objectives include developing a random survival forest (RSF) model for predicting biochemical failure, comparing it with a Cox model, and assessing predictive accuracy over time. Multinational cohort data will validate the model's performance, aiming to improve clinical management of recurrent prostate cancer. METHODS: This multicenter retrospective study collected data from 13 medical facilities across 5 countries: Germany, Cyprus, Australia, Italy, and Switzerland. A total of 1029 patients who underwent sRT following PSMA-PET-based assessment for PSA persistence or recurrence were included. Patients were treated between July 2013 and June 2020, with clinical decisions guided by PSMA-PET results and contemporary standards. The primary end point was freedom from biochemical failure, defined as 2 consecutive PSA rises >0.2 ng/mL after treatment. Data were divided into training (708 patients), testing (271 patients), and external validation (50 patients) sets for machine learning algorithm development and validation. RSF models were used, with 1000 trees per model, optimizing predictive performance using the Harrell concordance index and Brier score. Statistical analysis used R Statistical Software (R Foundation for Statistical Computing), and ethical approval was obtained from participating institutions. RESULTS: Baseline characteristics of 1029 patients undergoing sRT PSMA-PET-based assessment were analyzed. The median age at sRT was 70 (IQR 64-74) years. PSMA-PET scans revealed local recurrences in 43.9% (430/979) and nodal recurrences in 27.2% (266/979) of patients. Treatment included dose-escalated sRT to pelvic lymphatics in 35.6% (349/979) of cases. The external outlier validation set showed distinct features, including higher rates of positive lymph nodes (47/50, 94% vs 266/979, 27.2% in the learning cohort) and lower delivered sRT doses (<66 Gy in 57/979, 5.8% vs 46/50, 92% of patients; P<.001). The RSF model, validated internally and externally, demonstrated robust predictive performance (Harrell C-index range: 0.54-0.91) across training and validation datasets, outperforming a previously published nomogram. CONCLUSIONS: The developed RSF model demonstrates enhanced predictive accuracy, potentially improving patient outcomes and assisting clinicians in making treatment decisions.
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Aprendizado de Máquina , Recidiva Local de Neoplasia , Prostatectomia , Neoplasias da Próstata , Terapia de Salvação , Humanos , Masculino , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Prostatectomia/métodos , Terapia de Salvação/métodos , Idoso , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/radioterapia , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/métodos , Antígeno Prostático Específico/sangue , Antígenos de Superfície/metabolismo , Glutamato Carboxipeptidase II/metabolismo , Radioterapia Guiada por Imagem/métodos , NomogramasAssuntos
Imagem por Ressonância Magnética Intervencionista , Neoplasias da Próstata , Ultrassom Focalizado Transretal de Alta Intensidade , Humanos , Masculino , Imagem por Ressonância Magnética Intervencionista/métodos , Próstata/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/terapia , Ultrassom Focalizado Transretal de Alta Intensidade/métodosRESUMO
Prostate-specific membrane antigen (PSMA), a transmembrane glycoprotein, was shown to be expressed 100-1000 fold higher in prostate adenocarcinoma as compared to normal prostate epithelium. Given the enzymatic function of PSMA with the presence of an internalization triggering motif, various Glu-urea-Lys-based inhibitors have been developed and, amongst others, radiolabeled with positron emitters for targeted positron emission tomography imaging such as 68Ga-PSMA-HBED-CC Glu-urea-Lys(Ahx) as well as with beta and alpha-emitting radioisotopes for targeted therapy, e.g., 177Lu-PSMA-617. In this paper, we review and discuss the potential implications for targeted imaging and therapy of altered PSMA-glycosylation, of PSMA-driven activation of the P13K/Akt/mTOR, of the evolution over time and the relationship with androgen signaling and changes in DNA methylation of PSMA, and of androgen deprivation therapy (ADT) in prostate carcinoma.
Assuntos
Antígenos de Superfície , Glutamato Carboxipeptidase II , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/metabolismo , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/terapia , Neoplasias da Próstata/patologia , Glutamato Carboxipeptidase II/metabolismo , Antígenos de Superfície/metabolismo , Tomografia por Emissão de Pósitrons/métodos , Glicosilação , Terapia de Alvo Molecular/métodosRESUMO
OBJECTIVE: To identify the factors that determine the minimum length of biopsy sample required for accurate diagnosis. MATERIALS AND METHODS: A retrospective analysis was conducted on 1202 cases that underwent rectal ultrasound-guided trans-perineal prostate biopsy (TPB) with standardized biopsy surgical procedures and pathological evaluation. Logistic regression correlation analysis and the imbalance between groups was eliminated by propensity score matching of patients' own factors between groups (positive group and negative group). ROC curve optimal threshold analysis were performed to identify the independent factors associated with cancer detection rate and the minimum length of biopsy sample required for accurate diagnosis. RESULTS: The study included 1202 cases that underwent standardized 8-18 needle initial puncture biopsies from June 2020 to October 2023. The cancer detection rate was 40.02% (481/1202), with Gleason scores of 6, 7, 8, 9, and 10 in 164, 134, 107, 67, and 9 patients, respectively. The percentage of patients with clinical significance (International Society of Urological Pathology (ISUP) ≥ 2) was 65.90% (317/481). Multivariate analysis showed that age,prostate-specific antigen(PSA), prostate volume,positive multi-parametric magnetic resonance imaging (mp-MRI) and length of biopsy samples were significant factors (P < 0.05)ãInterestingly, biopsy sample length did not correlate with the prostate volume (Pearson correlation P = 0.069). ROC curve analysis: The area under the curve AUC for sample length were 0.674 and 0.664 at before and after propensity score matching,respectively; the optimal thresholds were 12.25 mm and 11.00mm at before and after propensity score matching,respectively. CONCLUSION: The independent predictors of cancer detection rate during TPB are age, PSA, prostate volume, positive mp-MRI, and sample length. Among these, sample length is the most critical indicator affecting puncture quality, and the minimum value of biopsy sample length to be obtained is 11.00mm.
Assuntos
Biópsia Guiada por Imagem , Períneo , Próstata , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/patologia , Neoplasias da Próstata/diagnóstico por imagem , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Próstata/patologia , Próstata/diagnóstico por imagem , Biópsia Guiada por Imagem/métodos , Períneo/patologia , Ultrassonografia de IntervençãoRESUMO
PURPOSE: Emerging evidence suggests that the use of artificial intelligence can assist in the timely detection and optimization of therapeutic approach in patients with prostate cancer. The conventional perspective on radiomics encompassing segmentation and the extraction of radiomic features considers it as an independent and sequential process. However, it is not necessary to adhere to this viewpoint. In this study, we show that besides generating masks from which radiomic features can be extracted, prostate segmentation and reconstruction models provide valuable information in their feature space, which can improve the quality of radiomic signatures models for disease aggressiveness classification. MATERIALS AND METHODS: We perform 2,244 experiments with deep learning features extracted from 13 different models trained using different anatomic zones and characterize how modeling decisions, such as deep feature aggregation and dimensionality reduction, affect performance. RESULTS: While models using deep features from full gland and radiomic features consistently lead to improved disease aggressiveness prediction performance, others are detrimental. Our results suggest that the use of deep features can be beneficial, but an appropriate and comprehensive assessment is necessary to ensure that their inclusion does not harm predictive performance. CONCLUSION: The study findings reveal that incorporating deep features derived from autoencoder models trained to reconstruct the full prostate gland (both zonal models show worse performance than radiomics only models), combined with radiomic features, often lead to a statistically significant increase in model performance for disease aggressiveness classification. Additionally, the results also demonstrate that the choice of feature selection is key to achieving good performance, with principal component analysis (PCA) and PCA + relief being the best approaches and that there is no clear difference between the three proposed latent representation extraction techniques.
Assuntos
Aprendizado Profundo , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Processamento de Imagem Assistida por Computador/métodos , Algoritmos , Prognóstico , Interpretação de Imagem Assistida por Computador/métodos , RadiômicaRESUMO
PURPOSE: To evaluate MRI and histological concordance in prostate cancer (PCa) identification via mapped transperineal biopsies. METHODOLOGY: Retrospective per-lesion analysis of patients undergoing MRI and transperineal biopsy at the Valencian Institute of Oncology (2016-2024) using CAPROSIVO PCa data. Patients underwent MRI, with or without regions of interest (ROI), followed by transperineal biopsies (3-5 cores/ROI, 20-30 systematic). Sensitivity (Se), specificity (Sp), negative predictive value (NPV), positive predictive value (PPV), and area under the curve (AUC) were calculated, considering PI-RADS 3 lesions as positive or negative. Gleason Grade Group (GG) > 1 defined clinically significant PCa (csPCa). RESULTS: 1817 lesions were analyzed from 1325 patients (median age 67, median PSA 6.3 ng/ml). 53% MRI were negative, GG > 1 prevalence was 38.4%. MRI-negative cases showed varying PCa rates: 57.4% negative, 30.2% GG 1, and 12.4% GG > 1. PI-RADS 3 lesions had mixed outcomes: 45.6% benign, 13.1% GG 1, and 41.3% GG > 1. 9.2% PI-RADS 4-5 lesions were negative, 9% GG 1, and 81.7% GG > 1. For PI-RADS 3 lesions considered positive, Se, Sp, NPV, PPV, and AUC were 82.9%, 75%, 87.6%, 67.4%, and 0.79 respectively. Considering PI-RADS 3 as negative yielded 64.8% Se, 91% Sp, 80.6% NPV, 81.7% PPV, and 0.78 AUC. CONCLUSION: MRI and mapped prostate biopsies exhibited moderate concordance. MRI could miss up to one in five csPCa foci and misinterpret one in three ROIs. Careful MRI interpretation is crucial for optimizing patient care.
Assuntos
Biópsia Guiada por Imagem , Imageamento por Ressonância Magnética , Períneo , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/patologia , Neoplasias da Próstata/diagnóstico por imagem , Estudos Retrospectivos , Idoso , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Biópsia Guiada por Imagem/métodos , Próstata/patologia , Próstata/diagnóstico por imagem , Gradação de TumoresRESUMO
Prostate cancer (PCa) is a prevalent malignancy in men, and the management of localized disease has evolved significantly in recent years. Focal therapy, wherein the biopsy confirmed site of tumor with margins is treated leaving the remaining gland intact, has emerged as a promising strategy for treating localized clinically significant PCa, minimizing side effects associated with radical therapies. We present the technical aspects, a summary of the most relevant evidence to date on the performance and safety of this technique, and the characteristic MR imaging findings during treatment, in the early posttreatment period and in the long term.
Assuntos
Imagem por Ressonância Magnética Intervencionista , Neoplasias da Próstata , Humanos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/terapia , Masculino , Imagem por Ressonância Magnética Intervencionista/métodos , Próstata/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodosRESUMO
Unspecific bone uptake (UBU) related to [18F]PSMA-1007 PET/CT imaging represents a clinical challenge. We aimed to assess whether a combination of clinical, biochemical, and imaging parameters could predict skeletal metastases in patients with [18F]PSMA-1007 bone focal uptake, aiding in result interpretation. Methods: We retrospectively analyzed [18F]PSMA-1007 PET/CT performed in hormone-sensitive prostate cancer (PCa) patients at 3 tertiary-level cancer centers. A fourth center was involved in performing an external validation. For each, a volume of interest was drawn using a threshold method to extract SUVmax, SUVmean, PSMA tumor volume, and total lesion PSMA. The same volume of interest was applied to CT images to calculate the mean Hounsfield units (HUmean) and maximum Hounsfield units. Clinical and laboratory data were collected from electronic medical records. A composite reference standard, including follow-up histopathology, biochemistry, and imaging data, was used to distinguish between PCa bone metastases and UBU. PET readers with less (n = 2) or more (n = 2) experience, masked to the reference standard, were asked to visually rate a subset of focal bone uptake (n = 178) as PCa metastases or not. Results: In total, 448 bone [18F]PSMA-1007 focal uptake specimens were identified in 267 PCa patients. Of the 448 uptake samples, 188 (41.9%) corresponded to PCa metastases. Ongoing androgen deprivation therapy at PET/CT (P < 0.001) with determination of SUVmax (P < 0.001) and HUmean (P < 0.001) independently predicted bone metastases. A composite prediction score, the bone uptake metastatic probability (BUMP) score, achieving an area under the receiver-operating-characteristic curve (AUC) of 0.87, was validated through a 10-fold internal and external validation (n = 89 bone uptake, 51% metastatic; AUC, 0.92). The BUMP score's AUC was significantly higher than that of HUmean (AUC, 0.62) and remained high among lesions with HUmean in the first tertile (AUC, 0.80). A decision-curve analysis showed a higher net benefit with the score. Compared with the visual assessment, the BUMP score provided added value in terms of specificity in less-experienced PET readers (88% vs. 54%, P < 0.001). Conclusion: The BUMP score accurately distinguished UBU from bone metastases in PCa patients with [18F]PSMA-1007 focal bone uptake at PET imaging, offering additional value compared with the simple assessment of the osteoblastic CT correlate. Its use could help clinicians interpret imaging results, particularly those with less experience, potentially reducing the risk of patient overstaging.
Assuntos
Neoplasias Ósseas , Oligopeptídeos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/metabolismo , Neoplasias da Próstata/patologia , Idoso , Estudos Retrospectivos , Neoplasias Ósseas/secundário , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/metabolismo , Pessoa de Meia-Idade , Niacinamida/análogos & derivados , Radioisótopos de Flúor , Transporte Biológico , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/metabolismo , Idoso de 80 Anos ou maisAssuntos
Neoplasias Pulmonares , Tumores Neuroendócrinos , Tomografia por Emissão de Pósitrons , Neoplasias da Próstata , Compostos Radiofarmacêuticos , Humanos , Neoplasias da Próstata/diagnóstico por imagem , Tumores Neuroendócrinos/diagnóstico por imagem , Masculino , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodosRESUMO
INTRODUCTION: This study aimed to evaluate the relationship between pathological and clinical risk classifications in newly diagnosed prostate cancer patients, and 68Ga-PSMA PET/CT data and serum Prostate Specific Antigen (PSA) values. METHOD: A total of 203 patients who were diagnosed with prostate cancer between 2019 and 2023, who had not yet received treatment and who underwent 68Ga-PSMA PET/CT for staging purposes were included in this study. RESULTS: There was a substantial correlation between D'Amico risk classification, Gleason score, ISUP classification, and the presence or absence of metastasis (p < 0.0001). The median SUVmax value of the prostate gland and the D'Amico risk classification were statistically significantly correlated. (p < 0.0001). There was a statistically significant correlation between the ISUP classification and the PSA value and prostate gland SUVmax value (p < 0.0001). There was a significant correlation between the median SUVmax values of the prostate gland at the time of diagnosis and the patients with and without metastases (p < 0.0001). According to the data obtained from ROC analysis, patients with prostate gland SUVmax values of 8.75 and above were found to have a high probability of metastasis with a sensitivity of 78.9% and a specificity of 59.05%. CONCLUSION: Our study showed that 68Ga-PSMA PET/CT is a highly effective method for staging newly diagnosed high-risk prostate cancer. The probability of metastasis was found to be dramatically increased in Gleason 8 and above. According to D'Amico risk classification, metastasis was detected in at least half of high-risk patients. Since the sensitivity of metastasis was 78.9% in patients with prostate gland SUVmax value above 8.75, we think that these patients should be carefully reported in terms of metastasis.
Assuntos
Isótopos de Gálio , Radioisótopos de Gálio , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Idoso , Pessoa de Meia-Idade , Antígeno Prostático Específico/sangue , Idoso de 80 Anos ou mais , Gradação de Tumores , Ácido Edético/análogos & derivados , Estadiamento de Neoplasias , Medição de Risco/métodosRESUMO
BACKGROUND AND PURPOSE: Magnetic resonance (MR)-guided radiotherapy (MRgRT) enhances treatment precision and adaptive capabilities, potentially supporting a simulation-free (sim-free) workflow. This work reports the first clinical implementation of a sim-free workflow using the MR-Linac for prostate cancer patients treated with stereotactic ablative radiotherapy (SABR). MATERIALS AND METHODS: Fifteen patients who had undergone a prostate-specific membrane antigen positron emission tomography/CT (PSMA-PET/CT) scan as part of diagnostic workup were included in this work. Two reference plans were generated per patient: one using PSMA-PET/CT (sim-free plan) and the other using standard simulation CT (simCT plan). Dosimetric evaluations included comparisons between simCT, sim-free, and first fraction plans. Timing measurements were conducted to assess durations for both simCT and sim-free pre-treatment workflows. RESULTS: All 15 patients underwent successful treatment using a sim-free workflow. Dosimetric differences between simCT, sim-free, and first fraction plans were minor and within acceptable clinical limits, with no major violations of standardised criteria. The sim-free workflow took on average 130 min, while the simCT workflow took 103 min. CONCLUSION: This work demonstrates the feasibility and benefits of sim-free MR-guided adaptive radiotherapy for prostate SABR, representing the first reported clinical experience in an ablative setting. By eliminating traditional simulation scans, this approach reduces patient burden by minimising hospital visits and enhances treatment accessibility.
Assuntos
Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Próstata , Radiocirurgia , Planejamento da Radioterapia Assistida por Computador , Radioterapia Guiada por Imagem , Humanos , Masculino , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/patologia , Radiocirurgia/métodos , Radioterapia Guiada por Imagem/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Idoso , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Dosagem Radioterapêutica , Imageamento por Ressonância Magnética/métodos , Fluxo de Trabalho , Pessoa de Meia-Idade , Idoso de 80 Anos ou maisRESUMO
BACKGROUND AND PURPOSE: Fast and automated generation of treatment plans is desirable for magnetic resonance imaging (MRI)-guided adaptive radiotherapy (MRIgART). This study proposed a novel patient-specific auto-planning method and validated its feasibility in improving the existing online planning workflow. MATERIALS AND METHODS: Data from 40 patients with prostate cancer were collected retrospectively. A patient-specific auto-planning method was proposed to generate adaptive treatment plans. First, a population dose-prediction model (M0) was trained using data from previous patients. Second, a patient-specific model (Mps) was created for each new patient by fine-tuning M0 with the patient's data. Finally, an auto plan was optimized using the parameters derived from the predicted dose distribution by Mps. The auto plans were compared with manual plans in terms of plan quality, efficiency, dosimetric verification, and clinical evaluation. RESULTS: The auto plans improved target coverage, reduced irradiation to the rectum, and provided comparable protection to other organs-at-risk. Target coverage for the planning target volume (+0.61 %, P = 0.023) and clinical target volume 4000 (+1.60 %, P < 0.001) increased. V2900cGy (-1.06 %, P = 0.004) and V1810cGy (-2.49 %, P < 0.001) to the rectal wall and V1810cGy (-2.82 %, P = 0.012) to the rectum were significantly reduced. The auto plans required less planning time (-3.92 min, P = 0.001), monitor units (-46.48, P = 0.003), and delivery time (-0.26 min, P = 0.004), and their gamma pass rates (3 %/2 mm) were higher (+0.47 %, P = 0.014). CONCLUSION: The proposed patient-specific auto-planning method demonstrated a robust level of automation and was able to generate high-quality treatment plans in less time for MRIgART in prostate cancer.