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Zanelli E, Giannarini G, Cereser L, Zuiani C, Como G, Pizzolitto S, Crestani A, Valotto C, Ficarra V, Girometti R. Head-to-head comparison between multiparametric MRI, the partin tables, memorial sloan kettering cancer center nomogram, and CAPRA score in predicting extraprostatic cancer in patients undergoing radical prostatectomy. J Magn Reson Imaging 2019; 50:1604-1613. [PMID: 30957321 DOI: 10.1002/jmri.26743] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/23/2019] [Accepted: 03/25/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND It is unclear whether clinical models including the Partin tables (PT), the Memorial Sloan Kettering Cancer Center nomogram (MSKCCn), and the cancer of the prostate risk assessment (CAPRA) can benefit from incorporating multiparametric magnetic resonance imaging (mpMRI) when staging prostate cancer (PCa). PURPOSE To compare the accuracy of clinical models, mpMRI, and mpMRI plus clinical models in predicting stage ≥pT3 of PCa. STUDY TYPE Prospective monocentric cohort study. POPULATION Seventy-three patients who underwent radical prostatectomy between 2016-2018. FIELD STRENGTH/SEQUENCE 3.0T using turbo spin echo (TSE) imaging, single-shot echoplanar diffusion-weighted imaging, and T1 -weighted high-resolution-isotropic-volume-examination (THRIVE) contrast-enhanced imaging. ASSESSMENT We calculated the probability of extraprostatic extension (EPE) using the PT and MSKCC, as well as the CAPRA score. Three readers with 2-8 years of experience in mpMRI independently staged PCa on imaging. STATISTICAL TESTS Receiver operating characteristics analysis and logistic regression analysis to investigate the per-patient accuracy of mpMRI vs. clinical models vs. mpMRI plus clinical models in predicting stage ≥pT3. The alpha level was 0.05. RESULTS Median probability for EPE and MSKCCn was 27.3% and 47.0%, respectively. Median CAPRA score was 3. Stage ≥pT3 occurred in 32.9% of patients. Areas under the curve (AUCs) were 0.62 for PT, 0.62 for MSKCCn, 0.64 for CAPRA, and 0.73-0.75 for mpMRI (readers 1-3) (P > 0.05 for all comparisons). Compared with mpMRI, the combination of mpMRI with PT or MSKCCn provided lower AUCs (P > 0.05 for all the readers), while the combination with CAPRA provided significantly higher (P < 0.05) AUCs in the case of readers 1 and 3. On multivariable analysis, mpMRI by reader 1 was the only independent predictor of stage ≥pT3 (odds ratio 7.40). DATA CONCLUSION: mpMRI was more accurate than clinical models and mpMRI plus clinical models in predicting stage ≥pT3, except for the combination of mpMRI and CAPRA in two out of three readers. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1604-1613.
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Affiliation(s)
- Elisa Zanelli
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, Udine, Italy
| | - Gianluca Giannarini
- Urology Unit, "S. Maria della Misericordia" University Hospital, Udine, Italy
| | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, Udine, Italy
| | - Giuseppe Como
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, Udine, Italy
| | - Stefano Pizzolitto
- Pathology Unit, "S. Maria della Misericordia" University Hospital, Udine, Italy
| | - Alessandro Crestani
- Urology Unit, "S. Maria della Misericordia" University Hospital, Udine, Italy
| | - Claudio Valotto
- Urology Unit, "S. Maria della Misericordia" University Hospital, Udine, Italy
| | - Vincenzo Ficarra
- Urology Unit, Dipartimento di Patologia Umana dell'adulto e dell'età evolutiva Gaetano Barresi, University of Messina, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, Udine, Italy
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Girometti R, Cereser L, Bonato F, Zuiani C. Evolution of prostate MRI: from multiparametric standard to less-is-better and different-is better strategies. Eur Radiol Exp 2019; 3:5. [PMID: 30693407 PMCID: PMC6890868 DOI: 10.1186/s41747-019-0088-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/04/2019] [Indexed: 12/31/2022] Open
Abstract
Multiparametric magnetic resonance imaging (mpMRI) has become the standard of care to achieve accurate and reproducible diagnosis of prostate cancer. However, mpMRI is quite demanding in terms of technical rigour, patient's tolerability and safety, expertise in interpretation, and costs. This paper reviews the main technical strategies proposed as less-is-better solutions for clinical practice (non-contrast biparametric MRI, reduction of acquisition time, abbreviated protocols, computer-aided diagnosis systems), discussing them in the light of the available evidence and of the concurrent evolution of Prostate Imaging Reporting and Data System (PI-RADS). We also summarised research results on those advanced techniques representing an alternative different-is-better line of the still ongoing evolution of prostate MRI (quantitative diffusion-weighted imaging, quantitative dynamic contrast enhancement, intravoxel incoherent motion, diffusion tensor imaging, diffusional kurtosis imaging, restriction spectrum imaging, radiomics analysis, hybrid positron emission tomography/MRI).
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Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine - University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15-33100, Udine, Italy.
| | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine - University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Filippo Bonato
- Institute of Radiology, Department of Medicine, University of Udine - University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine - University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15-33100, Udine, Italy
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Kozikowski M, Malewski W, Michalak W, Dobruch J. Clinical utility of MRI in the decision-making process before radical prostatectomy: Systematic review and meta-analysis. PLoS One 2019; 14:e0210194. [PMID: 30615661 PMCID: PMC6322775 DOI: 10.1371/journal.pone.0210194] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/18/2018] [Indexed: 11/19/2022] Open
Abstract
Context Magnetic resonance imaging (MRI) is currently the most accurate imaging modality to assess local prostate cancer stage. Despite a growing body of evidence, incorporation of MRI images into decision-making process concerning surgical template of radical prostatectomy, is complex and still poorly understood. Objective We sought to determine the value of MRI in preoperative planning before radical prostatectomy. Materials and methods Systematic search through electronic PubMed, EMBASE, and Cochrane databases from 2000 up to April 2018 was performed. Only studies that used preoperative MRI in decision-making process regarding extension of resection in patients with prostate cancer, in whom radical prostatectomy was an initial form of treatment were included into analysis. Their quality was scored by Risk Of Bias In Non-Randomized Studies of Interventions system. Meta-analysis was performed to calculate the weighted summary proportion under the fixed or random effects model as appropriate and pooled effects were depicted on forest plots. Results The results showed that the preoperative MRI led to the modification of initial surgical template in one third of cases (35%). This occurred increasingly with the rising prostate cancer-risk category: 28%, 33%, 52% in low-, intermediate- and high-risk group, respectively. Modification of neurovascular bundle-sparing surgery based on MRI appeared to have no impact on the positive surgical margin rate. The decision based on MRI was correct on average in 77% of cases and differed across prostate cancer-risk categories: 63%, 75% and 91% in low-, intermediate- and high-risk group, accordingly. Conclusions In summary, MRI has a considerable impact on the decision-making process regarding the extent of resection during radical prostatectomy. Adaptation of MRI images by operating surgeons has at worst no significant impact on surgical margin status, however its ability to decrease the positive surgical margin rates remains unconfirmed.
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Affiliation(s)
- Mieszko Kozikowski
- Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
- * E-mail:
| | - Wojciech Malewski
- Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Wojciech Michalak
- Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jakub Dobruch
- Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
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Duvnjak P, Schulman AA, Holtz JN, Huang J, Polascik TJ, Gupta RT. Multiparametric Prostate MR Imaging: Impact on Clinical Staging and Decision Making. Urol Clin North Am 2018; 45:455-466. [DOI: 10.1016/j.ucl.2018.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Multiparametric magnetic resonance imaging versus Partin tables and the Memorial Sloan-Kettering cancer center nomogram in risk stratification of patients with prostate cancer referred to external beam radiation therapy. Radiol Med 2018; 123:778-787. [DOI: 10.1007/s11547-018-0903-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 05/02/2018] [Indexed: 12/30/2022]
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Multiparametric Prostate MR Imaging: Impact on Clinical Staging and Decision Making. Radiol Clin North Am 2018; 56:239-250. [DOI: 10.1016/j.rcl.2017.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Hegde JV, Demanes DJ, Veruttipong D, Raince J, Park SJ, Raman SS, Nickols NG, King CR, Kishan AU, Steinberg ML, Kamrava M. Pretreatment 3T multiparametric MRI staging predicts for biochemical failure in high-risk prostate cancer treated with combination high-dose-rate brachytherapy and external beam radiotherapy. Brachytherapy 2017; 16:1106-1112. [PMID: 28807747 DOI: 10.1016/j.brachy.2017.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/02/2017] [Accepted: 07/13/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether pretreatment 3T multiparametric MRI (mpMRI) staging impacts biochemical recurrence-free survival (BRFS) or distant metastasis-free survival (DMFS) for men with high-risk prostate cancer treated with combination high-dose-rate (HDR) brachytherapy and external beam radiation therapy (EBRT). MATERIALS AND METHODS This institutional review board-approved retrospective study included a cohort of 37 men with high-risk prostate cancer treated with HDR brachytherapy and EBRT after 3T mpMRI. Kaplan-Meier analysis was used to evaluate whether mpMRI evidence of extracapsular extension or seminal vesicle invasion (SVI) resulted in differences in BRFS or DMFS. Pretreatment and treatment-related variables were evaluated for association with biochemical failure (Phoenix definition) and distant metastatic failure using univariate Cox regression analysis. RESULTS The median prostate-specific antigen at diagnosis was 9 ng/mL (range 2-100). Biopsy Gleason score (bGS) was ≤8 in 38% and nine in 62%. Clinical T-category was T1-T2 in 89%, T3a in 8%, and T3b in 3%. With a median followup of 30.6 months, actuarial 3-year BRFS and DMFS were 76% and 86%, respectively. Kaplan-Meier analysis revealed that mpMRI evidence of extracapsular extension or SVI resulted in significantly higher rates of both biochemical recurrence and distant failure. Using Cox regression analysis, only mpMRI evidence of SVI vs. no SVI predicted for biochemical failure (hazard ratio 13.98, p = 0.0055). CONCLUSIONS For high-risk prostate cancer treated with combination HDR brachytherapy and EBRT, mpMRI evidence of SVI predicted for biochemical failure, whereas traditional pretreatment variables did not. Therefore, pretreatment 3T mpMRI appears useful for identifying men who may benefit from treatment intensification.
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Affiliation(s)
- John V Hegde
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA.
| | - D Jeffrey Demanes
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Darlene Veruttipong
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Jagdeep Raince
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Sang-June Park
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Steven S Raman
- Departments of Radiology, Urology, and Surgery, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Nicholas G Nickols
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Christopher R King
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Samuel Oschin Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA
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Couñago F, Sancho G, Catalá V, Hernández D, Recio M, Montemuiño S, Hernández JA, Maldonado A, del Cerro E. Magnetic resonance imaging for prostate cancer before radical and salvage radiotherapy: What radiation oncologists need to know. World J Clin Oncol 2017; 8:305-319. [PMID: 28848697 PMCID: PMC5554874 DOI: 10.5306/wjco.v8.i4.305] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/30/2017] [Accepted: 06/12/2017] [Indexed: 02/06/2023] Open
Abstract
External beam radiotherapy (EBRT) is one of the principal curative treatments for patients with prostate cancer (PCa). Risk group classification is based on prostate-specific antigen (PSA) level, Gleason score, and T-stage. After risk group determination, the treatment volume and dose are defined and androgen deprivation therapy is prescribed, if appropriate. Traditionally, imaging has played only a minor role in T-staging due to the low diagnostic accuracy of conventional imaging strategies such as transrectal ultrasound, computed tomography, and morphologic magnetic resonance imaging (MRI). As a result, a notable percentage of tumours are understaged, leading to inappropriate and imprecise EBRT. The development of multiparametric MRI (mpMRI), an imaging technique that combines morphologic studies with functional diffusion-weighted sequences and dynamic contrast-enhanced imaging, has revolutionized the diagnosis and management of PCa. As a result, mpMRI is now used in staging PCa prior to EBRT, with possible implications for both risk group classification and treatment decision-making for EBRT. mpMRI is also being used in salvage radiotherapy (SRT), the treatment of choice for patients who develop biochemical recurrence after radical prostatectomy. In the clinical context of biochemical relapse, it is essential to accurately determine the site of recurrence - pelvic (local, nodal, or bone) or distant - in order to select the optimal therapeutic management approach. Studies have demonstrated the value of mpMRI in detecting local recurrences - even in patients with low PSA levels (0.3-0.5 ng/mL) - and in diagnosing bone and nodal metastasis. The main objective of this review is to update the role of mpMRI prior to radical EBRT or SRT. We also consider future directions for the use and development of MRI in the field of radiation oncology.
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Harvey H, Orton MR, Morgan VA, Parker C, Dearnaley D, Fisher C, deSouza NM. Volumetry of the dominant intraprostatic tumour lesion: intersequence and interobserver differences on multiparametric MRI. Br J Radiol 2017; 90:20160416. [PMID: 28055249 PMCID: PMC5601508 DOI: 10.1259/bjr.20160416] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 11/10/2016] [Accepted: 01/03/2017] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To establish the interobserver reproducibility of tumour volumetry on individual multiparametric (mp) prostate MRI sequences, validate measurements with histology and determine whether functional to morphological volume ratios reflect Gleason score. METHODS 41 males with prostate cancer treated with prostatectomy (Cohort 1) or radical radiotherapy (Cohort 2), who had pre-treatment mpMRI [T2 weighted (T2W) MRI, diffusion-weighted (DW)-MRI and dynamic contrast-enhanced (DCE)-MRI], were studied retrospectively. Dominant intraprostatic lesions (DIPLs) were manually delineated on each sequence and volumes were compared between observers (n = 40 analyzable) and with radical prostatectomy (n = 20). Volume ratios of DW-MRI and DCE-MRI to T2W MRI were documented and compared between Gleason grade 3 + 3, 3 + 4 and 4 + 3 or greater categories. RESULTS Limits of agreement of DIPL volumes between observers were: T2W MRI 0.9, -1.1 cm3, DW-MRI 1.3, -1.7 cm3 and DCE-MRI 0.74, -0.89 cm3. In Cohort 1, T2W volumes overestimated fixed specimen histological volumes (+33% Observer 1, +16% Observer 2); DW- and DCE-MRI underestimated histological volume, the latter markedly so (-32% Observer 1, -79% Observer 2). Differences between T2W, DW- and DCE-MRI volumes were significant (p < 10-8). The ratio of DW-MRI volume (73.9 ± 18.1% Observer 1, 72.5 ± 21.9% Observer 2) and DCE-MRI volume (42.6 ± 24.6% Observer 1, 34.3 ± 24.9% Observer 2) to T2W volume was significantly different (p < 10-8), but these volume ratios did not differ between the Gleason grades. CONCLUSION The low variability of the DIPL volume on T2W MRI between Observers and agreement with histology indicates its suitability for delineation of gross tumour volume for radiotherapy planning. The volume of cellular tumour represented by DW-MRI is greater than the vascular (DCE) abnormality; ratios of both to T2W volume are independent of Gleason score. Advances in knowledge: (1) Manual volume measurement of tumour is reproducible within 1 cm3 between observers on all sequences, confirming suitability across observers for radiotherapy planning. (2) Volumes derived on T2W MRI most accurately represent in vivo lesion volumes. (3) The proportion of cellular (DW-MRI) or vascular (DCE-MRI) volume to morphological (T2W MRI) volume is not affected by Gleason score.
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Affiliation(s)
- Hugh Harvey
- Cancer Research UK Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Matthew R Orton
- Cancer Research UK Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Veronica A Morgan
- Cancer Research UK Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Chris Parker
- Academic Urology Unit, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - David Dearnaley
- Academic Urology Unit, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Cyril Fisher
- Department of Histopathology, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Nandita M deSouza
- Cancer Research UK Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
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Couñago F, Del Cerro E, Díaz-Gavela AA, Marcos FJ, Recio M, Thuissard I, Sanz-Rosa D, Olaciregui K, Mateo M, Cerezo L. Letter by Couñago et al. regarding article "Impact of multiparametric magnetic resonance imaging on risk group assessment of patients with prostate cancer addressed to external beam radiation therapy". Eur J Radiol 2016; 85:2296-2297. [PMID: 27660186 DOI: 10.1016/j.ejrad.2016.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/12/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quiron, Madrid, Spain.
| | - Elia Del Cerro
- Department of Radiation Oncology, Hospital Universitario Quiron, Madrid, Spain
| | | | | | - Manuel Recio
- Department of Radiology, Hospital Universitario Quiron, Madrid, Spain
| | - Israel Thuissard
- Pharmacy and Biotechnology Department, School of Biomedical Sciences, Universidad Europea, Madrid, Spain
| | - David Sanz-Rosa
- Clinical Department, School of Biomedical Sciences, Universidad Europea, Madrid, Spain
| | | | - María Mateo
- Hospital Universitario Quiron, Madrid, Spain
| | - Laura Cerezo
- Departament of Radiation Oncology, Hospital Universitario La Princesa, Madrid, Spain
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Reply letter. Eur J Radiol 2016; 85:2298-2299. [PMID: 27769539 DOI: 10.1016/j.ejrad.2016.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/10/2016] [Indexed: 11/24/2022]
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Nicolae AM, Venugopal N, Ravi A. Trends in targeted prostate brachytherapy: from multiparametric MRI to nanomolecular radiosensitizers. Cancer Nanotechnol 2016; 7:6. [PMID: 27441041 PMCID: PMC4932125 DOI: 10.1186/s12645-016-0018-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/14/2016] [Indexed: 01/21/2023] Open
Abstract
The treatment of localized prostate cancer is expected to become a significant problem in the next decade as an increasingly aging population becomes prone to developing the disease. Recent research into the biological nature of prostate cancer has shown that large localized doses of radiation to the cancer offer excellent long-term disease control. Brachytherapy, a form of localized radiation therapy, has been shown to be one of the most effective methods for delivering high radiation doses to the cancer; however, recent evidence suggests that increasing the localized radiation dose without bound may cause unacceptable increases in long-term side effects. This review focuses on methods that have been proposed, or are already in clinical use, to safely escalate the dose of radiation within the prostate. The advent of multiparametric magnetic resonance imaging (mpMRI) to better identify and localize intraprostatic tumors, and nanomolecular radiosensitizers such as gold nanoparticles (GNPs), may be used synergistically to increase doses to cancerous tissue without the requisite hazard of increased side effects.
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Affiliation(s)
- Alexandru Mihai Nicolae
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N3M5 Canada
| | | | - Ananth Ravi
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N3M5 Canada
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