You have accessJournal of UrologyProstate Cancer: Detection and Screening IV1 Apr 20122049 MAGNETIC RESONANCE IMAGE-GUIDED PROSTATE BIOPSY VERSUS TRANSPERINEAL TEMPLATE PROSTATE BIOPSY IN THE DIAGNOSIS OF CLINICALLY SIGNIFICANT PROSTATE CANCER Veeru Kasivisvanathan, Robert Dufour, Caroline Moore, Hashim Ahmed, Alex Freeman, Susan Charman, Clare Allen, Jan van der Meulen, and Mark Emberton Veeru KasivisvanathanVeeru Kasivisvanathan London, United Kingdom More articles by this author , Robert DufourRobert Dufour London, United Kingdom More articles by this author , Caroline MooreCaroline Moore London, United Kingdom More articles by this author , Hashim AhmedHashim Ahmed London, United Kingdom More articles by this author , Alex FreemanAlex Freeman London, United Kingdom More articles by this author , Susan CharmanSusan Charman London, United Kingdom More articles by this author , Clare AllenClare Allen London, United Kingdom More articles by this author , Jan van der MeulenJan van der Meulen London, United Kingdom More articles by this author , and Mark EmbertonMark Emberton London, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2214AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transperineal Template Prostate Biopsy (TPB) reduces the random and systematic error associated with transrectal ultrasound-guided biopsies in the diagnosis of prostate cancer. An alternative test to both is magnetic resonance image (MRI)-guided biopsy, an intervention that limits sampling to areas depicted on MRI as having a high probability of prostate cancer. It may confer the accuracy of TPB but reduce the sampling burden. We aimed to test this hypothesis. METHODS 115 consecutive men with a raised PSA underwent a multi-parametric (mp)MRI (T2-weighted, Dynamic contrast, diffusion-weighted, 1.5 Tesla pelvic-phased array) prior to any biopsy. Those men who scored 3 or above on an ordinal radiological scale of suspicion for clinically significant prostate cancer were offered a combination of transperineal MRI-guided biopsy followed by TPB. Primary endpoints were a) the proportion of men with clinically significant cancer (maximum cancer core length ≥4mm and/or Gleason score ≥3 + 4) and b) the proportion of men with clinically insignificant cancer (maximum cancer core length ≤3mm and Gleason score ≤3 + 3). RESULTS Mean age was 63.5±7.5, presenting PSA was 7.5±4.2ng/ml, mean number of targeted cores was 4.9±2.3 and mean number of TPB cores was 35.6±19.9. The sampling density for TPB was 0.88 +/− 0.55 cores/ml. TPB identified cancer in 87/115 (76%) men at a sampling efficiency of 47.0 cores per diagnosis. Clinically significant cancer was found in 70/115 (61%) men and insignificant cancer in 17/115 (15%). In contrast, mpMRI-guided biopsy, detected 76/115 (66%) cancers at a sampling efficiency of 7.4 cores per diagnosis of cancer. Of these, 68/115 (59%) were clinically significant and 8/115 (7%) were clinically insignificant. Sixteen clinically significant cancers were missed by the MRI-guided biopsy and 14 clinically significant cancers missed by TPB. mpMRI-guided biopsy identified 5 clinically insignificant cancers not detected by TPB in contrast to TPB that identified 14 clinically insignificant cancers not detected by mpMRI-guided biopsy. CONCLUSIONS Cores targeted to a suspicious area on mpMRI have a similar detection rate to transperineal template biopsies in the detection of clinically important prostate cancer. In addition, this strategy is more likely to overlook clinically insignificant prostate cancer. This is achieved with a considerably lower sampling burden. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e826-e827 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Metrics Author Information Veeru Kasivisvanathan London, United Kingdom More articles by this author Robert Dufour London, United Kingdom More articles by this author Caroline Moore London, United Kingdom More articles by this author Hashim Ahmed London, United Kingdom More articles by this author Alex Freeman London, United Kingdom More articles by this author Susan Charman London, United Kingdom More articles by this author Clare Allen London, United Kingdom More articles by this author Jan van der Meulen London, United Kingdom More articles by this author Mark Emberton London, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prostate biopsy

10.1016/j.juro.2012.02.2214

Cite

Citations (2)

Threshold volumes for urological cancer surgery: a survey of UK urologists

BJU International (2004)

Martin Nuttall Jan van der Meulen Gregor McIntosh David Gillatt Mark Emberton

OBJECTIVE To determine minimum threshold levels of activity set by surgeons for urological cancer surgery, and to relate threshold levels to stated current procedural volume. METHODS In all, 307 consultant urological surgeons were sent a questionnaire asking them to state for four urological cancer operations of different complexity their current procedural volume; whether minimum volume thresholds per surgeon should be implemented; and if so, the level of such thresholds; 212 (69%) replied. RESULTS For all four procedures ≥ 75% of surgeons advocated the setting of a minimum volume threshold. Overall, surgeons set the highest thresholds for radical prostatectomy and the lowest for radical cystectomy with continent diversion. There was no significant association between either the principle of supporting minimum volume thresholds or the level of such a threshold and the number of years worked as a consultant surgeon. The level of surgeon‐derived minimum thresholds increased with increasing surgeon procedural volume. CONCLUSION Most surgeons supported the principle of setting minimum volume thresholds. These thresholds appear to be influenced by current procedural volume and by procedural complexity. By setting thresholds greater than their current volume, some surgeons implicitly indicate that their current volume is insufficient to maintain their surgical competency.

10.1111/j.1464-410x.2004.05095.x

Cite

Citations (15)

PD34-07 PSA FAILS TO PREDICT TREATMENT FAILURE IN FOCAL HIGH-INTENSITY FOCUSED ULTRASOUND THERAPY IN PROSTATE CANCER

The Journal of Urology (2018)

Philipp Huber Naveed Afzal Manit Arya Silvan Boxler Susan C. Charman

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy II1 Apr 2018PD34-07 PSA FAILS TO PREDICT TREATMENT FAILURE IN FOCAL HIGH-INTENSITY FOCUSED ULTRASOUND THERAPY IN PROSTATE CANCER Philipp M. Huber, Naveed Afzal, Manit Arya, Silvan Boxler, Susan Charman, Andrew Cornaby, Tim Dudderidge, Mark Emberton, Stephanie Guillaumier, Richard J. Hindley, Lucas Leemann, Henry Lewi, Neil McCartan, Caroline M. Moore, Raj Nigam, Chris Ogden, Raj Persad, Karishma Shah, George N. Thalmann, Jaspal Virdi, Mathias Winkler, and Hashim U. Ahmed Philipp M. HuberPhilipp M. Huber More articles by this author , Naveed AfzalNaveed Afzal More articles by this author , Manit AryaManit Arya More articles by this author , Silvan BoxlerSilvan Boxler More articles by this author , Susan CharmanSusan Charman More articles by this author , Andrew CornabyAndrew Cornaby More articles by this author , Tim DudderidgeTim Dudderidge More articles by this author , Mark EmbertonMark Emberton More articles by this author , Stephanie GuillaumierStephanie Guillaumier More articles by this author , Richard J. HindleyRichard J. Hindley More articles by this author , Lucas LeemannLucas Leemann More articles by this author , Henry LewiHenry Lewi More articles by this author , Neil McCartanNeil McCartan More articles by this author , Caroline M. MooreCaroline M. Moore More articles by this author , Raj NigamRaj Nigam More articles by this author , Chris OgdenChris Ogden More articles by this author , Raj PersadRaj Persad More articles by this author , Karishma ShahKarishma Shah More articles by this author , George N. ThalmannGeorge N. Thalmann More articles by this author , Jaspal VirdiJaspal Virdi More articles by this author , Mathias WinklerMathias Winkler More articles by this author , and Hashim U. AhmedHashim U. Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1574AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine if PSA kinetics following focal high-intensity focused ultrasound (HIFU) for the treatment of non-metastatic prostate cancer can predict treatment failure. METHODS Retrospective analysis of our prospectively maintained HIFU (Sonablate 500) database, 598 patients were identified who underwent a focal HIFU (03/2007 to 11/2016). Follow-up with 3-monthly clinical visits and PSA testing in the first year. Thereafter PSA 6-monthly or annually at least. Routine and for-cause mpMRI followed by biopsies were offered. Treatment failure was defined by any secondary treatment (ADT/chemotherapy, cryotherapy, EBRT, RRP, or re-HIFU), metastasis from prostate cancer without further treatment, tumour recurrence with Gleason score ≥7 on prostate biopsy, or prostate cancer-related mortality. We evaluated a whole series of »nadir plus XX« thresholds (with XX from 0.1 to 2.0) for predicting failure using sensitivity and specificity, and Receiver Operating Characteristic (ROC) curve (statistics using R-language). RESULTS Median Gleason (range) 7 (6-9), in 80% Gleason ≥3+4=7. Tumours staged as localised T1c-T2c in 522/596 (88%) cases, 74/596 (12.4%) were radiological T3a/b. Baseline median (IQR) PSA was 7.80ng/ml (5.96-10.45) in those with failure and 6.77ng/ml (2.65-9.71) in those without failure. Using ASTRO criteria, sensitivity was 18.7%, specificity 68.3%. Evaluating other PSA nadir+XX thresholds, the highest sensitivity of 61.2% was shown for nadir+0.1ng/ml; the highest specificity of 59.1% for nadir+2.0ng/ml. All definitions of PSA failure incorporating nadir+XX thresholds led to significant false positives with the ROC curve shifted below the 50% line (Figure 1). CONCLUSIONS PSA kinetics following focal HIFU therapy occur differently following whole-gland therapy. Using any »nadir plus« definition leads to significant rates of false positives which might lead to unnecessary diagnostic procedures. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e658 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Philipp M. Huber More articles by this author Naveed Afzal More articles by this author Manit Arya More articles by this author Silvan Boxler More articles by this author Susan Charman More articles by this author Andrew Cornaby More articles by this author Tim Dudderidge More articles by this author Mark Emberton More articles by this author Stephanie Guillaumier More articles by this author Richard J. Hindley More articles by this author Lucas Leemann More articles by this author Henry Lewi More articles by this author Neil McCartan More articles by this author Caroline M. Moore More articles by this author Raj Nigam More articles by this author Chris Ogden More articles by this author Raj Persad More articles by this author Karishma Shah More articles by this author George N. Thalmann More articles by this author Jaspal Virdi More articles by this author Mathias Winkler More articles by this author Hashim U. Ahmed More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ogden

George (robot)

High-intensity focused ultrasound

10.1016/j.juro.2018.02.1574

Cite

Citations (1)

A Dedicated Prostate MRI Teaching Course Improves the Ability of the Urologist to Interpret Clinically Significant Prostate Cancer on Multiparametric MRI

European Urology (2018)

Veeru Kasivisvanathan Alessandro Ambrosi Francesco Giganti Edwin Chau Alex Kirkham

Multiparametric MRI

10.1016/j.eururo.2018.09.033

Cite

Citations (18)

The role of MRI in active surveillance of prostate cancer

Current Opinion in Urology (2013)

Caroline M. Moore Ashley Ridout Mark Emberton

Purpose of review The aim of active surveillance is to avoid radical treatment and its side-effects in men who have truly low risk prostate cancer, whilst offering radical treatment to those men who are at higher risk of local progression or metastatic disease. The traditional tools used to attribute these risk categories are prostate specific antigen, digital rectal examination, transrectal biopsy and their repeated application over time. MRI is emerging as a tool which may be able to more accurately determine the risk of significant disease at diagnosis and progression of disease over time. This review will examine the role of MRI in men on active surveillance. Recent findings The body of work on MRI as a tool for the detection of significant cancer is rapidly increasing, both in men undergoing initial assessment for prostate cancer risk, and in those who have low risk cancer on standard transrectal ultrasound guided biopsy. In addition, the use of MRI as a tool to detect change in prostate cancer is being explored by a small number of groups. Summary Multiparametric MRI is a useful tool in the initial assessment and surveillance of men who choose to avoid radical treatment when first diagnosed with localized prostate cancer.

Watchful waiting

10.1097/mou.0b013e32835f899f

Cite

Citations (29)

Image quality assessment by overlapping task-specific and task-agnostic measures: application to prostate multiparametric MR images for cancer segmentation

arXiv (Cornell University) (2022)

Shaheer U. Saeed Yan Wen Yunguan Fu Francesco Giganti Qianye Yang

Image quality assessment (IQA) in medical imaging can be used to ensure that downstream clinical tasks can be reliably performed. Quantifying the impact of an image on the specific target tasks, also named as task amenability, is needed. A task-specific IQA has recently been proposed to learn an image-amenability-predicting controller simultaneously with a target task predictor. This allows for the trained IQA controller to measure the impact an image has on the target task performance, when this task is performed using the predictor, e.g. segmentation and classification neural networks in modern clinical applications. In this work, we propose an extension to this task-specific IQA approach, by adding a task-agnostic IQA based on auto-encoding as the target task. Analysing the intersection between low-quality images, deemed by both the task-specific and task-agnostic IQA, may help to differentiate the underpinning factors that caused the poor target task performance. For example, common imaging artefacts may not adversely affect the target task, which would lead to a low task-agnostic quality and a high task-specific quality, whilst individual cases considered clinically challenging, which can not be improved by better imaging equipment or protocols, is likely to result in a high task-agnostic quality but a low task-specific quality. We first describe a flexible reward shaping strategy which allows for the adjustment of weighting between task-agnostic and task-specific quality scoring. Furthermore, we evaluate the proposed algorithm using a clinically challenging target task of prostate tumour segmentation on multiparametric magnetic resonance (mpMR) images, from 850 patients. The proposed reward shaping strategy, with appropriately weighted task-specific and task-agnostic qualities, successfully identified samples that need re-acquisition due to defected imaging process.

10.48550/arxiv.2202.09798

Cite

Citations (0)

98: Catheter-Associated Urinary Tract Infections: Can Empirical Treatment be Right?

The Journal of Urology (2004)

H.D. Wazait Hitendra Patel Jan van der Meulen Ronald Miller Mark Emberton

You have accessJournal of UrologyDiscussed Poster, Saturday, May 8, 2004, 1:00 - 5:00 pm1 Apr 200498: Catheter-Associated Urinary Tract Infections: Can Empirical Treatment be Right? Hassan D. Wazait, Hitendra Patel, Jan van der Meulen, R.A. Miller, and Mark Emberton Hassan D. WazaitHassan D. Wazait More articles by this author , Hitendra PatelHitendra Patel More articles by this author , Jan van der MeulenJan van der Meulen More articles by this author , R.A. MillerR.A. Miller More articles by this author , and Mark EmbertonMark Emberton More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)37360-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "98: Catheter-Associated Urinary Tract Infections: Can Empirical Treatment be Right?." The Journal of Urology, 171(4S), p. 26 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 26 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Hassan D. Wazait More articles by this author Hitendra Patel More articles by this author Jan van der Meulen More articles by this author R.A. Miller More articles by this author Mark Emberton More articles by this author Expand All Advertisement PDF DownloadLoading ...

Miller

10.1016/s0022-5347(18)37360-9

Cite

Citations (0)

Combiner and HyperCombiner Networks: Rules to Combine Multimodality MR Images for Prostate Cancer Localisation

arXiv (Cornell University) (2023)

Yan Wen Bernard Chiu Ziyi Shen Qianye Yang Tom Syer

One of the distinct characteristics in radiologists' reading of multiparametric prostate MR scans, using reporting systems such as PI-RADS v2.1, is to score individual types of MR modalities, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced, and then combine these image-modality-specific scores using standardised decision rules to predict the likelihood of clinically significant cancer. This work aims to demonstrate that it is feasible for low-dimensional parametric models to model such decision rules in the proposed Combiner networks, without compromising the accuracy of predicting radiologic labels: First, it is shown that either a linear mixture model or a nonlinear stacking model is sufficient to model PI-RADS decision rules for localising prostate cancer. Second, parameters of these (generalised) linear models are proposed as hyperparameters, to weigh multiple networks that independently represent individual image modalities in the Combiner network training, as opposed to end-to-end modality ensemble. A HyperCombiner network is developed to train a single image segmentation network that can be conditioned on these hyperparameters during inference, for much improved efficiency. Experimental results based on data from 850 patients, for the application of automating radiologist labelling multi-parametric MR, compare the proposed combiner networks with other commonly-adopted end-to-end networks. Using the added advantages of obtaining and interpreting the modality combining rules, in terms of the linear weights or odds-ratios on individual image modalities, three clinical applications are presented for prostate cancer segmentation, including modality availability assessment, importance quantification and rule discovery.

Modality (human–computer interaction)

10.48550/arxiv.2307.08279

Cite

Citations (0)

Morbidity associated with redo-HIFU of localized prostate cancer

Berge Richard Hindley Hashim U. Ahmed L Dickinson Neil McCartan

Source

Cite

Citations (0)

An update from the ReIMAGINE Prostate Cancer Risk Study (NCT04060589): A prospective cohort study in men with a suspicion of prostate cancer who are referred onto a magnetic resonance imaging–based diagnostic pathway with donation of tissue, blood, and urine for biomarker analyses

European Urology (2021)

Teresa Marsden Hashim U. Ahmed Mark Emberton

10.1016/j.eururo.2021.06.011

Cite

Citations (2)