The COMPARE (COMparing treatment options for ProstAte cancer) study aimed to evaluate and quantify the trade-offs patients make between different aspects of active surveillance and definitive therapy.A discrete choice experiment tool was used to elicit patient preferences for different treatment characteristics in 34 urology departments. Patients with localized prostate cancer completed the discrete choice experiment within 1 week of being diagnosed and before they made treatment decisions. The discrete choice experiment was pretested (5) and piloted (106) with patients. Patients chose their preferred treatment profile based on the 6 characteristics of treatment type (active surveillance, focal therapy, radical therapy), return to normal activities, erectile function, urinary function, not needing more cancer treatment and 10 to 15-year cancer specific survival. Different tools were designed for patients with low-intermediate (468) and high risk (166) disease. An error components conditional logit model was used to estimate preferences and trade-offs between treatment characteristics.Patients with low-intermediate risk disease were willing to trade 6.99% absolute decrease in survival to have active surveillance over definitive therapy. They were willing to trade 0.75%, 0.46% and 0.19% absolute decrease in survival for a 1-month reduction in time to return to normal activities and 1% absolute improvements in urinary and sexual function, respectively. Patients with high risk disease were willing to trade 3.10%, 1.04% and 0.41% absolute decrease in survival for a 1-month reduction in time to return to normal activities and 1% absolute improvements in urinary and sexual function, respectively.Patients with low-intermediate risk prostate cancer preferred active surveillance to definitive therapy. Patients of all risk levels were willing to trade cancer specific survival for improved quality of life.

Watson

10.1097/ju.0000000000000754

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Citations (38)

Will the attributes of multiparametric MRI permit the creation of a new approach to therapy?

Current Opinion in Urology (2015)

Caroline M. Moore Mark Emberton

To explore the concept that MRI can be used to permit a new approach to therapy of localized prostate cancer.With the development of multiparametric MRI, we can characterize cancer within the prostate, in terms of location, volume and radiological phenotype. The use of volume and location to identify candidates for focal ablative therapy is well established.The radiological phenotype of a tumour includes the vascularity and diffusion characteristics of that tumour. These characteristics may help us to develop novel interventions to target particular characteristics of a tumour.The assessment of novel interventions such as sulforaphanes found in broccoli, and common medications used for other diseases such as aspirin and metformin typically use population based studies, or repeat biopsy studies in large groups of men on active surveillance. MRI, with its accurate detection of change in visible tumour over a 6-month period, could allow rapid noninvasive assessment of a novel intervention.MRI could be used to allow the rapid and efficient assessment of dietary and other interventions to identify candidates for assessment in larger studies and potentially, to identify subgroups of tumours which would be most suited to a given intervention.

Multiparametric MRI

Radiogenomics

Vascularity

10.1097/mou.0000000000000214

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Prostate Cancer IRE Study (PRIS): A Randomized Controlled Trial Comparing Focal Therapy to Radical Treatment in Localized Prostate Cancer

European Urology Open Science (2023)

Anna Lantz Per Nordlund Ugo Giovanni Falagario Fredrik Jäderling Orhan Özbek

The aim of focal treatments (FTs) in prostate cancer (PCa) is to treat lesions while preserving surrounding benign tissue and anatomic structures. Irreversible electroporation (IRE) is a nonthermal technique that uses high-voltage electric pulses to increase membrane permeability and induce membrane disruption in cells, which potentially causes less damage to the surrounding tissue in comparison to other ablative techniques. We summarize the study protocol for the Prostate Cancer IRE Study (PRIS), which involves two parallel randomized controlled trials comparing IRE with (1) robot-assisted radical prostatectomy (RARP) or (2) radiotherapy in men with newly diagnosed intermediate-risk PCa (NCT05513443). To reduce the number of patients for inclusion and the study duration, the primary outcomes are functional outcomes: urinary incontinence in study 1 and irritative urinary symptoms in study 2. Providing evidence of the lower impact of IRE on functional outcomes will lay a foundation for the design of future multicenter studies with an oncological outcome as the primary endpoint. Erectile function, quality of life, treatment failure, adverse events, and cost effectiveness will be evaluated as secondary objectives. Patients diagnosed with Gleason score 3 + 4 or 4 + 3 PCa from a single lesion visible on magnetic resonance imaging (MRI) without any Gleason grade 4 or higher in systematic biopsies outside of the target (unifocal significant disease), aged ≥40 yr, with no established extraprostatic extension on multiparametric MRI, a lesion volume of <1.5 cm3, prostate-specific antigen <20 ng/ml, and stage ≤T2b are eligible for inclusion. The study plan is to recruit 184 men.

Irreversible Electroporation

Clinical endpoint

10.1016/j.euros.2023.03.003

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Prostate cancer segmentation from MRI by a multistream fusion encoder

Medical Physics (2023)

Mingjie Jiang Baohua Yuan Weixuan Kou Yan Wen Harry Marshall

Targeted prostate biopsy guided by multiparametric magnetic resonance imaging (mpMRI) detects more clinically significant lesions than conventional systemic biopsy. Lesion segmentation is required for planning MRI-targeted biopsies. The requirement for integrating image features available in T2-weighted and diffusion-weighted images poses a challenge in prostate lesion segmentation from mpMRI.A flexible and efficient multistream fusion encoder is proposed in this work to facilitate the multiscale fusion of features from multiple imaging streams. A patch-based loss function is introduced to improve the accuracy in segmenting small lesions.The proposed multistream encoder fuses features extracted in the three imaging streams at each layer of the network, thereby allowing improved feature maps to propagate downstream and benefit segmentation performance. The fusion is achieved through a spatial attention map generated by optimally weighting the contribution of the convolution outputs from each stream. This design provides flexibility for the network to highlight image modalities according to their relative influence on the segmentation performance. The encoder also performs multiscale integration by highlighting the input feature maps (low-level features) with the spatial attention maps generated from convolution outputs (high-level features). The Dice similarity coefficient (DSC), serving as a cost function, is less sensitive to incorrect segmentation for small lesions. We address this issue by introducing a patch-based loss function that provides an average of the DSCs obtained from local image patches. This local average DSC is equally sensitive to large and small lesions, as the patch-based DSCs associated with small and large lesions have equal weights in this average DSC.The framework was evaluated in 931 sets of images acquired in several clinical studies at two centers in Hong Kong and the United Kingdom. In particular, the training, validation, and test sets contain 615, 144, and 172 sets of images, respectively. The proposed framework outperformed single-stream networks and three recently proposed multistream networks, attaining F1 scores of 82.2 and 87.6% in the lesion and patient levels, respectively. The average inference time for an axial image was 11.8 ms.The accuracy and efficiency afforded by the proposed framework would accelerate the MRI interpretation workflow of MRI-targeted biopsy and focal therapies.

Feature (linguistics)

Modality (human–computer interaction)

Convolution (computer science)

10.1002/mp.16374

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Focal therapy for prostate cancer

Oxford University Press eBooks (2017)

Hashim U. Ahmed Louise Dickinson Mark Emberton

Minimally-invasive therapies in localized prostate cancer offer the potential to reduce side effects and the healthcare burden/costs associated with radical modalities such as surgery or radiotherapy. As radical treatments carry significant perioperative morbidity (wound infection, haemorrhage, hospital stay), potentially life-long side effects (such as incontinence, erectile dysfunction, rectal toxicity), and fail to cure many men, ablative therapies that reduce treatment burden while retaining acceptable cancer control have increasingly become areas of evaluation. This chapter reviews the role of these approaches and the therapeutic dilemma that men with localized low volume prostate cancer currently face as in the context of novel therapies which aim to find a middle ground—tissue-preserving focal therapy—that follows the paradigm of almost all other solid organ cancers.

Modalities

10.1093/med/9780199659579.003.0065

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What tumours should we treat with focal therapy based on risk category, grade, size and location?

Current Opinion in Urology (2015)

Clément Orczyk Mark Emberton Hashim U. Ahmed

Focal therapy aims to reduce side-effects of active whole-gland therapies with an acceptable or noninferior oncologic benefit for the patient. The definition of the lesion to treat using this tissue-preserving approach is central, and there is a recent shift in considering more aggressive disease than in the past. This article examines recent consensus reports, assessment of emerging techniques, histologic considerations as well as results of trials and their development.Accumulation of evidence reinforces the concept of clinically significant disease. Latest histologic assessment studies specify the index lesion characteristics. Index lesion localization was accurately evaluated by both multiparametric MRI (mpMRI)-targeted and transperineal mapping biopsy techniques against reference standard. mpMRI continues its development in accurate disease stratification. Development of new treatment modalities allows the clinician to investigate treatment of a lesion in various zonal anatomy locations. Consensus reports establish the intermediate risk population as the target for focal therapy, leaving very low risk disease to surveillance. Reviews of past clinical trials, including intermediate risk population, reveal encouraging oncologic follow-up. Ongoing trials will test focal therapy of index lesion with surveillance of insignificant secondary lesions.Focal therapy should be investigated for intermediate risk population, leaving very low risk to surveillance. Detection and stratification techniques, namely mpMRI-targeted and transperineal biopsies, have an evolving role in lesion selection to confirm encouraging oncologic benefit for the patient.

Multiparametric MRI

Modalities

Risk Stratification

10.1097/mou.0000000000000170

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Focal therapy for prostate cancer. Alternative treatment

Actas Urológicas Españolas (English Edition) (2014)

F. Gómez-Veiga S. Martínez-Breijo E. Solsona-Narbón C. Hernández A. Ciudin

10.1016/j.acuroe.2014.05.008

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MP70-02 CORRELATION OF MPMRI CONTOURS WITH 3-DIMENSIONAL 5MM TRANSPERINEAL PROSTATE MAPPING BIOPSY WITHIN THE PROMIS TRIAL PILOT: WHAT MARGINS ARE REQUIRED?

The Journal of Urology (2017)

Clément Orczyk Yi Peng Hu Ahmed El‐Shater Bosaily Eli Gibson Alex Kirkham

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy I1 Apr 2017MP70-02 CORRELATION OF MPMRI CONTOURS WITH 3-DIMENSIONAL 5MM TRANSPERINEAL PROSTATE MAPPING BIOPSY WITHIN THE PROMIS TRIAL PILOT: WHAT MARGINS ARE REQUIRED? Clement Orczyk, Yi Peng Hu, Ahmed El-Shater Bosaily, Eli Gibson, Alex Kirkham, Shonit Punwani, Esther Bonmati, Louise Brown, Yolana Coraco-Moraes, Katie Ward, Rick Kaplan, Dean Barratt, Mark Emberton, and Hashim U Ahmed Clement OrczykClement Orczyk More articles by this author , Yi Peng HuYi Peng Hu More articles by this author , Ahmed El-Shater BosailyAhmed El-Shater Bosaily More articles by this author , Eli GibsonEli Gibson More articles by this author , Alex KirkhamAlex Kirkham More articles by this author , Shonit PunwaniShonit Punwani More articles by this author , Esther BonmatiEsther Bonmati More articles by this author , Louise BrownLouise Brown More articles by this author , Yolana Coraco-MoraesYolana Coraco-Moraes More articles by this author , Katie WardKatie Ward More articles by this author , Rick KaplanRick Kaplan More articles by this author , Dean BarrattDean Barratt More articles by this author , Mark EmbertonMark Emberton 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.2017.02.2278AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES mpMRI offers the possibility to locate cancer in 3-Dimensions and aid surgical planning. We investigated the margin needed around an mpMRI lesion for complete disease control in a prospectively enrolled biopsy naïve population who underwent mpMRI followed by Transperineal Prostate Mapping with biopsies taken every 5mm(5TPM). METHODS 94 patients included in this analysis were part of the pilot phase of Prostate MRI Imaging Study (NCT01292291) investigating accuracy of mpMRI against standard of care with TPM as a reference test. All patients were biopsy-naïve with a PSA below 15ng/ml. All patients underwent 1.5T mpMRI with standardized protocol (T2W, Diffusion, DCE), blinded reported using Likert scoring. Each core was separately labelled and oriented in space. Each prostate and MRI lesion was contoured on T2W-imaging, blinded to pathology. A 3D digital map of the TPM was reconstructed using an in-house software. Correlation between mpMRI and biopsy findings was automatically carried out using a platform generating the registration based on landmarks. We report the margin ‘M’ around the MRI lesion as the maximum distance within a set of negative biopsy location surrounding the MRI lesion. Results are also stratified by MRI score, Gleason Score, lesion eligibility to focal therapy and significance. RESULTS 41 patients (median PSA 6.5ng/ml, median age 62) were found to harbour cancer at 5TPM in this cohort, yielding 75 MRI lesions that corresponded to cancer at 5TPM. The median number of MRI lesions per patient was 1.5. As a control of registration, correlation between MRI volume and TPM volume was ?=0.92 (p<0.001). Lesion characteristics are summarized in Table 1. The mean margin (enclosing a perimeter of negative cores) for MRI lesions corresponding the cancer at 5TPM was 7.0 mm (SD 4.6mm). For lesion eligible for focal therapy (n= 35), the mean margin was 7.3 (SD 4.3mm). The mean Gleason score of biopsy core outside the MRI lesion was 6.7 (+/- 0.5). CONCLUSIONS Our study is the first to report a margin around a mpMRI lesion when based on prostates that have not been removed using surgery and evaluated against a very accurate 3-dimensional 5mm mapping biopsy. These findings have implications for focal therapy and nerve-sparing surgery. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e935 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Clement Orczyk More articles by this author Yi Peng Hu More articles by this author Ahmed El-Shater Bosaily More articles by this author Eli Gibson More articles by this author Alex Kirkham More articles by this author Shonit Punwani More articles by this author Esther Bonmati More articles by this author Louise Brown More articles by this author Yolana Coraco-Moraes More articles by this author Katie Ward More articles by this author Rick Kaplan More articles by this author Dean Barratt More articles by this author Mark Emberton More articles by this author Hashim U Ahmed More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prostate biopsy

10.1016/j.juro.2017.02.2278

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Multicenter study evaluating extraprostatic uptake of 11C-choline, 18F-methylcholine, and 18F-ethylcholine in male patients

Nuclear Medicine Communications (2015)

Athar Haroon Lucia Zanoni Monica Celli Seyed Rasoul Zakavi Mohsen Beheshti

The aim of the study was to evaluate the visceral localization of the three most commonly used choline-based radiotracers (C-choline, F-methylcholine, and F-ethylcholine) with the aim of analyzing uptake in metabolically and anatomically disease-free patients.A total of 1250 standardized uptake values (SUVmax, SUVmean) were analyzed in 45 anatomical regions in 45 patients (15 patients with C-choline, 15 with F-methylcholine, and 15 with F-ethylcholine). These patients were selected from a cohort of 3721 choline PET/computed tomography studies performed at three teaching hospitals over a period of 10 years. They had no evidence of metabolically active primary disease, metastatic disease, or altered morphology on the computed tomography component of the study or any evidence of disease elsewhere on other imaging modalities. The sites of primary disease (prostate and seminal vesicles) were excluded from evaluation.No adverse effect was documented when using the three tracers. Visceral localization was the same for all three tracers. Viscera with a statistical difference in intensity of uptake included the choroid plexus (P=0.0001), occipital lobe (P=0.014), parietal lobe (P=0.008), cerebellum (P=0.003), parotid gland (P=0.005), submandibular gland (P=0.001), tonsils (P=0.001), thyroid (P=0.0001), lungs (P=0.001), aorta (P=0.001), pulmonary artery (P=0.0001), liver segments I (P=0.005), III (P=0.005), IVB (P=0.03), and V (P=0.01), spleen [hilum (P=0.0009), body (P=0.0001)], pancreas [head (P=0.0001), body (P=0.01), tail (P=0.002)], esophagus (P=0.001), stomach (P=0.0001), duodenum (P=0.0002), large intestine (P=0.008), and rectum (P=0.0001). Elsewhere, no statistical difference was observed. Excreted activity was noted in the kidneys and bladder.This study demonstrates that the visceral localization of C-choline, F-methylcholine, and F-ethylcholine in disease-free patients is similar. Depending on the tracer uptake pattern, the viscera can be divided into two distinct categories: those with a statistically significant difference in uptake and those with no difference in uptake. The study outlines the range of SUVs for various organs for the three tracers and identifies some of the potential pitfalls in the evaluation of 'nonavid' but clinically significant presentation of different disease entities.

Choline

10.1097/mnm.0000000000000372

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Citations (25)