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Prostate Cancer: Diagnosis and evaluation: Difference between revisions

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****'''<span style="color:#ff0000">PI-RADS 5: 72%</span>'''
****'''<span style="color:#ff0000">PI-RADS 5: 72%</span>'''
** Lesions in the peripheral zone appear round or irregular, and are focally hypointense, whereas transition zone lesions are non-circumscribed and moderately hypointense, and may exhibit a characteristic ‘‘erased charcoal’’ sign.
** Lesions in the peripheral zone appear round or irregular, and are focally hypointense, whereas transition zone lesions are non-circumscribed and moderately hypointense, and may exhibit a characteristic ‘‘erased charcoal’’ sign.
* '''<span style="color:#ff0000">MRI in Prostate Cancer</span>'''
* '''<span style="color:#ff00ff">Cochrane Systematic Review and Meta-analysis (2019)</span>'''
** '''<span style="color:#ff00ff">Cochrane Systematic Review and Meta-analysis (2019)</span>'''
**'''MRI compared with template‐guided biopsy'''
***'''MRI compared with template‐guided biopsy'''
***'''Detection of grade 2 or higher prostate cancer'''
****'''Detection of grade 2 or higher prostate cancer'''
****'''Sensitivity: 0.91 (95% CI 0.83 to 0.95)'''
*****'''Sensitivity: 0.91 (95% CI 0.83 to 0.95)'''
****'''Specificity: 0.37 (95% CI 0.29 to 0.46)'''
*****'''Specificity: 0.37 (95% CI 0.29 to 0.46)'''
***'''Detection of grade 3 or higher prostate cancer'''
****'''Detection of grade 3 or higher prostate cancer'''
****'''Sensitivity: 0.95 (95% CI 0.87 to 0.99)'''
*****'''Sensitivity: 0.95 (95% CI 0.87 to 0.99)'''
****'''Specificity: 0.35 (95% CI 0.26 to 0.46)'''
*****'''Specificity: 0.35 (95% CI 0.26 to 0.46)'''
**[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483565/ Drost, Frank‐Jan H., et al.] "Prostate MRI, with or without MRI‐targeted biopsy, and systematic biopsy for detecting prostate cancer." ''Cochrane Database of Systematic Reviews'' 4 (2019).
***[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483565/ Drost, Frank‐Jan H., et al.] "Prostate MRI, with or without MRI‐targeted biopsy, and systematic biopsy for detecting prostate cancer." ''Cochrane Database of Systematic Reviews'' 4 (2019).
*'''<span style="color:#ff0000">Randomized trials evaluating MRI in Prostate Cancer</span>'''
**'''<span style="color:#ff00ff">PROMIS (2017)</span>'''
**'''<span style="color:#ff00ff">PROMIS (2017)</span>'''
*** '''<span style="color:#ff0000">Objective:</span> compare the <span style="color:#ff0000">accuracy of mpMRI</span> with TRUS biopsy to determine the utility of mpMRI as a triage test <span style="color:#ff0000">to decide which men with an elevated PSA may be able to avoid biopsy</span>'''
*** '''<span style="color:#ff0000">Objective:</span> compare <span style="color:#ff0000">accuracy of mpMRI</span> vs. standard TRUS biopsy, with template prostate mapping biopsy as gold standard reference'''
*** '''<span style="color:#ff0000">Population: 576 men with a clinical suspicion of prostate cancer (PSA ≤15 ng/mL)</span>'''
*** <span style="color:#ff0000">Population: 576 men with a clinical suspicion of prostate cancer (elevated serum PSA (up to 15 ng/mL) within previous 3 months, suspicious digital rectal examination, suspected organ confined stage T2 or lower on rectal examination, or family history)</span>
*** '''<span style="color:#ff0000">Intervention: mpMRI followed by standard TRUS biopsy with template prostate mapping biopsy as gold standard reference</span>'''
*** '''<span style="color:#ff0000">Intervention: mpMRI followed by template prostate mapping biopsy as gold standard reference and then standard TRUS biopsy</span>'''
*** '''<span style="color:#ff0000">Results:</span>'''
****Patients with positive mpMRI did not undergo targeted biopsy
**** '''<span style="color:#ff0000">mpMRI displayed a moderate sensitivity</span>''' and negative predictive value for predicting Gleason ≥3+4 disease (88% and 76%, respectively), '''<span style="color:#ff0000">but poor specificity</span>''' and positive predictive value (45% and 65%, respectively).
*** Primary outcomes: sensitivity and specificity of mpMRI vs. standard TRUS biopsy
*** [https://pubmed.ncbi.nlm.nih.gov/28110982/ Ahmed, Hashim U., et al.] "Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study." The Lancet 389.10071 (2017): 815-822.
***'''<span style="color:#ff0000">Results:</span>'''
**** '''<span style="color:#ff0000">mpMRI displayed a moderate sensitivity</span>''' (88%) and negative predictive value (76%), '''<span style="color:#ff0000">but poor specificity</span>''' (45%) and positive predictive value (65%).
***[https://pubmed.ncbi.nlm.nih.gov/28110982/ Ahmed, Hashim U., et al.] "Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study." The Lancet 389.10071 (2017): 815-822.
** '''<span style="color:#ff00ff">PRECISION (2018)</span>'''
** '''<span style="color:#ff00ff">PRECISION (2018)</span>'''
*** Objective: can MRI be used to increase detection of clinically significant prostate cancer and decrease detection of clinically insignificant prostate cancer
*** Objective: can MRI be used to increase detection of clinically significant prostate cancer and decrease detection of clinically insignificant prostate cancer
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