Identification of the prostate cancer index lesion by real-time elastography: considerations for focal therapy of prostate cancer

Springer Science and Business Media LLC - Tập 29 - Trang 589-594 - 2011
Jochen Walz1, Myriam Marcy2, Jeanne Thomassin Pianna2, Serge Brunelle3, Gwenaelle Gravis4, Naji Salem5, Franck Bladou6
1Department of Urology, Institut Paoli-Calmettes, Marseille, France
2Department of Pathology, Institut Paoli-Calmettes, Marseille, France
3Department of Radiology, Institut Paoli-Calmettes, Marseille, France
4Department of Oncology, Institut Paoli-Calmettes, Marseille, France
5Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France
6Department of Urology, Jewish Hospital, Montreal, Canada

Tóm tắt

Focal therapy of prostate cancer is gaining more and more interest. One of the drawbacks of focal therapy of prostate cancer is the problem of correct identification of prostate cancer lesions. The aim of the study was to evaluate the ability of real-time elastography to correctly identify the prostate cancer index lesion. In 32 patients, real-time elastography was performed the day before prostatectomy. During the examination, the location of the main lesion suspicious for prostate cancer was prospectively recorded. Moreover, the results of the randomized multicore biopsies were also used to predict the location of the index lesion. The preoperative elastography results, the biopsy results, and a combined use of elastography and biopsy results were then compared with the pathological results to calculate the diagnostic values for correct index lesion identification. When using real-time elastography alone to identify the prostate cancer index lesion, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 58.8, 43.3, 54.1, 48.1, and 51.6%, respectively. Data from randomized biopsies alone achieved 67.8, 48.4, 56.8, 60.0, and 58.1%, respectively. The combination of elastography and biopsy data increased the values to, respectively, 84.9, 48.4, 61.9, 75.0, and 66.1%. In this study, real-time elastography alone did not allow to identify the prostate cancer index lesion with satisfactory reliability. The combination of real-time elastography and data from randomized 12 core biopsies allows promising ability to correctly identify the prostate cancer index lesion.

Tài liệu tham khảo

Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M, Guazzoni G, Guillonneau B, Menon M, Montorsi F, Patel V, Rassweiler J, Van Poppel H (2009) Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 55(5):1037–1063 Michl UH, Friedrich MG, Graefen M, Haese A, Heinzer H, Huland H (2006) Prediction of postoperative sexual function after nerve sparing radical retropubic prostatectomy. J Urol 176(1):227–231 Heidenreich A, Aus G, Bolla M, Joniau S, Matveev VB, Schmid HP, Zattoni F (2008) EAU guidelines on prostate cancer. Eur Urol 53(1):68–80 Ward JF (2010) Contemporary outcomes of focal therapy in prostate cancer: what do we know so far. World J Urol 28(5):593–597 Lindner U, Lawrentschuk N, Trachtenberg J (2010) Image guidance for focal therapy of prostate cancer. World J Urol 28(6):727–734 Ahmed HU (2009) The index lesion and the origin of prostate cancer. N Engl J Med 361(17):1704–1706 Pallwein L, Mitterberger M, Struve P, Pinggera G, Horninger W, Bartsch G, Aigner F, Lorenz A, Pedross F, Frauscher F (2007) Real-time elastography for detecting prostate cancer: preliminary experience. BJU Int 100(1):42–46 Salomon G, Kollerman J, Thederan I, Chun FK, Budaus L, Schlomm T, Isbarn H, Heinzer H, Huland H, Graefen M (2008) Evaluation of prostate cancer detection with ultrasound real-time elastography: a comparison with step section pathological analysis after radical prostatectomy. Eur Urol 54(6):1354–1362 Tsutsumi M, Miyagawa T, Matsumura T, Kawazoe N, Ishikawa S, Shimokama T, Shiina T, Miyanaga N, Akaza H (2007) The impact of real-time tissue elasticity imaging (elastography) on the detection of prostate cancer: clinicopathological analysis. Int J Clin Oncol 12(4):250–255 Sumura M, Shigeno K, Hyuga T, Yoneda T, Shiina H, Igawa M (2007) Initial evaluation of prostate cancer with real-time elastography based on step-section pathologic analysis after radical prostatectomy: a preliminary study. Int J Urol 14(9):811–816 Konig K, Scheipers U, Pesavento A, Lorenz A, Ermert H, Senge T (2005) Initial experiences with real-time elastography guided biopsies of the prostate. J Urol 174(1):115–117 Frota R, Stein RJ, Turna B, Kamoi K, Lin YC, Magi-Galluzzi C, Aron M, Gill IS (2009) Are prostate needle biopsies predictive of the laterality of significant cancer and positive surgical margins? BJU Int 104(11):1599–1603 McNeal JE, Villers AA, Redwine EA, Freiha FS, Stamey TA (1990) Capsular penetration in prostate cancer. Significance for natural history and treatment. Am J Surg Pathol 14(3):240–247 Sartor AO, Hricak H, Wheeler TM, Coleman J, Penson DF, Carroll PR, Rubin MA, Scardino PT (2008) Evaluating localized prostate cancer and identifying candidates for focal therapy. Urology 72(6 Suppl):S12–S24 Wise AM, Stamey TA, McNeal JE, Clayton JL (2002) Morphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens. Urology 60(2):264–269 Bott SR, Ahmed HU, Hindley RG, Abdul-Rahman A, Freeman A, Emberton M (2010) The index lesion and focal therapy: an analysis of the pathological characteristics of prostate cancer. BJU Int 106(11):1607–1611 Karavitakis M, Winkler M, Abel P, Livni N, Beckley I, Ahmed HU (2011) Histological characteristics of the index lesion in whole-mount radical prostatectomy specimens: implications for focal therapy. Prostate Cancer Prostatic Dis 14(1):46–52 Aihara M, Wheeler TM, Ohori M, Scardino PT (1994) Heterogeneity of prostate cancer in radical prostatectomy specimens. Urology 43(1):60–66 discussion 66–67 Ward JF, Nakanishi H, Pisters L, Babaian RJ, Troncoso P (2009) Cancer ablation with regional templates applied to prostatectomy specimens from men who were eligible for focal therapy. BJU Int 104(4):490–497 Puech P, Potiron E, Lemaitre L, Leroy X, Haber GP, Crouzet S, Kamoi K, Villers A (2009) Dynamic contrast-enhanced-magnetic resonance imaging evaluation of intraprostatic prostate cancer: correlation with radical prostatectomy specimens. Urology 74(5):1094–1099