Imaging for prostate cancer recurrence

Context: Correct identification of metastatic sites in recurrent prostate cancer (PCa) is of crucial importance because it leads to further treatment decisions. Objective: To provide an overview on current imaging procedures and their performance in recurrent PCa. Evidence acquisition: Medline search via PubMed was performed with the keywords imaging, recurrent, and prostate cancer as well as more detailed searches including the keywords bone scan, bone scintigraphy, computed tomography, magnetic resonance imaging, positron emission tomography, PET, choline, FDG, prostate-specific membrane antigen, and PSMA, with emphasis on recent literature from 2010 to the present. Non-English published literature was excluded. Abstracts and full-text articles were reviewed and assessed for relevant content. Evidence synthesis: In diagnostic imaging and particularly with newer technologies like positron emission tomography (PET), a profound lack of prospectively designed studies in recurrent PCa has to be noted. In most studies histologic validation has only been performed in a subset of patient cohorts. Heterogeneity of included patient cohorts, lack of standardized assessment, as well as diverging end points, hamper systematic comparison of different image modalities. Thus evidence for currently used imaging in recurrent PCa is only presented descriptively. Conclusions: Computed tomography and magnetic resonance imaging (MRI) as well as bone scintigraphy still represent the standard imaging for recurrent PCa; however, particularly for detection of local recurrence, multiparametric MRI is a valuable imaging modality. PET using choline and particularly tracers against prostate-specific membrane antigen might improve visualization of metastatic lesions. These findings need to be validated in prospective trials. Patient summary: Imaging of recurrent prostate cancer (PCa) is important to guide further treatment. Computed tomography, magnetic resonance imaging, and bone scintigraphy represent the current standard. Positron emission tomography, especially with cancer-specific tracers, might improve imaging of recurrent PCa in the future. Standard imaging for recurrent prostate cancer includes computed tomography, scintigraphy, and magnetic resonance imaging (MRI). Multiparametric MRI can differentiate local recurrence from residual benign tissue. Positron emission tomography using choline, and particularly tracers against prostate-specific membrane antigen, might improve visualization of metastatic lesions. Validation in prospective trials is required

A proposal of a new nomogram for predicting upstaging in contemporary D'Amico low-risk prostate cancer patients

Unfavorable prostate cancer (PCa) disease at final pathology affects at least 10 % of D'Amico low-risk patients. Thus, conservative therapies including active surveillance may be wrongfully applied. The purposes were to assess the rate of upstaging in a contemporary cohort of D'Amico low-risk PCa patients and to develop and externally validate a nomogram as upstaging prediction tool in two European cohorts. Analyses were restricted to 2007 patients who harbored low-risk PCa at ae10-cores initial biopsy according to D'Amico classification (PSA T2a). Patients underwent radical prostatectomy at a high-volume center in Hamburg, Germany, from 2010 to 2015. The Hamburg cohort was randomly divided into development (n = 1338) and validation cohorts (n = 669). The development cohort was used to devise a nomogram predicting upstaging, defined as presence of aepT3 and/or lymph node invasion. The nomogram was externally validated in two European validation cohorts (Hamburg, n = 669; Milan, n = 465). Upstaging was observed in 187/1338 (14.0 %) of low-risk patients. In multivariable models, four of ten tested variables achieved independent predictor status: age (OR 1.07, 95 % CI 1.04-1.09), PSA (OR 1.21, 95 % CI 1.12-1.31), prostate volume (OR 0.97, 95 % CI 0.96-0.98) and percentage of positive cores (OR 1.02, 95 % CI 1.01-1.03). In external validation, the nomogram demonstrated 70.8 % (Hamburg) and 70.0 % (Milan) accuracy, respectively, with excellent concordance between predicted and observed values. Our proposed nomogram is capable to accurately identify D'Amico low-risk patients at risk of upstaging, utilizing four routinely available clinical variables, age, PSA, prostate volume and percentage of positive biopsy cores. Unfavorable prostate cancer disease at final pathology affects at least 10 % of D'Amico low-risk patients. Thus, we developed and externally validated a new nomogram based on contemporary low-risk prostate cancer patients to accurately identify D'Amico low-risk patients at risk of upstaging. It utilizes four routine variables, age, PSA, prostate volume and percentage of positive biopsy cores

A proposal of a new nomogram for predicting upstaging in contemporary D\u2019Amico low-risk prostate cancer patients

Purpose: Unfavorable prostate cancer (PCa) disease at final pathology affects at least 10 % of D\u2019Amico low-risk patients. Thus, conservative therapies including active surveillance may be wrongfully applied. The purposes were to assess the rate of upstaging in a contemporary cohort of D\u2019Amico low-risk PCa patients and to develop and externally validate a nomogram as upstaging prediction tool in two European cohorts. Methods: Analyses were restricted to 2007 patients who harbored low-risk PCa at 6510-cores initial biopsy according to D\u2019Amico classification (PSA <10.0 ng/ml, Gleason score <7 and clinical stage 64T2a). Patients underwent radical prostatectomy at a high-volume center in Hamburg, Germany, from 2010 to 2015. The Hamburg cohort was randomly divided into development (n = 1338) and validation cohorts (n = 669). The development cohort was used to devise a nomogram predicting upstaging, defined as presence of 65pT3 and/or lymph node invasion. The nomogram was externally validated in two European validation cohorts (Hamburg, n = 669; Milan, n = 465). Results: Upstaging was observed in 187/1338 (14.0 %) of low-risk patients. In multivariable models, four of ten tested variables achieved independent predictor status: age (OR 1.07, 95 % CI 1.04\u20131.09), PSA (OR 1.21, 95 % CI 1.12\u20131.31), prostate volume (OR 0.97, 95 % CI 0.96\u20130.98) and percentage of positive cores (OR 1.02, 95 % CI 1.01\u20131.03). In external validation, the nomogram demonstrated 70.8 % (Hamburg) and 70.0 % (Milan) accuracy, respectively, with excellent concordance between predicted and observed values. Conclusions: Our proposed nomogram is capable to accurately identify D\u2019Amico low-risk patients at risk of upstaging, utilizing four routinely available clinical variables, age, PSA, prostate volume and percentage of positive biopsy cores. Patient summary: Unfavorable prostate cancer disease at final pathology affects at least 10 % of D\u2019Amico low-risk patients. Thus, we developed and externally validated a new nomogram based on contemporary low-risk prostate cancer patients to accurately identify D\u2019Amico low-risk patients at risk of upstaging. It utilizes four routine variables, age, PSA, prostate volume and percentage of positive biopsy cores