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Thread: Genetic correlates of PCa visibility (and invisibility) on mpMRI [Comment article]

  1. #1

    Genetic correlates of PCa visibility (and invisibility) on mpMRI [Comment article]

    Added to Topic (C) of the Subforum today:

    Genetic correlates of prostate cancer visibility (and invisibility) on mpMRI: It’s time to take stock [2019, Comment from the UK, Full Text]

    https://onlinelibrary.wiley.com/doi/...1111/bju.14919

    Abstract

    Multiparametric magnetic resonance imaging (mpMRI) has enhanced risk stratification for men at risk of prostate cancer, through accurate pre‐biopsy detection of high‐risk disease [1]. However, it has become apparent that not all clinically significant prostate cancer is detected by mpMRI. Approximately 10‐20% of significant disease is invisible to mpMRI, depending on the threshold set for significance, and on the quality of mpMRI acquisition and interpretation. The threshold for significance has recently been challenged by the 29‐year follow‐up of the SPCG‐4 study, in which men with overall Gleason score 3 + 4 did not suffer prostate‐cancer‐related death [2], whilst those with overall Gleason score 4 + 3 did suffer prostate‐cancer related death (adjusted relative risk 5.73; 95% CI 1.59–20.67) potentially suggesting a new threshold for clinically significant disease. This finding is important, given that in PROMIS, no men with overall Gleason score 4 + 3 had negative pre‐biopsy mpMRI [1], indicating that actually mpMRI may identify all truly significant cancer (if SPCG‐4 is used to guide our threshold). Nonetheless, over the past two years, there has been increasing drive to better understand the nature of mpMRI‐inconspicuous disease, particularly at the molecular level.
    [Emphasis mine]

    See the Full Text of this comment for a discussion of mpMRI-invisible lesions and correlation with genomics, high-risk disease (esp. metastatic castration-resistant prostate cancer), and overall survival.

    The implications of these findings about invisible lesions will be debated. In the meantime, my take-home message is that men having targeted biopsies should insist on having the all the standard zone cores taken in addition to extra cores in mpMRI-identified targets. IMO, studies that conclude biopsies (especially first-time biopsies) can be limited to PIRADS-identified targets are doing a disservice.

    Djin
    Last edited by DjinTonic; 10-18-2019 at 02:46 PM.

  2. #2
    Top User
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    I concur..

  3. #3
    Top User garyi's Avatar
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    Agreed, since I had a supposedly 'invisible' one inch lesion on my prostate wall, that neither 3TmpMRI nor imperfect DaVinci robot eyes could see.

    Note that my targeted biopsy took three cores from all four quadrants, and another 3 or 4, with some overlap, from the suspect area. As Djin recommends, do insist that cores come from all quadrants.
    72...LUTS for the past 7 years
    TURP 2/16,
    G3+4 discovered
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    CIPRO antibiotic = C. Diff infection 7/16
    Cured with Vanco for 14 days
    Second 3T MRI 1/17
    Worsened bulging of posterior capsule
    Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
    Grade Disease 81%, Likelihood of Organ Confined 80%
    RALP 7/13/17 Dr. Gonzaglo @ Univ of Miami
    G3+4 Confirmed, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor still in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    Radiation Procitis, and Ulcerative Colitis flaired after 20 years
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19, .078 5/19, .074 7/19, .081 9/19, .116 11/19
    We'll see....what is not known dwarfs what is thought to be fact

  4. #4
    Thanks for that, Djin. Though I'm just a pup in understanding all this stuff, given the multi-focal nature of PCa it seems logical to me to get all the zones looked at every time they're poking around in there. The proverbial no-brainer in fact.

    Again, I - and all of us to be sure - so greatly appreciate all the research you do!
    Born 1953. All care at Kaiser in LA.

    10/11/18: 2 positive low volume (5-20%) G6 cores out of 12. Prostate vol 33g.
    Jan-June 2019: saw several uros, only initial one recommends treatment: all others AS.
    7/15/19: Dr. Leonard Marks at UCLA: AS. UCLA radiologist finds nothing abnormal in MRI.
    Currently on AS.
    Urolift for BPH 10/21/19

    PSA
    8/2/18: 1.2
    3/26/19: 1.8
    6/14/19: 2.2
    10/18/19: 2.0

    Head and neck cancer 2009: Surgery and 31 days IMRT. NED for 10 years and counting.

  5. #5
    Quote Originally Posted by Skipper Chuck View Post
    Thanks for that, Djin. Though I'm just a pup in understanding all this stuff, given the multi-focal nature of PCa it seems logical to me to get all the zones looked at every time they're poking around in there. The proverbial no-brainer in fact.

    Again, I - and all of us to be sure - so greatly appreciate all the research you do!
    TY -- my pleasure. While a few studies emphasized this point about always adding PIRADS 3-5 areas to the standard TRUS cores, one study did come out in favor of MRI cores only. Of course the hope is that negative imaging would negate the need for a biopsy -- but we aren't there. Also, as I like to point out, a TRUS biopsy isn't exactly "random: cores in each zones; rather, the uro tries to hig any suspicious (darker or "hypoechoic") areas with the biopsy needle. While these areas aren't necessarily cancer, the augmented biopsy acts as "backup" imaging.

    Djin

 

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