Top

Published in:

Open Access 08-08-2022 | Prostate Cancer | Urogenital

Validating the screening criteria for bone metastases in treatment-naïve unfavorable intermediate and high-risk prostate cancer - the prevalence and location of bone- and lymph node metastases

Authors: Erik Rud, Daniyal Noor, Kristina Flor Galtung, Fredrik Ottosson, Maciej Jacewicz, Eduard Baco, Peter Mæhre Lauritzen

Published in: European Radiology | Issue 12/2022

Abstract

Objective

The European Association of Urology (EAU) recommends a bone scan for newly diagnosed unfavorable intermediate- and high-risk prostate cancer. We aimed to validate the screening criteria for bone metastases in patients with treatment-naïve prostate cancer.

Methods

This single-center retrospective study included all patients with treatment-naïve unfavorable intermediate- or high-risk prostate cancer. All underwent MRI of the lumbar column (T2Dixon) and pelvis (3DT2w, DWI, and T2 Dixon). The presence and location of lymph node and bone metastases were registered according to risk groups and radiological (rad) T-stage. The risk of lymph node metastases was assessed by odds ratio (OR).

Results

We included 390 patients, of which 68% were high-risk and 32% were unfavorable intermediate-risk. In the high-risk group, the rate of regional- and non-regional lymph node metastases was 11% and 6%, respectively, and the rate of bone metastases was 10%. In the unfavorable intermediate-risk group, the rate of regional- and non-regional lymph node metastases was 4% and 0.8%, respectively, and the rate of bone metastases was 0.8%. Metastases occurred exclusively in the lumbar column in 0.5% of all patients, in the pelvis in 4%, and the pelvis and lumbar column in 3%. All patients with bone metastases had radT3-4, and patients with radT3-4 showed a four-fold increased risk of lymph node metastases (OR 4.48, 95% CI: 2.1–9.5).

Conclusion

Bone metastases were found in 10% with high-risk prostate cancer and 0.8% with unfavorable intermediate-risk. Therefore, we question the recommendation to screen the unfavorable intermediate-risk group for bone metastases.

Key Points

• The rate of bone metastases was 10% in high-risk patients and 0.8% in the unfavorable intermediate-risk group.

• The rate of lymph-node metastases was 17% in high-risk patients and 5% in the unfavorable intermediate-risk group.

• No bone metastases were seen in radiologically localized disease.

Mottet N, van den Bergh RCN, Briers E et al (2020) EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 79:243–262. https://doi.org/10.1016/j.eururo.2020.09.042CrossRefPubMed

Bubendorf L, Schöpfer A, Wagner U et al (2000) Metastatic patterns of prostate cancer: an autopsy study of 1,589 patients. Hum Pathol 31:578–583. https://doi.org/10.1053/hp.2000.6698CrossRefPubMed

Batson OV (1940) The function of the vertebral veins and their role in the spread of metastases. Ann Surg 112:138–149. https://doi.org/10.1097/00000658-194007000-00016CrossRefPubMedPubMedCentral

Ottosson F, Baco E, Lauritzen PM, Rud E (2020) The prevalence and locations of bone metastases using whole-body MRI in treatment-naïve intermediate- and high-risk prostate cancer. Eur Radiol 31:2747–2753. https://doi.org/10.1007/s00330-020-07363-xCrossRefPubMedPubMedCentral

Woo S, Kim SY, Kim SH, Cho JY (2016) JOURNAL CLUB: Identification of bone metastasis with routine prostate MRI: a study of patients with newly diagnosed prostate cancer. AJR Am J Roentgenol 206:1156–1163. https://doi.org/10.2214/ajr.15.15761CrossRefPubMed

Cumming J, Hacking N, Fairhurst J et al (1990) Distribution of bony metastases in prostatic carcinoma. Br J Urol 66:411–414. https://doi.org/10.1111/j.1464-410x.1990.tb14964.xCrossRefPubMed

Maurer T, Gschwend JE, Rauscher I et al (2015) Diagnostic efficacy of (68)Gallium-PSMA-PET compared to conventional imaging in lymph node staging of 130 consecutive patients with intermediate to high-risk prostate cancer. J Urol 195:1436–1443. https://doi.org/10.1016/j.juro.2015.12.025CrossRefPubMed

Budäus L, Leyh-Bannurah S-R, Salomon G et al (2016) Initial experience of (68)Ga-PSMA PET/CT imaging in high-risk prostate cancer patients prior to radical prostatectomy. Eur Urol 69:393–396. https://doi.org/10.1016/j.eururo.2015.06.010CrossRefPubMed

Gupta M, Choudhury PS, Hazarika D, Rawal S (2017) A comparative study of 68Gallium-prostate specific membrane antigen positron emission tomography-computed tomography and magnetic resonance imaging for lymph node staging in high risk prostate cancer patients: an initial experience. World J Nucl Med 16:186–191. https://doi.org/10.4103/1450-1147.207272CrossRefPubMedPubMedCentral

10.

van Kalmthout L, Braat A, de Keizer B et al (2021) Prospective validation of Gallium-68 prostate specific membrane antigen-positron emission tomography/computerized tomography for primary staging of prostate cancer. Reply. J Urol 205:1839–1840. https://doi.org/10.1097/ju.0000000000001082CrossRefPubMed

11.

Pinaquy J, Clermont-Galleran HD, Pasticier G et al (2015) Comparative effectiveness of [18F]-fluorocholine PET-CT and pelvic MRI with diffusion-weighted imaging for staging in patients with high-risk prostate cancer. Prostate 75:323–331. https://doi.org/10.1002/pros.22921CrossRefPubMed

12.

Heck MM, Souvatzoglou M, Retz M et al (2014) Prospective comparison of computed tomography, diffusion-weighted magnetic resonance imaging and [11C]choline positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer patients. Eur J Nucl Med Mol I 41:694–701. https://doi.org/10.1007/s00259-013-2634-1CrossRef

13.

den Bergh LV, Lerut E, Haustermans K et al (2015) Final analysis of a prospective trial on functional imaging for nodal staging in patients with prostate cancer at high risk for lymph node involvement. Urol Oncol 33:109.e23–109.e31. https://doi.org/10.1016/j.urolonc.2014.11.008CrossRefPubMed

14.

Hövels AM, Heesakkers RAM, Adang EM et al (2008) The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol 63:387–395. https://doi.org/10.1016/j.crad.2007.05.022CrossRefPubMed

15.

Zhou J, Gou Z, Wu R et al (2019) Comparison of PSMA-PET/CT, choline-PET/CT, NaF-PET/CT, MRI, and bone scintigraphy in the diagnosis of bone metastases in patients with prostate cancer: a systematic review and meta-analysis. Skelet Radiol 48:1915–1924. https://doi.org/10.1007/s00256-019-03230-zCrossRef

16.

Shen G, Deng H, Hu S, Jia Z (2014) Comparison of choline-PET/CT, MRI, SPECT, and bone scintigraphy in the diagnosis of bone metastases in patients with prostate cancer: a meta-analysis. Skelet Radiol 43:1503–1513. https://doi.org/10.1007/s00256-014-1903-9CrossRef

17.

Mehralivand S, Shih JH, Harmon S et al (2019) A grading system for the assessment of risk of extraprostatic extension of prostate cancer at multiparametric MRI. Radiology 290:709–719. https://doi.org/10.1148/radiol.2018181278CrossRefPubMed

18.

Purysko AS, Baroni RH, Giganti F et al (2021) PI-RADS Version 2.1: a critical review, from the AJR special series on radiology reporting and data systems. AJR Am J Roentgenol 216:20–32. https://doi.org/10.2214/ajr.20.24495CrossRefPubMed

19.

Turkbey B, Rosenkrantz AB, Haider MA et al (2019) Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2. Eur Urol 76:340–351. https://doi.org/10.1016/j.eururo.2019.02.033CrossRefPubMed

20.

Eurboonyanun K, Pisuchpen N, O’Shea A et al (2021) The absolute tumor-capsule contact length in the diagnosis of extraprostatic extension of prostate cancer. Abdom Radiol (NY):1–11. https://doi.org/10.1007/s00261-021-03063-2

21.

Rud E, Diep L, Baco E (2018) A prospective study evaluating indirect MRI-signs for the prediction of extraprostatic disease in patients with prostate cancer: tumor volume, tumor contact length and tumor apparent diffusion coefficient. World J Urol 36:629–637. https://doi.org/10.1007/s00345-018-2171-4CrossRefPubMed

22.

Rud E, Klotz D, Rennesund K et al (2015) Preoperative magnetic resonance imaging for detecting uni- and bilateral extraprostatic disease in patients with prostate cancer. World J Urol 33:1015–1021. https://doi.org/10.1007/s00345-014-1362-xCrossRefPubMed

23.

Baco E, Rud E, Vlatkovic L et al (2015) Predictive value of magnetic resonance imaging determined tumor contact length for extracapsular extension of prostate cancer. J Urol 193:466–472. https://doi.org/10.1016/j.juro.2014.08.084CrossRefPubMed

24.

Thoeny HC, Froehlich JM, Triantafyllou M et al (2014) Metastases in normal-sized pelvic lymph nodes: detection with diffusion-weighted MR imaging. Radiology 273:125–135. https://doi.org/10.1148/radiol.14132921CrossRefPubMed

25.

Kiss B, Thoeny HC, Studer UE (2016) Current status of lymph node imaging in bladder and prostate cancer. Urology 96:1–7. https://doi.org/10.1016/j.urology.2016.02.014CrossRefPubMed

26.

Maeder Y, Dunet V, Richard R et al (2018) Bone marrow metastases: T2-weighted Dixon spin-echo fat images can replace T1-weighted spin-echo images. Radiology 286:948–959. https://doi.org/10.1148/radiol.2017170325CrossRefPubMed

27.

Vargas HA, Schor-Bardach R, Long N et al (2017) Prostate cancer bone metastases on staging prostate MRI: prevalence and clinical features associated with their diagnosis. Abdom Radiol (New York) 42:271–277. https://doi.org/10.1007/s00261-016-0851-3CrossRef

28.

Larbi A, Omoumi P, Pasoglou V et al (2019) Whole-body MRI to assess bone involvement in prostate cancer and multiple myeloma: comparison of the diagnostic accuracies of the T1, short tau inversion recovery (STIR), and high b-values diffusion-weighted imaging (DWI) sequences. Eur Radiol 29:4503–4513. https://doi.org/10.1007/s00330-018-5796-1CrossRefPubMed

29.

Padhani AR, Lecouvet FE, Tunariu N et al (2017) METastasis Reporting and Data System for Prostate Cancer: practical guidelines for acquisition, interpretation, and reporting of whole-body magnetic resonance imaging-based evaluations of multiorgan involvement in advanced prostate cancer. Eur Urol 71:81–92. https://doi.org/10.1016/j.eururo.2016.05.033CrossRefPubMedPubMedCentral

30.

Abuzallouf S, Dayes I, Lukka H (2004) Baseline staging of newly diagnosed prostate cancer: a summary of the literature. J Urol 171:2122–2127. https://doi.org/10.1097/01.ju.0000123981.03084.06CrossRefPubMed

31.

KandaSwamy GV, Bennett A, Narahari K et al (2017) Establishing the pathways and indications for performing isotope bone scans in newly diagnosed intermediate-risk localised prostate cancer – results from a large contemporaneous cohort. BJU Int 120:E59–E63. https://doi.org/10.1111/bju.13850CrossRefPubMed

32.

McArthur C, McLaughlin G, Meddings RN (2012) Changing the referral criteria for bone scan in newly diagnosed prostate cancer patients. Br J Radiol 85:390–394. https://doi.org/10.1259/bjr/79184355CrossRefPubMedPubMedCentral

33.

O’Sullivan JM, Norman AR, Cook GJ et al (2003) Broadening the criteria for avoiding staging bone scans in prostate cancer: a retrospective study of patients at the Royal Marsden Hospital. BJU Int 92:685–689. https://doi.org/10.1046/j.1464-410x.2003.04480.xCrossRefPubMed

34.

Ayyathurai R, Mahapatra R, Rajasundaram R et al (2006) A study on staging bone scans in newly diagnosed prostate cancer. Urol Int 76:209–212. https://doi.org/10.1159/000091620CrossRefPubMed

35.

Lee JH, Park S (2019) Differentiation of schmorl nodes from bone metastases of the spine: use of apparent diffusion coefficient derived from DWI and fat fraction derived from a Dixon sequence. AJR Am J Roentgenol 213:W228–W235. https://doi.org/10.2214/ajr.18.21003CrossRefPubMed

36.

Donners R, Obmann MM, Boll D et al (2020) Dixon or DWI – comparing the utility of fat fraction and apparent diffusion coefficient to distinguish between malignant and acute osteoporotic vertebral fractures. Eur J Radiol 132:109342. https://doi.org/10.1016/j.ejrad.2020.109342CrossRefPubMed

37.

Liu L-P, Cui L-B, Zhang X-X et al (2015) Diagnostic performance of diffusion-weighted magnetic resonance imaging in bone malignancy. Medicine (Baltimore) 94:e1998. https://doi.org/10.1097/md.0000000000001998CrossRefPubMed

38.

Padhani AR, van Ree K, Collins DJ et al (2013) Assessing the relation between bone marrow signal intensity and apparent diffusion coefficient in diffusion-weighted MRI. AJR Am J Roentgenol 200:163–170. https://doi.org/10.2214/ajr.11.8185CrossRefPubMed

39.

Schmeel FC, Luetkens JA, Enkirch SJ et al (2018) Proton density fat fraction (PDFF) MR imaging for differentiation of acute benign and neoplastic compression fractures of the spine. Eur Radiol 28:5001–5009. https://doi.org/10.1007/s00330-018-5513-0CrossRefPubMed

40.

Kim DH, Yoo HJ, Hong SH et al (2017) Differentiation of acute osteoporotic and malignant vertebral fractures by quantification of fat fraction with a Dixon MRI sequence. AJR Am J Roentgenol 209:1331–1339. https://doi.org/10.2214/ajr.17.18168CrossRefPubMed

41.

Dyrberg E, Hendel HW, Huynh THV et al (2019) 68Ga-PSMA-PET/CT in comparison with 18F-fluoride-PET/CT and whole-body MRI for the detection of bone metastases in patients with prostate cancer: a prospective diagnostic accuracy study. Eur Radiol 29:1221–1230. https://doi.org/10.1007/s00330-018-5682-xCrossRefPubMed

42.

Zacho HD, Nielsen JB, Afshar-Oromieh A et al (2018) Prospective comparison of 68Ga-PSMA PET/CT, 18F-sodium fluoride PET/CT and diffusion weighted-MRI at for the detection of bone metastases in biochemically recurrent prostate cancer. Eur J Nucl Med Mol I 45:1884–1897. https://doi.org/10.1007/s00259-018-4058-4CrossRef

43.

Caglic I, Kovac V, Barrett T (2019) Multiparametric MRI - local staging of prostate cancer and beyond. Radiol Oncol 53:159–170. https://doi.org/10.2478/raon-2019-0021CrossRefPubMedPubMedCentral

44.

de Rooij M, Hamoen EH, Witjes JA et al (2016) Accuracy of magnetic resonance imaging for local staging of prostate cancer: a diagnostic meta-analysis. Eur Urol 70:233–245. https://doi.org/10.1016/j.eururo.2015.07.029CrossRefPubMed

45.

Draulans C, Everaerts W, Isebaert S et al (2019) Impact of magnetic resonance imaging on prostate cancer staging and European Association of Urology Risk Classification. Urology 130:113–119. https://doi.org/10.1016/j.urology.2019.04.023CrossRefPubMed

46.

Hegde JV, Chen MH, Mulkern RV et al (2013) Preoperative 3-Tesla multiparametric endorectal magnetic resonance imaging findings and the odds of upgrading and upstaging at radical prostatectomy in men with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 85:e101–e107. https://doi.org/10.1016/j.ijrobp.2012.08.032CrossRefPubMed

47.

Thoeny HC, Barbieri S, Froehlich JM et al (2017) Functional and targeted lymph node imaging in prostate cancer: current status and future challenges. Radiology 285:728–743. https://doi.org/10.1148/radiol.2017161517CrossRefPubMed

Title: Validating the screening criteria for bone metastases in treatment-naïve unfavorable intermediate and high-risk prostate cancer - the prevalence and location of bone- and lymph node metastases
Authors: Erik Rud
Daniyal Noor
Kristina Flor Galtung
Fredrik Ottosson
Maciej Jacewicz
Eduard Baco
Peter Mæhre Lauritzen
Publication date: 08-08-2022
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Metastasis
Prostate Cancer
Published in: European Radiology / Issue 12/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-022-08945-7

At a glance: The STEP trials

Springer Medicine

Validating the screening criteria for bone metastases in treatment-naïve unfavorable intermediate and high-risk prostate cancer - the prevalence and location of bone- and lymph node metastases

Abstract

Objective

Methods

Results

Conclusion

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Key Points

Please log in to get access to this content

Other articles of this Issue 12/2022

Assessment of main pancreatic duct cutoff with dilatation, but without visible pancreatic focal lesion on MDCT: a novel diagnostic approach for malignant stricture using a CT-based nomogram

Quantitative analysis of enhanced CT in differentiating well-differentiated pancreatic neuroendocrine tumors and poorly differentiated neuroendocrine carcinomas

The value of gadobenate dimeglumine–enhanced biliary imaging from the hepatobiliary phase for predicting post-hepatectomy liver failure in HCC patients

Predicting ultrasound-guided thermal ablation benefit in primary hyperparathyroidism

Temporal assessment of lesion morphology on radiological images beyond lesion volumes—a proof-of-principle study

The role of radiology in addressing the challenge of lung cancer after lung transplantation