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3 - Current clinical issues in prostate cancer that can be addressed by imaging
- Edited by Hedvig Hricak, Peter Scardino
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- Book:
- Prostate Cancer
- Published online:
- 23 December 2009
- Print publication:
- 20 November 2008, pp 29-42
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Summary
Introduction
The role of imaging in the management of prostate cancer has long been controversial, and imaging continues to be both overused and underused. Guidelines are available regarding the use of imaging for the assessment of advanced disease. However, in recent years, imaging technology has matured, image acquisition and interpretation have improved, and a host of clinical studies have demonstrated the potential of imaging for improving other aspects of prostate cancer care, including the detection of local primary or recurrent disease and surgical or radiation treatment planning. This review will discuss the many ways in which imaging can contribute to the evidence-based clinical management of prostate cancer, focusing on the most commonly used cross-sectional imaging modalities: transrectal ultrasound (TRUS), computed tomography (CT), magnetic resonance imaging (MRI), radionuclide bone scanning, positron-emission tomography (PET), and combined PET/CT.
Imaging in diagnosis
Prostate-specific antigen (PSA) testing and digital rectal examination (DRE) continue to be the mainstays of prostate cancer detection. When either of these yields abnormal results, TRUS-guided biopsy is performed. The initial biopsy session will detect cancer in about 29% of patients who undergo biopsy for suspected prostate cancer, depending on the PSA level and DRE results. However, the sensitivity for detection is about 80%–90%, depending on the biopsy scheme used [1, 2]. Cancers missed by systematic transrectal biopsy may be small or located in the anterior part of the gland, an area rarely sampled [3].
Preface
- Edited by Hedvig Hricak, Peter Scardino
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- Book:
- Prostate Cancer
- Published online:
- 23 December 2009
- Print publication:
- 20 November 2008, pp xi-xii
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Summary
Prostate cancer remains the most common internal malignancy in adult men in the western world. While there are many available treatment regimens for prostate cancer, there are few evidence-based guidelines for treatment selection, and the rationale behind common decision practices prior to localized primary or systemic therapy is continuously evolving. Providing optimal treatment selection and the most accurate outcome prediction requires the consideration and synthesis of multiple patient characteristics, which may include demographics (e.g., age, ethnicity), clinical variables (e.g., laboratory values, imaging features), pathologic findings (e.g., stage and grade), and the molecular characteristics of the tumor (e.g., receptor status, gene expression profiling). The multitude of parameters and diversity of expertise required mean that there has been a paradigm shift in the management of patients with prostate cancer, with a multidisciplinary disease management approach becoming more attractive to patients. For the radiologist, understanding the pathophysiology of prostate cancer, the critical clinical issues, and the advantages and limitations of different treatment approaches is essential for meaningful interpretation of imaging studies, be they ultrasound, computed tomography, magnetic resonance imaging or nuclear medicine studies. Similarly, for the practicing clinician, understanding the advantages and limitations of each imaging modality and appreciating the importance of optimal technique are crucial to rational incorporation of imaging studies into the care of the patient with prostate cancer. Promoting the spirit of a multidisciplinary approach, this volume includes detailed descriptions of anatomy, the natural history of prostate cancer, treatment options and imaging modalities.
PAPER STANDARD GAMBLE: A Paper-based Measure of Standard Gamble Utility for Current Health
- Phillip L. Ross, Benjamin Littenberg, Paul Fearn, Peter T. Scardino, Pierre I. Karakiewicz, Michael W. Kattan
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 19 / Issue 1 / January 2003
- Published online by Cambridge University Press:
- 22 January 2003, pp. 135-147
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Objectives: To develop and validate a paper-based instrument that is simple to administer and produces a reliable estimate of patient standard gamble (SG) utilities for current health status.
Methods: A 1-page paper questionnaire instrument, paper standard gamble (PSG), was designed to estimate SG utilities. We performed two studies to assess the validity of PSG. First we compared PSG and SG utilities for current health in patients with prostate cancer. They randomly received either PSG followed by SG or vice versa, always with an intervening SF-12. In the second validity study, we assessed the test-retest reliability of PSG by administering it to prostate cancer patients twice, at least 2 weeks apart.
Results: In the first study, utilities were assessed in 64 men (32 per SG/PSG order group). A paired-comparison t test suggested no difference between SG and PSG (mean difference = −0.007; 95% confidence interval (CI), $-$0.022 to 0.008). The concordance correlation coefficient was 0.92 (95% CI, 0.79 to 0.99). In the second study, test and retest PSGs were available for 184 patients. The concordance correlation coefficient was 0.88 (95% CI, 0.73 to 0.94).
Conclusions: These data suggest that PSG may serve as a reliable substitute for SG when current health utility is of interest. PSG may have particular advantages for acquisition of health-related quality-of-life data in longitudinal studies.