A 76-year-old male patient visited the Urology Department after undergoing a blood test and presenting an elevated prostate-specific antigen (PSA) of 7ng/mL, not too high to confirm malignancy, not too low to wait until the next follow-up. Due to the borderline PSA value, a magnetic resonance (MR) examination was indicated to rule out adenocarcinoma or other possible lesions in the prostate gland. A multiparametric prostate MRI protocol was followed acquiring a weighted T2 (T2w), a diffusion-weighted imaging (DWI) and a dynamic contrast-enhanced (DCE).
The radiological report showed a dominant index lesion with a focal T2 signal abnormality located in the right peripheral zone (PZ), and DWI demonstrated restricted diffusion, consistent with a PI-RADS 4 lesion. Regarding the standard blind biopsy, a prostate adenocarcinoma was detected in a total of six cylinders. Therefore, the patient participating in the study had a Gleason Score of 7 (4+3), which means a high risk of clinically significant prostate cancer.
All the above findings were detected using conventional methods and the qualitative radiological reading. The multiparametric prostate MRI reading is a time-consuming task and requires highly specialized knowledge of prostate physiology and pathology. It is only possible sometimes to find radiologists with experience in prostate reading, and even when they do, it still requires a great deal of time to process and analyze the large amount of data acquired. This situation implies significant resource consumption and a delayed action plan for the patient. In this case, the patient had to wait one month to be informed about his diagnosis, then he could start the planned therapy.
Current prostate cancer pathway
Is there a chance to improve and streamline the patient journey?
Quibim’s QP-Prostate® is an FDA 510(k), UKCA, and CE mark-cleared solution integrated into the hospital environment that speeds up the radiological reading process and provides quantitative measurements of the prostate gland. QP-Prostate® performs a multiparametric analysis of the prostate, providing an automated regional organ prostate segmentation, including the Transition + Central Zone (TZ + CZ), the PZ, and the seminal vesicles. This solution is integrated consistently into the Picture Archiving and Communication System (PACS), making prostate MRI readable at many levels in radiology. It was designed to increase accuracy and efficiency by automating post-processing tasks, providing objective measurements, and accelerating the segmentation and reporting times. QP-Prostate® offers a second opinion that could decrease intra- and inter-reader variabilities.
Quibim in current prostate cancer pathway
With the integration of QP-Prostate® solution in that hospital, the clinical flow of this man of 76 years of age would have been reduced by 10-20 days, subsequently, his treatment plan would have started sooner.
QP-Prostate® offers a fundamental change in the analysis of prostate MRI, increasing accuracy and efficiency and speeding up the patient journey.
Figure 1. Representative images from the MR sequences where a) the T2w axial image, b) the DWI sequence and c) the DCE sequence.
Figure 2. T2w MRI with the anatomical segmentation of the prostate gland overlayed (two different anatomical slices). The color map used is red for TZ + CZ, green for PZ and blue for seminal vesicles.
Figure 3. ADC (apparent diffusion coefficient) (a), Ktrans (volume transfer constant from the plasma compartment to the extravascular extracellular space) (b), kep (rate constant for transfer between extravascular space and the blood compartment) (c) and ve (volume of extracellular space per unit volume of tissue) (d) maps automatically calculated and shown as an overlay to the T2w, where red is associated with a high value and blue and purple with a low value.