title: Using imaging biomarkers to improve the planning of radical prostatectomies.
abstract: OBJECTIVE
  This exploratory pilot study aimed to evaluate whether adding imaging biomarkers to conventional staging improves complete excision rates after undergoing radical prostatectomy (RP) in the United Kingdom for patients who have not undergone population prostate specific antigen screening. We primarily considered estimates of lesion volume and location based on computer-aided analysis of ultrasound (US) raw radiofrequency (RF) data acquired during trans-rectal ultrasound. The imaging analysis device used had been shown to accurately detect tumor loci within the prostate in previous studies.
  
  
  METHODS
  US raw RF data were collected from motorized trans-rectal ultrasound of 68 consecutive men with operable prostate cancer. In this cohort (group 1), locations and volume measurements of lesions suspected of harboring cancer on US raw RF data analysis by prostate HistoScanning, were added to conventional presurgical staging.The unexposed control group comprised 100 men who underwent conventional presurgical staging only (group 2): 50 were operated before and 50 operated after group 1 recruitment. Changes to pre-operative surgical planning and positive lateral margins of RP prostate pathological specimens were the primary outcomes. Data were collected using a Microsoft Excel database and analyzed using Stata.
  
  
  RESULTS
  Baseline demographics were comparable. In group 1, consideration of the additional imaging biomarkers led to changes in 27 (19.9%) operative surgical plans. Absolute rate reduction of a positive surgical margin (PSM) attributable to the imaging-biomarkers was 13.3% (P = 0.029). For stage pT3, PSM rate was reduced from 45.8% (n = 44) to 21.2% (n = 11) (P = 0.0028).
  
  
  CONCLUSIONS
  Obtaining quantitative measurements of preoperative imaging biomarkers appears to improve PSM rates of patients undergoing RP. The greatest PSM rate reduction was observed for pT3 tumors.
authors.affiliation: Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Faure Walker
authors.affiliation: Department of Electrical Engineering, Imperial College of Science, Technology and Medicine, London, UK.
authors.forename: Dror
authors.initials: D
authors.lastname: Nir
authors.affiliation: Division of Surgery and Interventional Sciences, University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Simmons
authors.affiliation: Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Sachin
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Imperial College of Science, Technology and Medicine, London, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Chung
authors.affiliation: Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Leminski
authors.affiliation: Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Tina
authors.initials: T
authors.lastname: Rashid
authors.affiliation: Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Altaf
authors.initials: A
authors.lastname: Shamsuddin
authors.affiliation: Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK. Electronic address: Mathias.Winkler@imperial.nhs.uk.
authors.forename: Mathias
authors.initials: M
authors.lastname: Winkler
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000737:chemistry*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D014463:Ultrasonography / Q000379:methods
chemical_list: D014408:Biomarkers, Tumor
keywords: Imaging; Laparoscopic surgery; Prostate cancer; Radical prostatectomy