Adalgisa Guerra, doctorate degree in Medicine

The Hospital da Luz radiologist demonstrated the importance of the magnetic resonance examination for staging prostate cancer.

Adalgisa Guerra, Hospital da Luz radiologist, concluded her doctorate degree in Medicine, in the Clinical Research speciality, last March 7, at the Faculty of Medical Sciences / Nova Medical School, Lisbon Nova University. In her thesis - entitled "The impact of multiparametric Magnetic Resonance Imaging (mpMRI) on the staging of prostate cancer patients" -, the physician studied and showed, resorting to models built on data from exams to patients, the importance of magnetic resonance (MR) in the diagnosis and evaluation of prostate cancer extent.

Adalgisa Guerra, who is the coordinator of Hospital da Luz Lisboa Unit of Urogenital Imaging, explains the scope of the research:

• "Prostate cancer is one of the most frequent cancers in men, with an increasing incidence in Europe and the USA. Over the last ten years, its approach has suffered significant alterations, with the implementation of multiparametric MR (mpMRI) as method of diagnosis, prognostic and detection of tumour aggressiveness";
• "However, concerning the staging of this cancer, MR remains under scientific study, not yet globally accepted as test of reference in the local staging of prostate cancer for all patients";
• "In our clinical practice, we strongly believe that MR plays a fundamental role in the differentiation between localized tumours (confined to the prostate) and locally advanced tumours with extra-prostatic extension (EPE). This aspect is essential in the decision as to the therapeutic strategy to apply."

How MR can help differentiate these patients was one of the questions guiding this work, which integrated a longitudinal observation study in patients with this type of tumour and evaluated by MR. To that end, two models were built: a semantic one (interpretation of mpMR) and a radiomics model (built on quantitative data taken from MR imaging).

Among the main conclusions of the thesis, we highlight the following:

• MR is an imaging technique relevant for staging, and it should be performed on every patient before surgery. It can be very accurate in the diagnosis of EPE, even in earlier stages, in combination with a Gleason score of the tumour, reinforcing the confidence of the surgeon in the decision on the surgery to perform.
• The radiomics predictive model, combined with the semantic evaluation, can have a role in the surgical decision, but did not prove to be individually superior to the interpretative model.

The research work of this thesis counted with the support of the Clinical Research Program of Luz Saúde. The advisors of this thesis were Rui Maio (Nova Medical School), Filipe Caseiro Alves (Faculty of Medicine, Coimbra University) and Nikolaos Papanikolaou (Royal Mardsen Hospital, London).

The jury included Diogo Pais (president, of Nova Medical School), Arnaldo Figueiredo (Faculty of Medicine, Coimbra University), Manuela França (ICBAS, Porto), Hugo Marques (Católica Medical School), Rui Maio and Rui Miguel Mateus Marques (Nova Medical School).

In the photo above, the new doctor with some of the members: Diogo Pais, Rui Mateus Marques, Rui Maio, Adalgisa Guerra, Hugo Marques and Manuela França.

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