Clinical significance and predictors of oncologic outcome after radical prostatectomy for invisible prostate cancer on multiparametric MRI

Abstract

BackgroundThe objective of our study was to evaluate the clinical significance of invisible prostate cancer (iPCa) on multiparametric magnetic resonance imaging (mpMRI) by analyzing clinical parameters and oncologic outcomes.MethodsWe retrospectively reviewed the records of patients treated with radical prostatectomy (RP) from 2010 to 2015 at our institution. Before RP, all patients were confirmed to have prostate cancer based on prostate biopsy. We excluded patients who underwent neoadjuvant therapy. Additionally, we excluded patients who had incomplete mpMRI based on PI-RADS (Prostate Imaging Reporting and Data System). iPCa was defined as having no grade 3 or higher region of interests using a scoring system established by PI-RADS without limitations on interpretation from mpMRI by radiologists. We selected patients with iPCa using this protocol. We analyzed data using univariate and multivariate cox regression analysis, logistic analysis, Kaplan-Meier curves, and receiver operator characteristic curves to predict biochemical recurrence (BCR).ResultsA total of 213 patients with iPCa were selected according to the patient selection protocol. Among them, pathological findings showed that Gleason score (GS) G6, G7 and ≥ G8 were present in 115 cases (54.0%), 78 cases (36.6%), and 20 cases (9.4%), respectively. Further, extracapsular extension (ECE), positive surgical margins (PSM), and lymphovascular invasion (LVI) were present in 28 (13.1%), 18 (8.5%), and 3 cases (1.4%), respectively. Seminal vesicle invasion (SVI) was observed in one case (0.5%). During a median follow-up time of 51 months, BCR was observed 29 cases. Adverse pathology (AP) was defined as GS ≥8, ECE, SVI and LVI. AP and prostate specific antigen (PSA) were significantly associated with BCR. Moreover, PSA > 6.2 ng/ml was suggested as a cut-off value for predicting BCR.ConclusionsIn our results, cases of iPCa had clinically significant PCa, and AP and poor prognosis were also observed in some. Additionally, we found that PSA is the most clinically reliable predictor of oncologic outcome. We suggest that active treatment and diagnosis should be considered for patients with iPCa with PSA > 6.2 ng/ml.

Role of Multiparametric Magnetic Resonance Imaging in Predicting Pathologic Outcomes in Prostate Cancer

“…The results of some studies that compared mpMRI to whole-mount section analysis is shown in Table 2. While sensitivity differs substantially within the cohorts reported here (sensitivities ranging from 74.3% to 100%), an important finding is consistent in all of them, high sensitivity for csPC on a patient basis shows that mpMRI is a relatively reliable pretest before prostate biopsy [16,[27][28][29][30][31][32][33][34]. Equally important with the ongoing discussions on overdetection and overtreatment of PC is the limited sensitivity for low grade PC.…”

“…While this adoption is supported by the high detection rate of MRI-TB and SB, sensitivity on a lesion basis is not comparably high. In recent studies, detection rates on a lesion basis for any PC and csPC vary between 39% to 59% and 56% to 88%, respectively [ 16 27 28 29 30 31 32 33 34 ]. A summary of studies on this issue can be found in Table 2 .…”

Clinical Significance of Multiparametric Magnetic Resonance Imaging as a Preoperative Predictor of Oncologic Outcome in Very Low‐Risk Prostate Cancer

“…Even within the controlled limits PSA and PSA density were statistically significant. As already known, they may be predictors of the powerful oncologic outcome in PCa [16,30]. In addition, the suspicious lesions on mpMRI were also related to the GS upgrade.…”

“…According to the NCCN guidelines, we defined patients with very low-risk PCa as those with cT1c, biopsy GS 6, PSA < 10 ng/mL, presence of disease in fewer than 3 biopsy cores, < 50% PCa involvement in any core, and PSA density < 0.15 ng/mL 2 [9]. Additionally, we reviewed only patients with mpMRI based on the PI-RADS version 2 (PIRADS v2 ) [14], including standardized criteria for Likert scoring of multiparametric sequences (T1-weighted (T1W) and T2-weighted (T2W) imaging, diffusion-weighted imaging (DWI), apparent-diffusion coefficient (ADC), and dynamic contrast enhanced imaging (DCE)) using a 3.0T MRI system (Intera Achieva 3.0T, Phillips Medical System, Best, The Netherlands) [16]. All images were retrospectively reviewed by three experienced uroradiologists, who were blinded to the biopsy results and who conducted a consensus review of the mpMRI images of all patients.…”

Predictive Factors and Oncologic Outcome of Downgrade to Pathologic Gleason Score 6–7 after Radical Prostatectomy in Patients with Biopsy Gleason Score 8–10

“…The clinical characteristics of these patients including age, body mass index (BMI), preoperative PSA levels, prostate volume measured via TRUS, clinical stage on multiparametric magnetic resonance imaging (mpMRI), GS following prostate biopsy, and pathologic characteristics of RP specimens were obtained through a review of medical records. The mpMRI images included standardized criteria for Likert scoring of multiparametric sequences using a 3.0-T MRI system (Intera Achieva 3.0-T, Phillips Medical System, Best, The Netherlands) [16]. All pathologic diagnoses were performed by expert pathologists.…”