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European Radiology
Published in: European Radiology 10/2016

01-10-2016 | Urogenital

PI-RADS version 2 for prediction of pathological downgrading after radical prostatectomy: a preliminary study in patients with biopsy-proven Gleason Score 7 (3+4) prostate cancer

Authors: Sungmin Woo, Sang Youn Kim, Joongyub Lee, Seung Hyup Kim, Jeong Yeon Cho

Published in: European Radiology | Issue 10/2016

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Abstract

Objectives

To evaluate PI-RADSv2 for predicting pathological downgrading after radical prostatectomy (RP) in patients with biopsy-proven Gleason score (GS) 7(3+4) PC.

Methods

A total of 105 patients with biopsy-proven GS 7(3+4) PC who underwent multiparametric prostate MRI followed by RP were included. Two radiologists assigned PI-RADSv2 scores for each patient. Preoperative clinicopathological variables and PI-RADSv2 scores were compared between patients with and without downgrading after RP using the Wilcoxon rank sum test or Fisher’s exact test. Logistic regression analyses with Firth’s bias correction were performed to assess their association with downgrading.

Results

Pathological downgrading was identified in ten (9.5 %) patients. Prostate-specific antigen (PSA), PSA density, percentage of cores with GS 7(3+4), and greatest percentage of core length (GPCL) with GS 7(3+4) were significantly lower in patients with downgrading (p = 0.002-0.037). There was no significant difference in age and clinical stage (p = 0.537-0.755). PI-RADSv2 scores were significantly lower in patients with downgrading (3.8 versus 4.4, p = 0.012). At univariate logistic regression analysis, PSA, PSA density, and PI-RADSv2 scores were significant predictors of downgrading (p = 0.003-0.022). Multivariate analysis revealed only PSA density and PI-RADSv2 scores as independent predictors of downgrading (p = 0.014-0.042).

Conclusions

The PI-RADSv2 scoring system was an independent predictor of pathological downgrading after RP in patients with biopsy-proven GS 7(3+4) PC.

Key points

• PI-RADSv2 was an independent predictor of downgrading in biopsy-proven GS 7(3+4) PC
• PSA density was also an independent predictor of downgrading
• MRI may assist in identifying AS candidates in biopsy-proven GS 7(3+4) PC patients
Literature
1.
Albertsen PC, Hanley JA, Fine J (2005) 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA 293:2095–2101CrossRefPubMed
2.
Eggener SE, Mueller A, Berglund RK et al (2013) A multi-institutional evaluation of active surveillance for low risk prostate cancer. J Urol 189:S19–S25CrossRefPubMed
3.
Tosoian JJ, Trock BJ, Landis P et al (2011) Active surveillance program for prostate cancer: an update of the Johns Hopkins experience. J Clin Oncol 29:2185–2190CrossRefPubMed
4.
Lawrentschuk N, Klotz L (2011) Active surveillance for low-risk prostate cancer: an update. Nat Rev Urol 8:312–320CrossRefPubMed
5.
Cooperberg MR, Cowan JE, Hilton JF et al (2011) Outcomes of active surveillance for men with intermediate-risk prostate cancer. J Clin Oncol 29:228–234CrossRefPubMed
6.
Bul M, van den Bergh RC, Zhu X et al (2012) Outcomes of initially expectantly managed patients with low or intermediate risk screen-detected localized prostate cancer. BJU Int 110:1672–1677CrossRefPubMed
7.
Djavan B, Ravery V, Zlotta A et al (2001) Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: when should we stop? J Urol 166:1679–1683CrossRefPubMed
8.
Gondo T, Hricak H, Sala E et al (2014) Multiparametric 3T MRI for the prediction of pathological downgrading after radical prostatectomy in patients with biopsy-proven Gleason score 3+4 prostate cancer. Eur Radiol 24:3161–3170CrossRefPubMed
9.
Epstein JI, Feng Z, Trock BJ, Pierorazio PM (2012) Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades. Eur Urol 61:1019–1024CrossRefPubMedPubMedCentral
10.
Gondo T, Poon BY, Matsumoto K, Bernstein M, Sjoberg DD, Eastham JA (2015) Clinical role of pathological downgrading after radical prostatectomy in patients with biopsy confirmed Gleason score 3+4 prostate cancer. BJU Int 115:81–86CrossRefPubMed
11.
12.
13.
Muller BG, Shih JH, Sankineni S et al (2015) Prostate cancer: interobserver agreement and accuracy with the revised prostate imaging reporting and data system at multiparametric MR imaging. Radiology. doi:10.​1148/​radiol.​2015142818:​142818
14.
Vargas HA, Hotker AM, Goldman DA et al (2015) Updated prostate imaging reporting and data system (PIRADS v2) recommendations for the detection of clinically significant prostate cancer using multiparametric MRI: critical evaluation using whole-mount pathology as standard of reference. Eur Radiol. doi:10.​1007/​s00330-015-4015-6 PubMedCentral
15.
Bjurlin MA, Carter HB, Schellhammer P et al (2013) Optimization of initial prostate biopsy in clinical practice: sampling, labeling and specimen processing. J Urol 189:2039–2046CrossRefPubMedPubMedCentral
16.
Firth D (1993) Bias reduction of maximum likelihood estimates. Biometrika 80:27–38CrossRef
17.
Paul P, Pennell ML, Lemeshow S (2013) Standardizing the power of the Hosmer-Lemeshow goodness of fit test in large data sets. Stat Med 32:67–80CrossRefPubMed
18.
Ross HM, Kryvenko ON, Cowan JE, Simko JP, Wheeler TM, Epstein JI (2012) Do adenocarcinomas of the prostate with Gleason score (GS) </=6 have the potential to metastasize to lymph nodes? Am J Surg Pathol 36:1346–1352CrossRefPubMedPubMedCentral
19.
Ellis CL, Walsh PC, Partin AW, Epstein JI (2013) Multiple cores of Gleason score 6 correlate with favourable findings at radical prostatectomy. BJU Int 111:E306–E309CrossRefPubMedPubMedCentral
20.
Mullins JK, Feng Z, Trock BJ, Epstein JI, Walsh PC, Loeb S (2012) The impact of anatomical radical retropubic prostatectomy on cancer control: the 30-year anniversary. J Urol 188:2219–2224CrossRefPubMed
21.
Pan CC, Potter SR, Partin AW, Epstein JI (2000) The prognostic significance of tertiary Gleason patterns of higher grade in radical prostatectomy specimens: a proposal to modify the Gleason grading system. Am J Surg Pathol 24:563–569CrossRefPubMed
22.
Hricak H, Choyke PL, Eberhardt SC, Leibel SA, Scardino PT (2007) Imaging prostate cancer: a multidisciplinary perspective. Radiology 243:28–53CrossRefPubMed
23.
Woo S, Cho JY, Kim SY, Kim SH (2015) Extracapsular extension in prostate cancer: added value of diffusion-weighted MRI in patients with equivocal findings on T2-weighted imaging. AJR Am J Roentgenol 204:W168–W175CrossRefPubMed
24.
Kosaka T, Mizuno R, Shinojima T et al (2014) The implications of prostate-specific antigen density to predict clinically significant prostate cancer in men </= 50 years. Am J Clin Exp Urol 2:332–336PubMedPubMedCentral
25.
Woo S, Cho JY, Kim SY, Kim SH (2015) Periprostatic fat thickness on MRI: correlation with Gleason score in prostate cancer. AJR Am J Roentgenol 204:W43–W47CrossRefPubMed
26.
Gancarczyk KJ, Wu H, McLeod DG et al (2003) Using the percentage of biopsy cores positive for cancer, pretreatment PSA, and highest biopsy Gleason sum to predict pathologic stage after radical prostatectomy: the Center for Prostate Disease Research nomograms. Urology 61:589–595CrossRefPubMed
27.
Chang DT, Challacombe B, Lawrentschuk N (2013) Transperineal biopsy of the prostate—is this the future? Nat Rev Urol 10:690–702CrossRefPubMed
Metadata
Title
PI-RADS version 2 for prediction of pathological downgrading after radical prostatectomy: a preliminary study in patients with biopsy-proven Gleason Score 7 (3+4) prostate cancer
Authors
Sungmin Woo
Sang Youn Kim
Joongyub Lee
Seung Hyup Kim
Jeong Yeon Cho
Publication date
01-10-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 10/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4230-9

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