Sensitivity of Prostate Cancer Foci using 1.5 T Multiparametric Magnetic Resonance Imaging

doi:10.21203/rs.3.rs-70151/v1

Download PDF

Research article

Sensitivity of Prostate Cancer Foci using 1.5 T Multiparametric Magnetic Resonance Imaging

https://doi.org/10.21203/rs.3.rs-70151/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background: The detection of prostate cancer (CaP) has increasingly being carried out by multiparametric magnetic resonance imaging (mpMRI). Despite many previous studies, the sensitivity for clinically significant CaP (csCaP) was high, information on mpMRI false-negative lesions is limited. Therefore, the aim of this study was to evaluate the use and limitations of mpMRI in CaP.

Methods: A total of 228 CaP foci in 100 patients who underwent 1.5 T mpMRI and radical prostatectomy between December 2015 and June 2017 were retrospectively analyzed. The sensitivities of CaP foci, csCaP, and index tumors (ITs) were measured. Clinically significant CaP was defined into two categories based on the Gleason score (GS): csCaP/GS ≥3 + 4 (GS ≥3 + 4 or diameter >10 mm) and csCaP/GS ≥4 + 3 (GS ≥4 + 3 or diameter >10 mm). In addition, the characteristics of false-negative lesions were identified. The Prostate Imaging Reporting and Data System version 2 was used to determine an mpMRI positive lesion, defined as a lesion having a score of ≥3.

Results: The sensitivity of all legions, csCaP/GS ≥3 + 4, csCaP/GS ≥4 + 3, and ITs were 61.4%, 75.8%, 83.0%, and 91%, respectively. There were 91 lesions that were mpMRI false, 40% of which were csCaP/GS ≥3 + 4. There were three lesions with a GS of ≥8 and ≥10 mm in the false-negative results.

Conclusions: mpMRI can highly detect ITs and csCaP/GS ≥4 + 3; however, a few large and high-GS CaPs constitute undetectable lesions in 1.5 T mpMRI.

Nuclear Medicine & Medical Imaging

Prostate cancer

Magnetic resonance imaging

Radical prostatectomy

Index tumor

Clinically significant prostate cancer

Prostate cancer (CaP) is the second most prevalent cancer and fifth common cause of cancer death among men worldwide[1]. Currently, CaP is diagnosed using prostate-specific antigen level, digital rectal examination, and transrectal ultrasound-guided systemic biopsy as a standard care. However, overdiagnosis of insignificant CaP and misdiagnosis of clinically significant cancer (csCaP) can result from these strategies.

In recent years, after the emergence of multiparametric magnetic resonance imaging (mpMRI), the use of MRI in CaP has increased considerably. Previously, the capability of prostate MRI, which was assessed using T1- and T2-weighted imaging (T2WI), to detect CaP was limited. However, there have been improvements in the detection of CaP through multiparametric MRI, which combines anatomic T2WI with functional and physiologic assessment, including diffusion-weighted imaging (DWI) and its derivative, apparent-diffusion coefficient, dynamic contrast-enhanced (DCE) MRI, and, sometimes, other techniques such as in vivo magnetic resonance proton spectroscopy[2–16]. However, information on mpMRI false-negative lesions in previous reports is limited, and in most of these studies, 3 T mpMRI was used. Nevertheless, 1.5 T MRI was still used.

Therefore, we aimed to analyze the sensitivities of 1.5 T mpMRI without endorectal coil using radical prostatectomy (RP) specimens. In particular, we examined the details of false-negative lesions.

Patients

Men who underwent RP in Yamagata University Hospital between December 2015 and June 2017 were included in this study. Patients who received androgen deprivation therapy and transurethral resection of prostate before surgery were excluded.

mpMRI

All patients underwent 1.5 T mpMRI without endorectal coil before prostate biopsy. The orientation of the DWI and DCE MRI was the same as for the T2WI. Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) was used to evaluate the images obtained and were scored as follows: 1, clinically significant disease highly unlikely to be present; 2, clinically significant cancer unlikely to be present; 3, the presence of clinically significant cancer is equivocal; 4, clinically significant cancer likely to be present; and 5, clinically significant cancer highly likely to be present[17]. Basically, an mpMRI positive lesion was defined as a lesion with a score of ≥3 in the PI-RADS v2.

Pathological analysis

Whole prostate specimens were fixed in 10% buffered formaldehyde for 48 h, after which the specimens were sectioned perpendicular to the urethra in 4–6-mm serial axial slices and embedded into paraffin (FFPE block). A 5-μm-thick FFPE section was mounted on glass slides and stained with hematoxylin and eosin.

Each major cancer foci was evaluated for Gleason score (GS), largest size (mm), extra-prostatic extension (EPE), and surgical margin (SM). For each patient, up to three foci were always evaluated, but beyond that, minimal lesions were excluded.

IT was defined as a lesion having a maximum foci or a high GS within 5 mm of the maximum, which is considered to reflect mainly the prognosis[18, 19]. Prostate cancer was categorized into two groups: csCaP/GS ≥3 + 4 (GS ≥3 + 4 or diameter >10 mm) and csCaP/GS ≥4 + 3 (GS ≥4 + 3 or diameter >10 mm).

Statistical analyses

Differences were compared using the Welch t test and the Fisher test, and the free statistical software package R version 3.5.2 (https://cran.r-project.org) was used to perform all statistical analyses.

Clinicopathological characteristics

The characteristics of the 100 patients who underwent mpMRI before prostate biopsy and RP (96 robot-assisted and 4 open) are shown in Table 1. The following characteristics were found for the patients (median [range]): age, 67 years (52–78 years); prostate-specific antigen level, 7.14 ng/ml (3.33–28.24 ng/ml); and prostate volume, 36.0 g (19.5–74.0 g). According to National Comprehensive Cancer Network guidelines, of the 100 patients, 11, 60, and 29 were classified into low, intermediate, and poor risk, respectively.

Table 1

Patient characteristics
Number	100
Age, median (range)	67 (52-78)
Prostate-specific antigen, median (range), (ng/ml)	7.14 (3.33-28.24)
Clinical stage, n (%)
cT1c	4
cT2a	33
cT2b	13
cT2c	45
cT3a	4
Surgical approach, n
robotic-assisted	96
open	4
Risk category*, n
low	11
intermediate	60
high	29
Prostate volume, median (range), (g)	36.0 (19.5-74.0)
Pathological stage, n (%)
pT2a	11
pT2b	1
pT2c	47
pT3a	29
pT3b	5
undetectable	7
EPE, n
negative	52
positive	34
undetectable	14
SM, n
negative	66
positive	24
undetectable	10
*Risk Category was assigned according to National Comprehensive Cancer Network guidelines 2016. Abbreviations: EPE; extra-prostatic extension, SM; surgical margin

Data on a total of 228 tumor foci that were detected in tumors in the 100 RP specimens are shown in Table 2. GS was 6 in 94 (41.2%), 3 + 4 in 72 (31.5%), 4 + 3 in 27 (11.8%), and ≥8 in 35 (15.4%) specimens. As for tumor location, 153 (67.1%) and 75 (32.8%) tumors were located in the peripheral and transition zones, respectively. Moreover, positive rates of EPE and SM were higher in IT (n = 100) than in non-IT (n = 128) (p < 0.001) (Table 2).

Table 2

Characteristics of the individual tumor foci on prostatectomy specimen
	All lesions	Index tumor*	Non-index tumor	P value^†
Number	228	100	128
Gleason score, n (%)
6	94 (41.2%)	13 (13.0%)	81 (63.2%)	<0.001
3 + 4	72 (31.5%)	43 (43.0%)	29 (22.6%)	<0.001
3 + 5	3 (1.3%)	3 (3.0%)	0 (0.0%)	0.048
4 + 3	27 (11.8%)	16 (16.0%)	11 (8.7%)	0.085
4 + 4	6 (2.6%)	4 (4.0%)	2 (1.5%)	0.256
4 + 5	19 (8.3%)	16 (16.0%)	3 (2.3%)	0.0015
5 + 3	3 (1.3%)	1 (1.0%)	2 (1.5%)	0.713
5 + 4	4 (1.7%)	4 (4.0%)	0 (0.0%)	0.024
Location, n (%)
Peripheral zone	153 (67.1%)	62 (62.0%)	91 (71.1%)	0.148
Right peripheral zone	83 (36.4%)	33 (33.0%)	50 (39.0%)	0.347
Left peripheral zone	58 (25.4%)	18 (18.0%)	40 (31.2%)	0.031
Both peripheral zone	12 (5.2%)	11 (11.0%)	1 (0.7%)	<0.001
Transitional zone	75 (32.8%)	38 (38.0%)	37 (28.9%)	0.148
Right transitional zone	20 (8.7%)	4 (4.0%)	16 (12.5%)	0.0153
Left transitional zone	28 (12.2%)	9 (9.0%)	19 (14.9%)	0.184
Both transitional zone	27 (11.8%)	25 (25.0%)	2 (1.5%)	<0.001
EPE, n (%)
negative	176 (77.1%)	52 (52.0%)	126 (98.5%)	<0.001
positive	36 (15.7%)	34 (34.0%)	2 (1.5%)	<0.001
undetectable	14 (6.1%)	14 (14.0%)	0 (0.0%)	0.0016
SM, n (%)
negative	192 (84.2%)	66 (66.0%)	126 (98.5%)	<0.001
positive	24 (10.5%)	24 (24.0%)	0 (0.0%)	<0.001
undetectable	12 (5.2%)	10 (10.0%)	2 (1.5%)	0.002
*Index tumor was defined as a lesion having a maximum focus or a high Gleason score within 5 mm of the maximum. ^†Comparing between index tumor and non-index tumor. Abbreviations: EPE; extra-prostatic extension, SM; surgical margin

Sensitivity of mpMRI

The sensitivity of all 228 lesions was 61.4%. The ITs, csCaP/GS ≥4 + 3, diameter >10 mm, and GS ≥8 had relatively high sensitivities (91.0%, 85.3%, 85.7%, and 85.7%, respectively). There lesions with a diameter <10 mm, especially in the specimens with low GS had low sensitivities (diameter <10 mm, diameter <10 mm and GS 6, diameter <10 mm, and GS 3 + 4 had sensitivities of 31.1%, 24.6%, and 31.6%, respectively). Although lesions with a GS of 6 had low sensitivities (36.1%), lesions with a diameter of ≥10 mm were highly detected even in GS 6 (76.2%). Positive EPE and positive SM had relatively high sensitivities as well (91.7% and 79.2%, respectively). Approximately half of the lesions (48.2%) was mpMRI positive lesion. Whereas 72.2% of the lesions with a diameter >10 mm were diagnosed, only 22.0% of the lesions with a diameter of ≤10 mm were diagnosed (Table 3).

Table 3

Sensitivity of multiparametric magnetic resonance imaging for detection of prostatectomy pathology parameters
			Number	Sensitivity
			Number	score ≥3 on PI-RADS v2	score ≥4 on PI-RADS v2
All			228	61.4%	48.2%
Index tumor*			100	91.0%	77.0%
Maximum lesion			100	90.0%	76.0%
csCaP/GS ≥3 + 4^†			157	77.7%	63.1%
csCaP/GS ≥4 + 3^‡			136	85.3%	70.0%
Diameter
	≤5 mm		67	20.8%	11.9%
	>5 mm, ≤10 mm		42	47.6%	38.0%
	>10 mm		119	85.7%	72.2%
Gleason score
	6		94	36.1%	25.5%
	3 + 4		72	64.4%	56.9%
	4 + 3		27	74.0%	62.9%
	≥8		35	85.7%	74.2%
Diameter and Gleason score
	≤10 mm and Gleason score
		6	73	24.6%	15.1%
		3 + 4	19	31.6%	21.1%
		4 + 3	11	54.5%	45.5%
		≥8	6	66.7%	66.7%
	>10 mm and Gleason score
		6	21	76.2%	61.9%
		3 + 4	53	83.0%	69.8%
		4 + 3	16	100.0%	87.5%
		≥8	29	89.7%	75.9%
EPE
	positive		36	91.7%	77.8%
	negative		192	53.6%	42.7%
SM
	positive		24	79.2%	70.8%
	negative		209	57.8%	46.6%
*index tumor was a maximum lesion or a lesion having a high Gleason score within 5 mm length of the maximum. ^†csCaP/GS≥3 + 4; clinically significant prostate cancer (Gleason score ≥3 + 4 or diameter >10 mm), ^‡csCaP/GS≥4 + 3; clinically significant prostate cancer (Gleason score ≥4 + 3 or diameter >10 mm) Abbreviations: EPE; Extra-prostatic extension, SM; surgical margine, PI-RADS v2; Prostate Imaging and Reporting and Data System version 2

Characteristics of mpMRI false-negative lesions

There were 91 (39.9%) mpMRI false-negative lesions, 58 and 33 of which were classified as PI-RADS score 1 and 2, respectively. Surprisingly, 40.7% of mpMRI false-negative lesions were csCaP/GS ≥3 + 4, and 51.5% of score 2 lesions were csCaP/GS ≥4 + 3. Although only five lesions (5.5%) were GS ≥8, three of these had diameters ≥10 mm (Table 4). Of the nine mpMRI false-negative ITs, seven were GS ≤3 + 4; however, two lesions were large and GS 4 + 5 (Table 5).

Table 4

Characteristics of multiparametric magnetic resonance imaging false-negative lesions
	PI-RADS v2 score 1 (58 lesions)	PI-RADS v2 score 2 (33 lesions)	Total (91 lesions)
Index tumor*	3 (5.2%)	6 (18.2%)	9 (9.9%)
csCaP/GS ≥3 + 4^†	17 (29.3%)	20 (34.5%)	37 (40.7%)
csCaP/GS ≥4 + 3^‡	7 (12.1%)	17 (51.5%)	24 (26.4%)
Diameter (mm)
≤5	42 (72.4%)	10 (30.3%)	52 (57.1%)
>5, ≤10	12 (20.7%)	10 (30.3%)	22 (24.2%)
>10	4 (6.9%)	13 (39.4%)	17 (18.7%)
GS
6	44 (75.9%)	15 (45.6%)	59 (64.8%)
3 + 4	10 (17.2%)	12 (36.4%)	22 (24.2%)
4 + 3	2 (3.44%)	3 (9.0%)	5 (5.5%)
≥8	2 (3.44%)	3 (9.0%)	5 (5.5%)
Diameter and Gleason score
≤10 mm and Gleason score
6	41 (70.7%)	13 (39.4%)	54 (59.3%)
3 + 4	10 (17.2%)	3 (9.0%)	13 (14.3%)
4 + 3	2 (3.4%)	3 (9.0%)	5 (5.5%)
≥8	1 (1.7%)	1 (3.0%)	2 (2.2%)
>10 mm and Gleason score
6	3 (5.2%)	2 (6.1%)	5 (5.5%)
3 + 4	0 (0.0%)	9 (27.3%)	9 (9.9%)
4 + 3	0 (0.0%)	0 (0.0%)	0 (0.0%)
≥8	1 (1.7%)	2 (6.1%)	3 (3.3%)
EPE, n (%)
negative	57 (98.2%)	31 (93.9%)	88 (96.7%)
positive	1 (1.8%)	2 (6.1%)	3 (3.3%)
SM, n (%)
negative	57 (98.2%)	29 (87.9%)	86 (94.5%)
positive	1 (1.8%)	4 (12.1%)	5 (5.5%)
*Index tumor was defined as a lesion having a maximal focus or a high Gleason score within 5 mm of the maximum.^†csCaP/GS≥3 + 4; clinically significant prostate cancer (Gleason score ≥3 + 4 or diameter >10 mm),^‡csCaP/GS≥4 + 3; clinically significant prostate cancer (Gleason score ≥4 + 3 or diameter >10 mm) Abbreviation: PI-RADS v2; Prostate Imaging and Reporting and Data System version 2, EPE; extra-prostatic extension, SM; surgical margin

Table 5

Characteristic of magnetic resonance imaging negative lesions in index tumor*
Age (y)	PSA (ng/ml)	PV (g)	Location	PI-RADS v2				GS	EPE	SM	Solitary or multifocal	Diameter (mm)
Age (y)	PSA (ng/ml)	PV (g)	Location	T2WI	DWI	DCE	score	GS	EPE	SM	Solitary or multifocal	Diameter (mm)
70	10.6	67	PZ	4	2	positive	2	4 + 5	negative	negative	multifocal	20
65	4.7	61	PZ	1	1	positive	1	6	negative	negative	multifocal	2
66	5.4	36	PZ	2	2	x	2	3 + 4	positive	positive	multifocal	27
69	4.4	65	TZ	2	2	positive	2	3 + 4	unknown	positive	multifocal	20
64	12.7	70	TZ	1	1	negative	1	6	positive	positive	multifocal	14
67	10.4	31	PZ	3	2	negative	2	4 + 5	positive	positive	multifocal	23
60	10.8	26	TZ	2	3	negative	2	3 + 4	negative	negative	multifocal	17
63	4.8	42	PZ	2	2	negative	2	6	negative	negative	solitary	7
69	8.2	57	TZ	1	1	negative	1	6	negative	negative	solitary	7
*Inndex tumor was defined as a lesion having a maximum foci or a high Gleason score within 5 mm of the maximum. Abbreviations: PSA; prostatate specific antigen, PV; prostate volume, PI-RADS v2; Prostate Imaging and Reporting and Data System version 2, T2WI; T2-weighted imaging, DWI; diffusion weighted imaging, DCE; dynamic constract enhanced, GS; Gleason score, EPE; extra-prostatic extension, SM; surgical margine, PZ; peripheral zone, TZ; transition zone

Sensitivity of pT3

Lesions that were upgraded to pT3 are shown in Table 6. Only four (11.8%) cases of 13 pT3 were diagnosed as cT3 by mpMRI. On the other hand, all pT3 were diagnosed as cT3 by mpMRI.

Table 6

Upgraded lesion to pT3
Clinical Stage	Pathological Stage	number
cT1c	pT3a	3
cT2a	pT3a	5
	pT3b	1
cT2b	pT3a	5
	pT3b	1
cT2c	pT3a	13
	pT3b	2

The overall results of this study are similar to those of previous studies. The sensitivity of all lesions with a PI-RADS score of ≥ 3 was 61.4% in this study and 31–62% in previous studies that used RP specimens (Table 3)[6, 10, 15, 20]. The low sensitivity of all lesions reflects the low sensitivity of small and low-GS lesions. However, even in GS ≥ 8, mpMRI misdiagnosed one-third of the lesions with diameters of ≤ 10 mm. In lesions with GS 3 + 4 and diameter ≤ 10 mm, the sensitivity was only 31.6%, which caused the low sensitivity of csCaP/GS ≥ 3 + 4 (77.7%) (Table 3). Detection rates for csCaP/GS ≥ 3 + 4 (67–75%) in previous studies were similar.

csCaP is usually defined as lesions with GS ≥ 3 + 4 or diameter > 10 mm[21]. However, National Comprehensive Cancer Network guidelines also recommend active surveillance for GS 3 + 4 lesions. In addition, some recent studies have defined GS ≥ 4 + 3 as csCaP[8]. Therefore, we used two types in the analysis of csCaP. Compared with csCaP/GS ≥ 3 + 4, the sensitivity of csCaP/GS ≥ 4 + 3 in this study (85.7%) and in previous studies (91–95%) was relatively high[8] [22] (Table 3).

It has been suggested in recent reports that lesions associated with cancer progression and metastasis could be the largest lesions in prostate or highest GS within 5 mm of maximum, called IT[18] [19]. Focal therapy for limited CaP is rationally based on IT hypothesis. Multiparametric MRI, which might be considered a suitable tool for IT detection, has a high detection rate for IT (91% in this study and 80–91% in the previous studies). Nevertheless, the approximately 10% rate of misdiagnosis needs our attention (Table 3).

Tumors undetected in mpMRI are often characterized as small and multifocal[23]. Ninety-one (39.9%) lesions in this study were mpMRI negative, 67 (73.6%) of which were insignificant cancers (GS ≤ 3 + 4 and ≤ 10 mm) (Table 4). In case of IT, most undiagnosed lesions were multifocal cancers. However, it was surprising that two cases had an IT with ≥ 20 mm and GS 4 + 5. A previous study using mainly 3 T mpMRI mentioned that mpMRI negative lesions could be high GS, but large lesions with a high GS were fully detectable[4]. The intensity of the applied magnetic field may be reason for the missing cases with high-grade and large lesions in our study. In a study by Ulrich et al., the correlation between 1.5 and 3 T within the same patients was reported. This study revealed that comparable objective image quality is revealed by 1.5 T MRI in T2WI but is inferior to 3 T in DWI. The conclusions of the study indicated feasible diagnostic performance even in 1.5 T MRI[24]. However, the inferiority of 1.5 T MRI in DWI might lead to the misdiagnoses in this study.

Positive SM is an important factor that reflects the postoperative outcome[25] [26]. Postoperative functional outcomes, including continence and erectile function, are improved by neurovascular bundle preservation techniques[27] [28], which potentially increase positive SM when neurovascular bundle is preserved on the EPE positive side. Although mpMRI is mainly used to predict EPE before surgery, previous reports have mentioned that the sensitivity of EPE is not enough. A meta-analysis showed a sensitivity of 57% and a specificity of 91% for microscopic EPE[29]. The sensitivity and specificity in this study were only 11.8% and 100%, respectively (Table 6). Positive mpMRI lesions had more positive EPE and SM than mpMRI negative lesions (Table 3).

Several limitations of this study should be mentioned. First, this was a retrospective study. Second, the PI-RADS score was estimated by a single physician. Several studies have revealed that there are diagnostic differences across readers[10, 30]. Third, there could be differences in characteristics between patients who underwent RP in this study and those who underwent other treatments. Fourth, up to three lesions were always evaluated; however, minimal lesions beyond these three were excluded from this analysis.

Detection of IT and csCaP/GS ≥4 + 3 through mpMRI is high; however, large and high-GS CaPs are sometimes undetected in 1.5 T mpMRI.

CaP; prostate cancer, csCaP; clinically significant prostate cancer, MRI; magnetic resonance imaging, mpMRI; multiparametric magnetic resonance imaging, T2WI; T2-weighted imaging, DWI; diffusion-weighted imaging, DCE; dynamic contrast-enhanced, RP; radical prostatectomy, PI-RADS v2; Prostate Imaging Reporting and Data System version 2, GS; Gleason score, EPE; extra-prostatic extension, SM; surgical margin.

Ethics approval and consent to participate

The ethics committee of Yamagata University Faculty of Medicine approved the study (approval no.H28-34). The methods were conducted in accordance with the approved guidelines. All participates in this study have consented to participate with written consent form.

Availability of data and materials

The datasets during and/or analyzed during the current study available from the corresponding author on reasonable request.

Competing interests

The authors declare no conflict of interest.

Funding

None.

Authors’ contributions

SI, SN, TK, and NT participated in the design of the present study. SI drafted the manuscript and figures. SI performed statistical analyses. TN, MY, YK, HK, AY, TS, HN, and TY collected data. SN, TK, and NT participated in the coordination and helped with the drafting of the manuscript. All authors have read and approved the final manuscript.

Acknowledgements

We would like to thank Enago (www.enago.jp) for the English language editing.

Culp MB, Soerjomataram I, Efstathiou JA, Bray F, Jemal A. Recent Global Patterns in Prostate Cancer Incidence and Mortality Rates. Eur Urol 2019.
Turkbey B, Mani H, Shah V, Rastinehad AR, Bernardo M, Pohida T, Pang Y, Daar D, Benjamin C, McKinney YL, et al. Multiparametric 3T prostate magnetic resonance imaging to detect cancer: histopathological correlation using prostatectomy specimens processed in customized magnetic resonance imaging based molds. J Urol. 2011;186(5):1818–24.
Isebaert S, Van den Bergh L, Haustermans K, Joniau S, Lerut E, De Wever L, De Keyzer F, Budiharto T, Slagmolen P, Van Poppel H, et al. Multiparametric MRI for prostate cancer localization in correlation to whole-mount histopathology. J Magn Reson Imaging. 2013;37(6):1392–401.
Bratan F, Niaf E, Melodelima C, Chesnais AL, Souchon R, Mege-Lechevallier F, Colombel M, Rouviere O. Influence of imaging and histological factors on prostate cancer detection and localisation on multiparametric MRI: a prospective study. European radiology. 2013;23(7):2019–29.
Delongchamps NB, Lefevre A, Bouazza N, Beuvon F, Legman P, Cornud F: Detection of significant prostate cancer with magnetic resonance targeted biopsies–should transrectal ultrasound-magnetic resonance imaging fusion guided biopsies alone be a standard of care? J Urol 2015, 193(4):1198–1204.
Le JD, Tan N, Shkolyar E, Lu DY, Kwan L, Marks LS, Huang J, Margolis DJ, Raman SS, Reiter RE. Multifocality and prostate cancer detection by multiparametric magnetic resonance imaging: correlation with whole-mount histopathology. Eur Urol. 2015;67(3):569–76.
Radtke JP, Schwab C, Wolf MB, Freitag MT, Alt CD, Kesch C, Popeneciu IV, Huettenbrink C, Gasch C, Klein T, et al. Multiparametric Magnetic Resonance Imaging (MRI) and MRI-Transrectal Ultrasound Fusion Biopsy for Index Tumor Detection: Correlation with Radical Prostatectomy Specimen. Eur Urol. 2016;70(5):846–53.
Vargas HA, Hotker AM, Goldman DA, Moskowitz CS, Gondo T, Matsumoto K, Ehdaie B, Woo S, Fine SW, Reuter VE, et al. 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. European radiology. 2016;26(6):1606–12.
Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, Margolis D, Schnall MD, Shtern F, Tempany CM, et al. PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. Eur Urol. 2016;69(1):16–40.
Greer MD, Brown AM, Shih JH, Summers RM, Marko J, Law YM, Sankineni S, George AK, Merino MJ, Pinto PA, et al. Accuracy and agreement of PIRADSv2 for prostate cancer mpMRI: A multireader study. J Magn Reson Imaging. 2017;45(2):579–85.
Woo S, Suh CH, Kim SY, Cho JY, Kim SH: Diagnostic Performance of Prostate Imaging Reporting and Data System Version 2 for Detection of Prostate Cancer: A Systematic Review and Diagnostic Meta-analysis. Eur Urol 2017, 72(2):177–188.
Zhang L, Tang M, Chen S, Lei X, Zhang X, Huan Y. A meta-analysis of use of Prostate Imaging Reporting and Data System Version 2 (PI-RADS V2) with multiparametric MR imaging for the detection of prostate cancer. European radiology. 2017;27(12):5204–14.
Borofsky S, George AK, Gaur S, Bernardo M, Greer MD, Mertan FV, Taffel M, Moreno V, Merino MJ, Wood BJ, et al. What Are We Missing? False-Negative Cancers at Multiparametric MR Imaging of the Prostate. Radiology. 2018;286(1):186–95.
Porpiglia F, Checcucci SDEL, Garrou E, Manfredi D, Mele M, Pecoraro F, Passera A, Bollito R, Fiori E. C: Comparing Image-guided targeted Biopsies to Radical Prostatectomy Specimens for Accurate Characterization of the Index Tumor in Prostate Cancer. Anticancer research. 2018;38(5):3043–7.
Girometti R, Giannarini G, Greco F, Isola M, Cereser L, Como G, Sioletic S, Pizzolitto S, Crestani A, Ficarra V, et al. Interreader agreement of PI-RADS v. 2 in assessing prostate cancer with multiparametric MRI: A study using whole-mount histology as the standard of reference. J Magn Reson Imaging. 2019;49(2):546–55.
Kim R, Kim CK, Park JJ, Kim JH, Seo SI, Jeon SS, Lee HM. Prognostic Significance for Long-Term Outcomes Following Radical Prostatectomy in Men with Prostate Cancer: Evaluation with Prostate Imaging Reporting and Data System Version 2. Korean J Radiol. 2019;20(2):256–64.
Barrett T, Turkbey B, Choyke PL. PI-RADS version 2: what you need to know. Clinical radiology. 2015;70(11):1165–76.
Bott SR, Ahmed HU, Hindley RG, Abdul-Rahman A, Freeman A, Emberton M. The index lesion and focal therapy: an analysis of the pathological characteristics of prostate cancer. BJU Int. 2010;106(11):1607–11.
Ahmed HU, Arya M, Freeman A, Emberton M. Do low-grade and low-volume prostate cancers bear the hallmarks of malignancy? Lancet Oncol. 2012;13(11):e509–17.
Truong M, Hollenberg G, Weinberg E, Messing EM, Miyamoto H, Frye TP. Impact of Gleason Subtype on Prostate Cancer Detection Using Multiparametric Magnetic Resonance Imaging: Correlation with Final Histopathology. J Urol 2017.
Ploussard G, Epstein JI, Montironi R, Carroll PR, Wirth M, Grimm MO, Bjartell AS, Montorsi F, Freedland SJ, Erbersdobler A, et al. The contemporary concept of significant versus insignificant prostate cancer. Eur Urol. 2011;60(2):291–303.
Johnson DC, Raman SS, Mirak SA, Kwan L, Bajgiran AM, Hsu W, Maehara CK, Ahuja P, Faiena I, Pooli A, et al: Detection of Individual Prostate Cancer Foci via Multiparametric Magnetic Resonance Imaging. Eur Urol 2018.
Stabile A, Giganti F, Rosenkrantz AB, Taneja SS, Villeirs G, Gill IS, Allen C, Emberton M, Moore CM, Kasivisvanathan V. Multiparametric MRI for prostate cancer diagnosis: current status and future directions. Nature reviews Urology 2019.
Ullrich T, Quentin M, Oelers C, Dietzel F, Sawicki LM, Arsov C, Rabenalt R, Albers P, Antoch G, Blondin D, et al: Magnetic resonance imaging of the prostate at 1.5 versus 3.0T: A prospective comparison study of image quality. Eur J Radiol 2017, 90:192–197.
Yossepowitch O, Bjartell A, Eastham JA, Graefen M, Guillonneau BD, Karakiewicz PI, Montironi R, Montorsi F. Positive surgical margins in radical prostatectomy: outlining the problem and its long-term consequences. Eur Urol. 2009;55(1):87–99.
Roder MA. Radical prostatectomy for clinically localised prostate cancer at Rigshospitalet 1995–2011 - an analysis of surgical and oncological outcome. Danish medical journal. 2013;60(12):B4752.
Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol. 1982;128(3):492–7.
Reeves F, Preece P, Kapoor J, Everaerts W, Murphy DG, Corcoran NM, Costello AJ. Preservation of the neurovascular bundles is associated with improved time to continence after radical prostatectomy but not long-term continence rates: results of a systematic review and meta-analysis. Eur Urol. 2015;68(4):692–704.
de Rooij M, Hamoen EH, Witjes JA, Barentsz JO, Rovers MM: Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis. Eur Urol 2016, 70(2):233–245.
Park SY, Jung DC, Oh YT, Cho NH, Choi YD, Rha KH, Hong SJ, Han K. Prostate Cancer: PI-RADS Version 2 Helps Preoperatively Predict Clinically Significant Cancers. Radiology. 2016;280(1):108–16.

Download PDF

Version 1

posted

You are reading this latest preprint version

Sensitivity of Prostate Cancer Foci using 1.5 T Multiparametric Magnetic Resonance Imaging

Status:

Version 1

Abstract

Background

Methods

Patients

mpMRI

Pathological analysis

Statistical analyses

Results

Clinicopathological characteristics

Sensitivity of mpMRI

Characteristics of mpMRI false-negative lesions

Sensitivity of pT3

Discussion

Conclusions

Abbreviations

Declarations

Ethics approval and consent to participate

Availability of data and materials

Competing interests

Funding

Authors’ contributions

Acknowledgements

References

Status:

Version 1