ABSTRACT
OBJECTIVE
To evaluate the association between apparent diffusion coefficient (ADC) on initial
multiparametric MRI (mpMRI) and biopsy grade reclassification (GR) to grade group
(GG) ≥2 prostate cancer (CaP) in men on active surveillance (AS) with GG 1 CaP.
METHODS
We retrospectively identified 242 AS patients with reported ADC values on their initial
mpMRI. ADC value from the index lesion was assessed as an independent predictor of
GR using a Cox model. To ease clinical interpretation, we used a log-rank test to
establish an ADC cutoff of 1128 × 10−6 mm2/s for Kaplan-Meier analysis.
RESULTS
Of the 242 men, 70 underwent GR following initial mpMRI, of which 26 (37%) had GR
at the index lesion. There was no significant difference in the median interval between
biopsies for men with and without GR (P >.9). Men with GR had significantly lower median ADC than those without GR (P = .01). In multivariable analysis adjusting for age, prostate-specific antigen density,
and National Comprehensive Cancer Network risk group, a 100-unit decrease in ADC was
associated with a 12% increase in the risk of GR (HR = 1.12, 95% CI: 1.01–1.22, P = .03). Two- and 4-year rates of freedom from GR were significantly lower for men
with ADC <1128 × 10−6 mm2/s vs ADC ≥1128 × 10−6 mm2/s (62% and 42% vs 78% and 68%, respectively; P <.001).
CONCLUSION
For AS patients, lower ADC on initial mpMRI index lesion is associated with increased
risk of GR to GG ≥2 CaP and would be a useful component of multivariable risk prediction
tools.
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Article info
Publication history
Published online: January 15, 2020
Accepted:
January 2,
2020
Received:
September 13,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
