Abstract
Objectives
We present postprostatectomy pathology results from a series of prostate cancer (Pca)
Gleason grade group ≥2 patients who did not have findings suggestive of cancer on
preoperative pelvic magnetic resonance imaging (MRI).
Methods
We performed an institutional retrospective study of prostate magnetic resonance imaging
(MRI) examinations done from October 2015 to February 2018. We identified patients
who underwent prostatectomy for Pca Gleason ≥3 + 4 diagnosed on prostate biopsy with
no associated MRI findings suggestive of malignancy and analyzed their postprostatectomy
pathologic findings and MRI imaging results.
Results
At our institution, 850 men with Pca received MRI between 2015 and 2018, and 156/850
patients received robotic-assisted radical prostatectomy. Thirty-three patients (33/156 = 21%)
had negative MRI for PIRAD 3 or greater but had a biopsy showing significant Pca.
Their mean (range) age was 62.7 (50-86) years. Their median (interquartile range)
PSA, and PSA density were, 4.6 (3.7) ng/mL and 0.12 (0.05) ng/mL/cm2, respectively; all not significantly different from patients with visible lesions
on MRI who underwent surgery. On post prostatectomy pathology, 27/33 (82%) men had
Pca Gleason score 7 or greater. The most common pattern was infiltrative growth with
cancer glands intermingling between benign glands.
Conclusion
We describe the pathologic and imaging findings in an extensive series of men with
clinically significant Pca with no significant lesions on preoperative MRI. Our results
support the importance of patient counseling on the risk of missing significant Pca
on MRI in isolation from other clinical variables.
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Article info
Publication history
Published online: September 15, 2020
Accepted:
July 20,
2020
Received:
May 12,
2020
Footnotes
Conflicts of interest: None.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
