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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prostate magnetic resonance imaging interpretation varies substantially across radiologists.Eur Urol Focus. 2019; 5: 592-599
- Variability of the positive predictive value of PI-RADS for prostate MRI across 26 centers: experience of the society of abdominal radiology prostate cancer disease-focused panel.Radiology. 2020; 296: 76-84
- 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. 2016; 26: 1606-1612
- Accuracy of multiparametric MRI for prostate cancer detection: a meta-analysis.AJR Am J Roentgenol. 2014; 202: 343-351
- The diagnostic Performance of multiparametric magnetic resonance imaging to detect significant prostate cancer.J Urol. 2016; 195: 1428-1435
- AUA policy statement on the use of multiparametric magnetic resonance imaging in the diagnosis, staging and management of prostate cancer.J Urol. 2017; 198: 832-838
- Confirmatory magnetic resonance imaging with or without biopsy impacts decision making in newly diagnosed favorable risk prostate cancer.J Urol. 2019; 201: 923-928
- Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: the role of systematic and targeted biopsies.Cancer. 2016; 122: 884-892
- Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study.Lancet. 2017; 389: 815-822
- MRI-targeted or standard biopsy for prostate-cancer diagnosis.N Engl J Med. 2018; 378: 1767-1777
- How many cores should be obtained during saturation biopsy in the era of multiparametric magnetic resonance? xperience in 875 patients submitted to repeat prostate biopsy.Urology. 2020; 137: 133-137
- Can MRI/TRUS fusion targeted biopsy replace saturation prostate biopsy in the re-evaluation of men in active surveillance?.World J Urol. 2016; 34: 1249-1253
- The use of multiparametric magnetic resonance imaging for follow-up of patients included in active surveillance protocol. can PSA density discriminate patients at different risk of reclassification?.Clin Genitourin Cancer. 2020; https://doi.org/10.1016/j.clgc.2020.04.006
- Correlation between MRI phenotypes and a genomic classifier of prostate cancer: preliminary findings.Eur Radiol. 2019; 29: 4861-4870
- Characteristics of detected and missed prostate cancer foci on 3-T multiparametric MRI using an endorectal coil correlated with whole-mount thin-section histopathology.AJR Am J Roentgenol. 2015; 205: W87-W92
- Characterization and PI-RADS version 2 assessment of prostate cancers missed by prebiopsy 3-T multiparametric MRI: Correlation with whole-mount thin-section histopathology.Clin Imaging. 2019; 55: 174-180
- Clinical significance and predictors of oncologic outcome after radical prostatectomy for invisible prostate cancer on multiparametric MRI.BMC Cancer. 2018; 18: 1057
- Detection of individual prostate cancer foci via multiparametric magnetic resonance imaging.Eur Urol. 2019; 75: 712-720
- Impact of post prostate biopsy hemorrhage on multiparametric magnetic resonance imaging.Can J Urol. 2015; 22: 7698-7702
- The optimal timing of post-prostate biopsy magnetic resonance imaging to guide nerve-sparing surgery.Asian J Androl. 2014; 16: 280-284
- Multifocality and prostate cancer detection by multiparametric magnetic resonance imaging: correlation with whole-mount histopathology.Eur Urol. 2015; 67: 569-576
- False positive and false negative diagnoses of prostate cancer at multi-parametric prostate MRI in active surveillance.Insights Imaging. 2015; 6: 449-463
- Molecular hallmarks of multiparametric magnetic resonance imaging visibility in prostate cancer.Eur Urol. 2019; 76: 18-23
- Biologic significance of magnetic resonance imaging invisibility in localized prostate cancer.JCO Precision Oncol. 2019;; : 1-12
- Prostate magnetic resonance imaging interpretation varies substantially across radiologists.Eur Urol Focus. 2017; 5: 592-599
- Prostate magnetic resonance imaging: the truth lies in the eye of the beholder.Urol Oncol. 2018; 36: 159.e1-159.e5
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.
