Skip to main content

Advertisement

Log in

Prostatic ductal adenocarcinoma: an aggressive tumour variant unrecognized on T2 weighted magnetic resonance imaging (MRI)

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Introduction

Prostatic ductal adenocarcinoma (DCa) is an aggressive variant. The purpose of this study was to determine if T2 signal intensity (SI) differs from conventional adenocarcinoma (CCa).

Materials and methods

A retrospective study of patients who underwent preoperative MRI and prostatectomy between 2009 and 2012 was performed. T2 SI ratios (SIR) for tumour (T) to obturator internus muscle (M) and normal peripheral zone (PZ) were compared. Two radiologists evaluated the central gland/PZ to detect tumours and compared diagnostic accuracy.

Results

T2 SIR for DCa were 3.60 (T/M), 0.66 (T/PZ); 2.68 (T/M), 0.47 (T/PZ) for Gleason 9; 2.50 (T/M), 0.47 (T/PZ) for Gleason 7/8 and 3.95 (T/M), 0.73 (T/PZ) for Gleason 6 tumours. There was a difference in T2 T/M and T/PZ SIR between DCa and Gleason 9 (p = 0.003, p = 0.004) and Gleason 7/8 (p = 0.006, p = 0.002), but no difference in SIR between DCa and Gleason 6 tumours. The sensitivity for tumour detection was 0–27 % for DCa, 64–82 % for Gleason 9, 44–88 % for Gleason 7–8 and 0–20 % for Gleason 6. There was a difference in the sensitivity of detecting Gleason 9 and 7/8 tumours when compared to DCa (p = 0.004, p = 0.001).

Conclusions

DCa resembles Gleason score 6 tumour at T2-weighted MRI, which underestimates tumour grade and renders the tumour occult.

Key Points

Prostatic ductal adenocarcinoma is aggressive, resembling endometrial carcinoma at histopathology.

Prostatic ductal adenocarcinoma resembles Gleason score 6 tumour at T2-weighted MRI.

MRI grading may underestimate ductal adenocarcinoma based on increased T2 signal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Dube VE, Farrow GM, Greene LF (1973) Prostatic adenocarcinoma of ductal origin. Cancer 32:402–409

    Article  CAS  PubMed  Google Scholar 

  2. Bostwick DG, Kindrachuk RW, Rouse RV (1985) Prostatic adenocarcinoma with endometrioid features. Clinical, pathologic, and ultrastructural findings. Am J Surg Pathol 9:595–609

    Article  CAS  PubMed  Google Scholar 

  3. Brinker DA, Potter SR, Epstein JI (1999) Ductal adenocarcinoma of the prostate diagnosed on needle biopsy: correlation with clinical and radical prostatectomy findings and progression. Am J Surg Pathol 23:1471–1479

    Article  CAS  PubMed  Google Scholar 

  4. Epstein JI, Woodruff JM (1986) Adenocarcinoma of the prostate with endometrioid features. A light microscopic and immunohistochemical study of ten cases. Cancer 57:111–119

    Article  CAS  PubMed  Google Scholar 

  5. Lemberger RJ, Bishop MC, Bates CP, Blundell W, Ansell ID (1984) Carcinoma of the prostate of ductal origin. Br J Urol 56:706–709

    Article  CAS  PubMed  Google Scholar 

  6. Orihuela E, Green JM (2008) Ductal prostate cancer: contemporary management and outcomes. Urol Oncol 26:368–371

    Article  PubMed  Google Scholar 

  7. Humphrey PA (2012) Histological variants of prostatic carcinoma and their significance. Histopathology 60:59–74

    Article  PubMed  Google Scholar 

  8. Morgan TM, Welty CJ, Vakar-Lopez F, Lin DW, Wright JL (2010) Ductal adenocarcinoma of the prostate: increased mortality risk and decreased serum prostate specific antigen. J Urol 184:2303–2307

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Claus FG, Hricak H, Hattery RR (2004) Pretreatment evaluation of prostate cancer: role of MR imaging and 1H MR spectroscopy. Radiographics 24:S167–S180

    Article  PubMed  Google Scholar 

  10. Jung AJ, Westphalen AC (2012) Imaging prostate cancer. Radiol Clin N Am 50:1043–1059

    Article  PubMed  Google Scholar 

  11. Soylu FN, Eggener S, Oto A (2012) Local staging of prostate cancer with MRI. Diagn Interv Radiol 18:365–373

    PubMed  Google Scholar 

  12. Haider MA, van der Kwast TH, Tanguay J et al (2007) Combined T2-weighted and diffusion-weighted MRI for localization of prostate cancer. AJR Am J Roentgenol 189:323–328

    Article  PubMed  Google Scholar 

  13. Lim HK, Kim JK, Kim KA, Cho KS (2009) Prostate cancer: apparent diffusion coefficient map with T2-weighted images for detection—a multireader study. Radiology 250:145–151

    Article  PubMed  Google Scholar 

  14. Mazaheri Y, Hricak H, Fine SW et al (2009) Prostate tumor volume measurement with combined T2-weighted imaging and diffusion-weighted MR: correlation with pathologic tumor volume. Radiology 252:449–457

    Article  PubMed Central  PubMed  Google Scholar 

  15. Vargas HA, Akin O, Franiel T et al (2011) Diffusion-weighted endorectal MR imaging at 3 T for prostate cancer: tumor detection and assessment of aggressiveness. Radiology 259:775–784

    Article  PubMed Central  PubMed  Google Scholar 

  16. Futterer JJ, Heijmink SW, Scheenen TW et al (2006) Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging. Radiology 241:449–458

    Article  PubMed  Google Scholar 

  17. Delongchamps NB, Rouanne M, Flam T et al (2011) Multiparametric magnetic resonance imaging for the detection and localization of prostate cancer: combination of T2-weighted, dynamic contrast-enhanced and diffusion-weighted imaging. BJU Int 107:1411–1418

    Article  PubMed  Google Scholar 

  18. Langer DL, van der Kwast TH, Evans AJ, Trachtenberg J, Wilson BC, Haider MA (2009) Prostate cancer detection with multi-parametric MRI: logistic regression analysis of quantitative T2, diffusion-weighted imaging, and dynamic contrast-enhanced MRI. J Magn Reson Imaging 30:327–334

    Article  PubMed  Google Scholar 

  19. Turkbey B, Pinto PA, Mani H et al (2010) Prostate cancer: value of multiparametric MR imaging at 3 T for detection—histopathologic correlation. Radiology 255:89–99

    Article  PubMed Central  PubMed  Google Scholar 

  20. Kitajima K, Kaji Y, Fukabori Y, Yoshida K, Suganuma N, Sugimura K (2010) Prostate cancer detection with 3 T MRI: comparison of diffusion-weighted imaging and dynamic contrast-enhanced MRI in combination with T2-weighted imaging. J Magn Reson Imaging 31:625–631

    Article  PubMed  Google Scholar 

  21. Barentsz JO, Richenberg J, Clements R et al (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22:746–757

    Article  PubMed Central  PubMed  Google Scholar 

  22. Stamatakis L, Siddiqui MM, Nix JW et al (2013) Accuracy of multiparametric magnetic resonance imaging in confirming eligibility for active surveillance for men with prostate cancer. Cancer 119:3359–3366

    Article  PubMed  Google Scholar 

  23. Turkbey B, Mani H, Aras O et al (2013) Prostate cancer: can multiparametric MR imaging help identify patients who are candidates for active surveillance? Radiology 268:144–152

    Article  PubMed  Google Scholar 

  24. Hoeks CM, Hambrock T, Yakar D et al (2013) Transition zone prostate cancer: detection and localization with 3-T multiparametric MR imaging. Radiology 266:207–217

    Article  PubMed  Google Scholar 

  25. Westphalen AC, Rosenkrantz AB (2014) Prostate Imaging Reporting and Data System (PI-RADS): reflections on early experience with a standardized interpretation scheme for multiparametric prostate MRI. AJR Am J Roentgenol 202:121–123

    Article  PubMed  Google Scholar 

  26. Wang L, Mazaheri Y, Zhang J, Ishill NM, Kuroiwa K, Hricak H (2008) Assessment of biologic aggressiveness of prostate cancer: correlation of MR signal intensity with Gleason grade after radical prostatectomy. Radiology 246:168–176

    Article  PubMed  Google Scholar 

  27. Network NCC (2012) Clinical practice guidelines in oncology: prostate cancer. National Comprehensive Cancer network, Fort Washington, PA. http://www.nccn.com/files/cancer-guidelines/prostate/index.html#/1. Accessed 13 Sep 2013

  28. Hegde JV, Mulkern RV, Panych LP et al (2013) Multiparametric MRI of prostate cancer: an update on state-of-the-art techniques and their performance in detecting and localizing prostate cancer. J Magn Reson Imaging 37:1035–1054

    Article  PubMed Central  PubMed  Google Scholar 

  29. Kvale R, Moller B, Wahlqvist R et al (2009) Concordance between Gleason scores of needle biopsies and radical prostatectomy specimens: a population-based study. BJU Int 103:1647–1654

    Article  PubMed  Google Scholar 

  30. Rabbani F, Stroumbakis N, Kava BR, Cookson MS, Fair WR (1998) Incidence and clinical significance of false-negative sextant prostate biopsies. J Urol 159:1247–1250

    Article  CAS  PubMed  Google Scholar 

  31. Beddy P, O'Neill AC, Yamamoto AK, Addley HC, Reinhold C, Sala E (2012) FIGO staging system for endometrial cancer: added benefits of MR imaging. Radiographics 32:241–254

    Article  PubMed  Google Scholar 

  32. Heidenreich A, Bastian PJ, Bellmunt J et al (2012) Guidelines on prostate cancer. European Association of Urology, Arnhem, the Netherlands. http://www.uroweb.org/gls/pdf/08%20Prostate%20Cancer_LR%20March%2013th%202012.pdf. Accessed 13 Sep 2013

  33. Jackson W, Hamstra DA, Johnson S et al (2013) Gleason pattern 5 is the strongest pathologic predictor of recurrence, metastasis, and prostate cancer-specific death in patients receiving salvage radiation therapy following radical prostatectomy. Cancer 119:3287–3294

    Article  PubMed  Google Scholar 

  34. Mosse CA, Magi-Galluzzi C, Tsuzuki T, Epstein JI (2004) The prognostic significance of tertiary Gleason pattern 5 in radical prostatectomy specimens. Am J Surg Pathol 28:394–398

    Article  PubMed  Google Scholar 

  35. Kulkarni MV, Patton JA, Price RR (1986) Technical considerations for the use of surface coils in MRI. AJR Am J Roentgenol 147:373–378

    Article  CAS  PubMed  Google Scholar 

  36. Meeks JJ, Zhao LC, Cashy J, Kundu S (2012) Incidence and outcomes of ductal carcinoma of the prostate in the USA: analysis of data from the Surveillance, Epidemiology, and End Results program. BJU Int 109:831–834

    Article  PubMed  Google Scholar 

  37. Epstein JI, Allsbrook WC Jr, Amin MB, Egevad LL (2005) The 2005 International Society of Urological Pathology (ISUP) Consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 29:1228–1242

    Article  PubMed  Google Scholar 

  38. Hoeks CM, Barentsz JO, Hambrock T et al (2011) Prostate cancer: multiparametric MR imaging for detection, localization, and staging. Radiology 261:46–66

    Article  PubMed  Google Scholar 

  39. Langer DL, van der Kwast TH, Evans AJ et al (2010) Prostate tissue composition and MR measurements: investigating the relationships between ADC, T2, K(trans), v(e), and corresponding histologic features. Radiology 255:485–494

    Article  PubMed  Google Scholar 

  40. Kim BS, Kim TH, Kwon TG, Yoo ES (2012) Comparison of pelvic phased-array versus endorectal coil magnetic resonance imaging at 3 Tesla for local staging of prostate cancer. Yonsei Med J 53:550–556

    Article  PubMed Central  PubMed  Google Scholar 

  41. Eberhardt SC, Carter S, Casalino DD et al (2013) ACR appropriateness criteria prostate cancer—pretreatment detection, staging, and surveillance. J Am Coll Radiol 10:83–92

    Article  PubMed  Google Scholar 

  42. Bratan F, Niaf E, Melodelima C et al (2013) Influence of imaging and histological factors on prostate cancer detection and localisation on multiparametric MRI: a prospective study. Eur Radiol 23:2019–2029

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Nicola Schieda. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Dr. Anne Tsampalieros MD kindly provided statistical advice for this manuscript. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, case-control study, performed at one institution.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nicola Schieda.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schieda, N., Coffey, N., Gulavita, P. et al. Prostatic ductal adenocarcinoma: an aggressive tumour variant unrecognized on T2 weighted magnetic resonance imaging (MRI). Eur Radiol 24, 1349–1356 (2014). https://doi.org/10.1007/s00330-014-3150-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-014-3150-9

Keywords

Navigation