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Prostate cancer bone metastases on staging prostate MRI: prevalence and clinical features associated with their diagnosis

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Abstract

Purpose

Bone lesions on prostate MRI often raise concern about metastases. This study aimed to evaluate the prevalence of bone metastases on staging prostate MRI and evaluate associations between their MRI features and clinical/pathologic characteristics.

Methods

Retrospective, IRB-approved study of 3765 patients undergoing prostate MRI for newly diagnosed PCa between 2000 and 2014. The reference standard to calculate the prevalence of bone metastases was bone biopsy and/or ≥1-year follow-up after MRI. In a subsample of 228 patients, the MRI characteristics of bone lesions were recorded by two radiologists independently. Associations between MRI and clinical/pathologic findings, including National Comprehensive Cancer Network (NCCN) risk categories, were calculated.

Results

57/3765 patients (1.5%, 95% CI 1.2–2.0%) had bone metastases. No patient with NCCN low-risk PCa (Gleason < 7, PSA < 10 ng/mL, cT1-2a) had bone metastases. In the subsample, ≥1 bone lesion was present on MRI in 74% (95% CI 0.67–0.79) and 72% (95% CI 0.66–0.78) of patients (R1 and R2). Larger lesion diameter (OR 1.33/1.19; p < 0.001 for both readers) and the absence of intralesional fat (OR 0.07/0.11; p = 0.004/0.002 for R1/R2) were significantly associated with bone metastases.

Conclusion

Bone lesions are common in prostate MRI, but only rarely represent metastases. MRI should be interpreted in the context of clinical features that influence the likelihood of metastatic disease.

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Abbreviations

AUC:

Area under the curve

CaPSURE:

Cancer of the prostate strategic urologic research endeavor

CI:

Confidence interval

MRI:

Magnetic resonance imaging

NCCN:

National Comprehensive Cancer Network

OR:

Odds ratio

PCa:

Prostate cancer

PI-RADS:

Prostate imaging reporting and data system

PSA:

Prostate-specific antigen

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Author notes

    Authors and Affiliations

    1. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA

      Hebert Alberto Vargas, Rachel Schor-Bardach, Niamh Long, Anna N. Kirzner, Jane D. Cunningham, Ramon E. Sosa, Evis Sala, David M. Panicek & Hedvig Hricak

    2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA

      Debra A. Goldman & Chaya S. Moskowitz

    3. 1275 York Av, Room C278, New York, NY, 10021, USA

      Hebert Alberto Vargas

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    1. Hebert Alberto Vargas
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    2. Rachel Schor-Bardach
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    3. Niamh Long
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    Corresponding author

    Correspondence to Hebert Alberto Vargas.

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    Funding

    This study was partially funded by NIH Grant Number P30 CA008748.

    Conflict of interest

    The authors declare that they have no conflict of interest.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

    Additional information

    Hebert Alberto Vargas and Rachel Schor-Bardach have contributed equally to this manuscript.

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    Cite this article

    Vargas, H.A., Schor-Bardach, R., Long, N. et al. Prostate cancer bone metastases on staging prostate MRI: prevalence and clinical features associated with their diagnosis. Abdom Radiol 42, 271–277 (2017). https://doi.org/10.1007/s00261-016-0851-3

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    • DOI: https://doi.org/10.1007/s00261-016-0851-3

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