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Apical periurethral transition zone lesions: MRI and histology findings

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Abstract

Purpose

Apical periurethral transition zone (TZ) cancers can pose unique problems for surgery and radiation therapy. Here, we describe the appearance of such cancers on multiparametric MRI (mpMRI) and correlate this with histopathology derived from MRI-targeted biopsy.

Materials and methods

Between May 2011 and January 2019, a total of 4381 consecutive patients underwent 3 T mpMRI. Of these, 53 patients with 58 apical periurethral TZ lesions underwent TRUS/MRI fusion-guided biopsy and 12-core systematic TRUS-guided biopsy. Correlation was made with patient age, PSA, PSA density, whole prostate volume, and Gleason scores.

Results

A total 53 men (median age 68 years, median PSA 7.94 ng/ml) were identified as having at least one apical periurethral TZ lesion on mpMRI and 5 (9%) patients had more than one apical periurethral lesion. Thus, 58 lesions were identified in 53 patients. Of these 37/53 patients (69%) and 40/58 lesions were positive at biopsy for prostate cancer. Seven were diagnosed by 12-core systematic TRUS-guided biopsy and 34 were diagnosed by TRUS/MRI fusion-guided biopsy. Gleason score was ≥ 3 + 4 in 34/58 (58%) lesions.

Conclusion

Identification of apical periurethral TZ prostate cancers is important to help guide surgical and radiation therapy as these tumors are adjacent to critical structures. Because of the tendency to undersample the periurethral zone during TRUS biopsy, MRI-guided biopsy is particularly helpful for detecting apical periurethral TZ prostate cancers many of which prove to be clinically significant.

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Funding

This research is funded by intramural research program of NIH.

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Authors and Affiliations

  1. Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Sena Tuncer

  2. Molecular Imaging Program, NCI, NIH, 10 Center Drive, Room B3B85, Bethesda, MD, 20892, USA

    Sherif Mehralivand, Thomas Sanford, Peter L. Choyke & Baris Turkbey

  3. Clinical Research Directorate, Frederick National Laboratory for Cancer Research, NCI, NIH, Bethesda, MD, USA

    Stephanie A. Harmon

  4. Cognitive Science Branch, National Library of Medicine, Bethesda, MD, USA

    G. Thomas Brown

  5. Radiation Oncology Branch, NCI, NIH, Bethesda, MD, USA

    Lindsay S. Rowe

  6. Laboratory of Pathology, NCI, NIH, Bethesda, MD, USA

    Maria J. Merino

  7. Center for Interventional Oncology, NCI and Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, MD, USA

    Bradford J. Wood

  8. Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA

    Peter A. Pinto

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  1. Sena Tuncer
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  2. Sherif Mehralivand
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  4. Thomas Sanford
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Corresponding author

Correspondence to Baris Turkbey.

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Conflict of interest

Author BJW is supported by the Intramural Research Program of the NIH and the NIH Center for Interventional Oncology and NIH Grant # Z1A CL040015-08. NIH and Philips/InVivo Inc have a cooperative Research and Development Agreement. NIH and Philips/InVivo Inc have a patent license agreement and NIH and BJW, BT, PAP, PLC may receive royalties. The remaining authors have no disclosures.

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Tuncer, S., Mehralivand, S., Harmon, S.A. et al. Apical periurethral transition zone lesions: MRI and histology findings. Abdom Radiol 45, 3258–3264 (2020). https://doi.org/10.1007/s00261-019-02194-x

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  • DOI: https://doi.org/10.1007/s00261-019-02194-x

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