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Diffusion-weighted MRI, 11C-choline PET and 18F-fluorodeoxyglucose PET for predicting the Gleason score in prostate carcinoma

Abstract

Objectives

To evaluate the accuracy of transrectal ultrasound-guided (TRUS) biopsy, diffusion-weighted (DW) magnetic resonance imaging (MRI), 11C-choline (CHOL) positron emission tomography (PET), and 18F-fluorodeoxyglucose (FDG) PET in predicting the prostatectomy Gleason risk (GR).

Methods

The study included 21 patients who underwent TRUS biopsy and multi-technique imaging before radical prostatectomy. Values from five different tests (TRUS biopsy, DW MRI, CHOL PET, FDG PET, and combined DW MRI/CHOL PET) were correlated with the prostatectomy GR using Spearman’s ρ. Tests that were found to have significant correlations were used to classify patients into GR groups.

Results

The following tests had significant correlations with prostatectomy GR: TRUS biopsy (ρ = 0.617, P = 0.003), DW MRI (ρ = –0.601, P = 0.004), and combined DW MRI/CHOL PET (ρ = –0.623, P = 0.003). CHOL PET alone and FDG PET only had weak correlations. The correct GR classification rates were 67 % with TRUS biopsy, 67 % with DW MRI, and 76 % with combined DW MRI/CHOL PET.

Conclusions

DW MRI and combined DW MRI/CHOL PET have significant correlations and high rates of correct classification of the prostatectomy GR, the strength and accuracy of which are comparable with TRUS biopsy.

Key Points

Accurate determination of the Gleason score is essential for prostate cancer management.

DW MRI ± CHOL PET correlated significantly with prostatectomy Gleason score.

These correlations are similar to that between TRUS biopsy and prostatectomy.

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References

  1. Gleason DF (1966) Classification of prostatic carcinomas. Cancer Chemother Rep 50:125–128

    CAS  PubMed  Google Scholar 

  2. 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

    PubMed  Article  Google Scholar 

  3. Partin AW, Kattan MW, Subong EN et al (1997) Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. JAMA 277:1445–1451

    CAS  PubMed  Article  Google Scholar 

  4. Mohler J, Bahnson RR, Boston B et al (2010) NCCN clinical practice guidelines in oncology: prostate cancer. J Natl Compr Cancer Netw 8:162–200

    CAS  Google Scholar 

  5. Heidenreich A, Bolla M, Joniau S et al (2011) Guidelines on prostate cancer. European Association of Urology (EAU), the Netherlands. http://www.uroweb.org/gls/pdf/08_Prostate_Cancer.pdf. Accessed 1 Jul 2013

  6. Watanabe H, Igari D, Tanahashi Y, Harada K, Saitoh M (1975) Transrectal ultrasonotomography of the prostate. J Urol 114:734–739

    CAS  PubMed  Google Scholar 

  7. Fine SW, Epstein JI (2008) A contemporary study correlating prostate needle biopsy and radical prostatectomy Gleason score. J Urol 179:1335–1338, discussion 1338–1339

    PubMed  Article  Google Scholar 

  8. Loeb S, van den Heuvel S, Zhu X, Bangma CH, Schroder FH, Roobol MJ (2012) Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol 61:1110–1114

    PubMed  Article  Google Scholar 

  9. Chiang IN, Chang SJ, Pu YS, Huang KH, Yu HJ, Huang CY (2007) Major complications and associated risk factors of transrectal ultrasound guided prostate needle biopsy: a retrospective study of 1875 cases in taiwan. J Formos Med Assoc 106:929–934

    PubMed  Article  Google Scholar 

  10. D'Amico AV, Tempany CM, Cormack R et al (2000) Transperineal magnetic resonance image guided prostate biopsy. J Urol 164:385–387

    PubMed  Article  Google Scholar 

  11. Bittencourt LK, Barentsz JO, de Miranda LC, Gasparetto EL (2012) Prostate MRI: diffusion-weighted imaging at 1.5T correlates better with prostatectomy Gleason Grades than TRUS-guided biopsies in peripheral zone tumours. Eur Radiol 22:468–475

    PubMed  Article  Google Scholar 

  12. Yamamura J, Salomon G, Buchert R et al (2011) Magnetic resonance imaging of prostate cancer: diffusion-weighted imaging in comparison with sextant biopsy. J Comput Assist Tomogr 35:223–228

    PubMed  Article  Google Scholar 

  13. Turkbey B, Shah VP, Pang Y et al (2011) Is apparent diffusion coefficient associated with clinical risk scores for prostate cancers that are visible on 3-T MR images? Radiology 258:488–495

    PubMed  Article  Google Scholar 

  14. Zakian KL, Sircar K, Hricak H et al (2005) Correlation of proton MR spectroscopic imaging with gleason score based on step-section pathologic analysis after radical prostatectomy. Radiology 234:804–814

    PubMed  Article  Google Scholar 

  15. Oto A, Yang C, Kayhan A et al (2011) Diffusion-weighted and dynamic contrast-enhanced MRI of prostate cancer: correlation of quantitative MR parameters with Gleason score and tumor angiogenesis. AJR Am J Roentgenol 197:1382–1390

    PubMed  Article  Google Scholar 

  16. Piert M, Park H, Khan A et al (2009) Detection of aggressive primary prostate cancer with 11C-choline PET/CT using multimodality fusion techniques. J Nucl Med 50:1585–1593

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  17. Park H, Wood D, Hussain H et al (2012) Introducing parametric fusion PET/MRI of primary prostate cancer. J Nucl Med 53:546–551

    CAS  PubMed  Article  Google Scholar 

  18. Jadvar H (2009) FDG PET in prostate cancer. PET Clin 4:155–161

    PubMed Central  PubMed  Article  Google Scholar 

  19. Zelhof B, Pickles M, Liney G et al (2009) Correlation of diffusion-weighted magnetic resonance data with cellularity in prostate cancer. BJU Int 103:883–888

    PubMed  Article  Google Scholar 

  20. Gibbs P, Liney GP, Pickles MD, Zelhof B, Rodrigues G, Turnbull LW (2009) Correlation of ADC and T2 measurements with cell density in prostate cancer at 3.0 Tesla. Investig Radiol 44:572–576

    Article  Google Scholar 

  21. Chang JH, Joon DL, Lee ST et al (2011) Histopathological correlation of (11)C-choline PET scans for target volume definition in radical prostate radiotherapy. Radiother Oncol 99:187–192

    PubMed  Article  Google Scholar 

  22. Contractor K, Challapalli A, Barwick T et al (2011) Use of [11C]choline PET-CT as a noninvasive method for detecting pelvic lymph node status from prostate cancer and relationship with choline kinase expression. Clin Cancer Res 17:7673–7683

    CAS  PubMed  Article  Google Scholar 

  23. Haubner R (2010) PET radiopharmaceuticals in radiation treatment planning - synthesis and biological characteristics. Radiother Oncol 96:280–287

    PubMed  Article  Google Scholar 

  24. Smith CL, Mulligan RS, Poniger SS et al (2006) Radiolabelling of 11C-choline, a PET radiotracer for prostate cancer. Int Med J 36:A123

    Google Scholar 

  25. Chang JH, Lim Joon D, Lee ST et al (2012) Intensity modulated radiation therapy dose painting for localized prostate cancer using (11)C-choline positron emission tomography scans. Int J Radiat Oncol Biol Phys 83:e691–e696

    PubMed  Article  Google Scholar 

  26. Evans JD (1996) Straightforward statistics for the behavioral sciences. Brooks/Cole, Pacific Grove

    Google Scholar 

  27. Oto A, Kayhan A, Jiang Y et al (2010) Prostate cancer: differentiation of central gland cancer from benign prostatic hyperplasia by using diffusion-weighted and dynamic contrast-enhanced MR imaging. Radiology 257:715–723

    PubMed  Article  Google Scholar 

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

    PubMed  Article  Google Scholar 

  29. Soret M, Bacharach SL, Buvat I (2007) Partial-volume effect in PET tumor imaging. J Nucl Med 48:932–945

    PubMed  Article  Google Scholar 

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Acknowledgments

This study was supported by grant 487916 through Cancer Australia, Prostate Cancer Foundation Australia, Australian Government Department of Health and Aging. IDD was an Australian National Health and Medical Research Council Practitioner Fellow (487907). The authors gratefully acknowledge the contributions of Graham Hepworth from the Statistical Consulting Centre, University of Melbourne and the staff of the Radiation Oncology Centre, PET Centre and Department of Radiology, Austin Health.

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Correspondence to Ian D. Davis.

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Chang, J.H., Lim Joon, D., Lee, S.T. et al. Diffusion-weighted MRI, 11C-choline PET and 18F-fluorodeoxyglucose PET for predicting the Gleason score in prostate carcinoma. Eur Radiol 24, 715–722 (2014). https://doi.org/10.1007/s00330-013-3045-1

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  • DOI: https://doi.org/10.1007/s00330-013-3045-1

Keywords

  • Diffusion magnetic resonance imaging
  • Positron-emission tomography
  • Prostate cancer
  • Gleason grading