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European Radiology

, Volume 26, Issue 10, pp 3580–3587 | Cite as

PI-RADS version 2 for prediction of pathological downgrading after radical prostatectomy: a preliminary study in patients with biopsy-proven Gleason Score 7 (3+4) prostate cancer

  • Sungmin Woo
  • Sang Youn Kim
  • Joongyub Lee
  • Seung Hyup Kim
  • Jeong Yeon ChoEmail author
Urogenital

Abstract

Objectives

To evaluate PI-RADSv2 for predicting pathological downgrading after radical prostatectomy (RP) in patients with biopsy-proven Gleason score (GS) 7(3+4) PC.

Methods

A total of 105 patients with biopsy-proven GS 7(3+4) PC who underwent multiparametric prostate MRI followed by RP were included. Two radiologists assigned PI-RADSv2 scores for each patient. Preoperative clinicopathological variables and PI-RADSv2 scores were compared between patients with and without downgrading after RP using the Wilcoxon rank sum test or Fisher’s exact test. Logistic regression analyses with Firth’s bias correction were performed to assess their association with downgrading.

Results

Pathological downgrading was identified in ten (9.5 %) patients. Prostate-specific antigen (PSA), PSA density, percentage of cores with GS 7(3+4), and greatest percentage of core length (GPCL) with GS 7(3+4) were significantly lower in patients with downgrading (p = 0.002-0.037). There was no significant difference in age and clinical stage (p = 0.537-0.755). PI-RADSv2 scores were significantly lower in patients with downgrading (3.8 versus 4.4, p = 0.012). At univariate logistic regression analysis, PSA, PSA density, and PI-RADSv2 scores were significant predictors of downgrading (p = 0.003-0.022). Multivariate analysis revealed only PSA density and PI-RADSv2 scores as independent predictors of downgrading (p = 0.014-0.042).

Conclusions

The PI-RADSv2 scoring system was an independent predictor of pathological downgrading after RP in patients with biopsy-proven GS 7(3+4) PC.

Key points

PI-RADSv2 was an independent predictor of downgrading in biopsy-proven GS 7(3+4) PC

PSA density was also an independent predictor of downgrading

MRI may assist in identifying AS candidates in biopsy-proven GS 7(3+4) PC patients

Keywords

Prostate cancer MRI PI-RADS Gleason score Downgrade 

Abbreviations

AS

Active surveillance

CI

Confidence intervals

DCE-MRI

Dynamic contrast-enhanced MRI

DWI

Diffusion-weighted imaging

GPCL

Greatest percentage of involved core length

GS

Gleason score

MRI

Magnetic resonance imaging

OR

Odds ratio

PC

Prostate cancer

PI-RADS

Prostate Imaging-Reporting and Data System

PSA

Prostate-specific antigen

T1WI

T1-weighted image

T2WI

T2-weighted image

v2

Version 2

Notes

Acknowledgments

The scientific guarantor of this publication is Jeong Yeon Cho. 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. One of the authors (JL) has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Some study subjects or cohorts have been previously reported in [21]: Woo S, Cho JY, Kim SY, Kim SH (2015) Extracapsular extension in prostate cancer: added value of diffusion-weighted MRI in patients with equivocal findings on T2-weighted imaging. AJR Am J Roentgenol 204:W168-175 and [23] Woo S, Cho JY, Kim SY, Kim SH (2015) Periprostatic fat thickness on MRI: correlation with Gleason score in prostate cancer. AJR Am J Roentgenol 204:W43-47. Methodology: retrospective, cross-sectional study, performed at one institution.

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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Sungmin Woo
    • 1
  • Sang Youn Kim
    • 1
  • Joongyub Lee
    • 2
  • Seung Hyup Kim
    • 1
    • 3
  • Jeong Yeon Cho
    • 1
    • 3
    Email author
  1. 1.Department of RadiologySeoul National University College of MedicineSeoulKorea
  2. 2.Division of Clinical Epidemiology, Medical Research Collaborating Center, Biomedical Research InstitutionSeoul National University College of Medicine, Seoul National University HospitalSeoulKorea
  3. 3.Institute of Radiation Medicine and Kidney Research InstituteSeoul National University Medical Research CenterSeoulKorea

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