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Multiparametric 3T MRI for the prediction of pathological downgrading after radical prostatectomy in patients with biopsy-proven Gleason score 3 + 4 prostate cancer

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Abstract

Objectives

The aim of this study was to assess the diagnostic performance of pre-treatment 3-Tesla (3T) multiparametric magnetic resonance imaging (mpMRI) for predicting Gleason score (GS) downgrading after radical prostatectomy (RP) in patients with GS 3 + 4 prostate cancer (PCa) on biopsy.

Methods

We retrospectively reviewed 304 patients with biopsy-proven GS 3 + 4 PCa who underwent mpMRI before RP. On T2-weighted imaging and three mpMRI combinations (T2-weighted imaging + diffusion-weighted imaging [DWI], T2-weighted imaging + dynamic contrast-enhanced-MRI [DCE-MRI], and T2-weighted imaging + DWI + DCE-MRI), two radiologists (R1/R2) scored the presence of a dominant tumour using a 5-point Likert scale (1 = definitely absent to 5 = definitely present). Diagnostic performance in identifying downgrading was evaluated via areas under the curves (AUCs). Predictive accuracies of multivariate models were calculated.

Results

In predicting downgrading, T2-weighted imaging + DWI (AUC = 0.89/0.85 for R1/R2) performed significantly better than T2-weighted imaging alone (AUC = 0.72/0.73; p < 0.001/p = 0.02 for R1/R2), while T2-weighted imaging + DWI + DCE-MRI (AUC = 0.89/0.84 for R1/R2) performed no better than T2-weighted imaging + DWI (p = 0.48/p > 0.99 for R1/R2). On multivariate analysis, the clinical + mpMRI model incorporating T2-weighted imaging + DWI (AUC = 0.92/0.88 for R1/R2) predicted downgrading significantly better than the clinical model (AUC = 0.73; p < 0.001 for R1/R2).

Conclusion

mpMRI improves the ability to identify a subgroup of patients with Gleason 3 + 4 PCa on biopsy who are candidates for active surveillance. DCE-MRI (compared to T2 + DWI) offered no additional benefit to the prediction of downgrading.

Key Points

• Diagnostic performance of T2-weighted-imaging + DWI was better than T2-weighted-imaging alone.

• Diagnostic performance of T2-weighted-imaging + DWI was similar to T2-weighted-imaging + DWI + DCE-MRI.

• Combining clinical and T2-weighted-imaging + DWI features best predicted GS downgrading.

• mpMRI might prevent overtreatment by increasing eligibility for PCa active surveillance.

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Abbreviations

mpMRI:

Multiparametric magnetic resonance imaging

GS:

Gleason score

RP:

Radical prostatectomy

PCa:

Prostate cancer

PSA:

Prostate-specific antigen

DWI:

Diffusion-weighted imaging

DCE:

Dynamic contrast-enhanced

AUC:

Area under the curve

ADC:

Apparent diffusion coefficient

OR:

Odds ratio

CI:

Confidence interval

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Acknowledgments

The guarantor of this study is Hebert Alberto Vargas. 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. Two of the authors (Junting Zheng and Chaya S. Moskowitz) have significant statistical expertise. Institutional Review Board approval was obtained (WA0297-13). Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

This work was supported by the Sidney Kimmel Center for Prostate and Urologic Cancers. We are grateful to Ada Muellner, M.S., for editing the manuscript.

Author information

Authors and Affiliations

  1. Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Tatsuo Gondo, Melanie Bernstein & James A. Eastham

  2. Department of Urology, Tokyo Medical University, Tokyo, Japan

    Tatsuo Gondo

  3. Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Hedvig Hricak, Evis Sala & Hebert Alberto Vargas

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

    Junting Zheng & Chaya S. Moskowitz

Authors
  1. Tatsuo Gondo
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  2. Hedvig Hricak
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  7. James A. Eastham
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Correspondence to Hebert Alberto Vargas.

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Gondo, T., Hricak, H., Sala, E. et al. Multiparametric 3T MRI for the prediction of pathological downgrading after radical prostatectomy in patients with biopsy-proven Gleason score 3 + 4 prostate cancer. Eur Radiol 24, 3161–3170 (2014). https://doi.org/10.1007/s00330-014-3367-7

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  • DOI: https://doi.org/10.1007/s00330-014-3367-7

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