Skip to main content
SpringerLink
Log in

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

  • Urogenital
  • Published:
European Radiology Aims and scope Submit manuscript

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

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

References

  1. Albertsen PC, Hanley JA, Fine J (2005) 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA 293:2095–2101

    Article  CAS  PubMed  Google Scholar 

  2. Eggener SE, Mueller A, Berglund RK et al (2013) A multi-institutional evaluation of active surveillance for low risk prostate cancer. J Urol 189:S19–S25

    Article  PubMed  Google Scholar 

  3. Tosoian JJ, Trock BJ, Landis P et al (2011) Active surveillance program for prostate cancer: an update of the Johns Hopkins experience. J Clin Oncol 29:2185–2190

    Article  PubMed  Google Scholar 

  4. Lawrentschuk N, Klotz L (2011) Active surveillance for low-risk prostate cancer: an update. Nat Rev Urol 8:312–320

    Article  PubMed  Google Scholar 

  5. Cooperberg MR, Cowan JE, Hilton JF et al (2011) Outcomes of active surveillance for men with intermediate-risk prostate cancer. J Clin Oncol 29:228–234

    Article  PubMed  Google Scholar 

  6. Bul M, van den Bergh RC, Zhu X et al (2012) Outcomes of initially expectantly managed patients with low or intermediate risk screen-detected localized prostate cancer. BJU Int 110:1672–1677

    Article  PubMed  Google Scholar 

  7. Djavan B, Ravery V, Zlotta A et al (2001) Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: when should we stop? J Urol 166:1679–1683

    Article  CAS  PubMed  Google Scholar 

  8. Gondo T, Hricak H, Sala E et al (2014) 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

    Article  PubMed  Google Scholar 

  9. Epstein JI, Feng Z, Trock BJ, Pierorazio PM (2012) Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades. Eur Urol 61:1019–1024

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gondo T, Poon BY, Matsumoto K, Bernstein M, Sjoberg DD, Eastham JA (2015) Clinical role of pathological downgrading after radical prostatectomy in patients with biopsy confirmed Gleason score 3+4 prostate cancer. BJU Int 115:81–86

    Article  PubMed  Google Scholar 

  11. Barentsz JO, Richenberg J, Clements R et al (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22:746–757

    Article  PubMed  PubMed Central  Google Scholar 

  12. Barrett T, Turkbey B, Choyke PL (2015) PI-RADS version 2: what you need to know. Clin Radiol. doi:10.1016/j.crad.2015.06.093

    PubMed  Google Scholar 

  13. Muller BG, Shih JH, Sankineni S et al (2015) Prostate cancer: interobserver agreement and accuracy with the revised prostate imaging reporting and data system at multiparametric MR imaging. Radiology. doi:10.1148/radiol.2015142818:142818

    Google Scholar 

  14. Vargas HA, Hotker AM, Goldman DA et al (2015) Updated prostate imaging reporting and data system (PIRADS v2) recommendations for the detection of clinically significant prostate cancer using multiparametric MRI: critical evaluation using whole-mount pathology as standard of reference. Eur Radiol. doi:10.1007/s00330-015-4015-6

    PubMed Central  Google Scholar 

  15. Bjurlin MA, Carter HB, Schellhammer P et al (2013) Optimization of initial prostate biopsy in clinical practice: sampling, labeling and specimen processing. J Urol 189:2039–2046

    Article  PubMed  PubMed Central  Google Scholar 

  16. Firth D (1993) Bias reduction of maximum likelihood estimates. Biometrika 80:27–38

    Article  Google Scholar 

  17. Paul P, Pennell ML, Lemeshow S (2013) Standardizing the power of the Hosmer-Lemeshow goodness of fit test in large data sets. Stat Med 32:67–80

    Article  PubMed  Google Scholar 

  18. Ross HM, Kryvenko ON, Cowan JE, Simko JP, Wheeler TM, Epstein JI (2012) Do adenocarcinomas of the prostate with Gleason score (GS) </=6 have the potential to metastasize to lymph nodes? Am J Surg Pathol 36:1346–1352

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ellis CL, Walsh PC, Partin AW, Epstein JI (2013) Multiple cores of Gleason score 6 correlate with favourable findings at radical prostatectomy. BJU Int 111:E306–E309

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Mullins JK, Feng Z, Trock BJ, Epstein JI, Walsh PC, Loeb S (2012) The impact of anatomical radical retropubic prostatectomy on cancer control: the 30-year anniversary. J Urol 188:2219–2224

    Article  PubMed  Google Scholar 

  21. Pan CC, Potter SR, Partin AW, Epstein JI (2000) The prognostic significance of tertiary Gleason patterns of higher grade in radical prostatectomy specimens: a proposal to modify the Gleason grading system. Am J Surg Pathol 24:563–569

    Article  CAS  PubMed  Google Scholar 

  22. Hricak H, Choyke PL, Eberhardt SC, Leibel SA, Scardino PT (2007) Imaging prostate cancer: a multidisciplinary perspective. Radiology 243:28–53

    Article  PubMed  Google Scholar 

  23. 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–W175

    Article  PubMed  Google Scholar 

  24. Kosaka T, Mizuno R, Shinojima T et al (2014) The implications of prostate-specific antigen density to predict clinically significant prostate cancer in men </= 50 years. Am J Clin Exp Urol 2:332–336

    PubMed  PubMed Central  Google Scholar 

  25. 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–W47

    Article  PubMed  Google Scholar 

  26. Gancarczyk KJ, Wu H, McLeod DG et al (2003) Using the percentage of biopsy cores positive for cancer, pretreatment PSA, and highest biopsy Gleason sum to predict pathologic stage after radical prostatectomy: the Center for Prostate Disease Research nomograms. Urology 61:589–595

    Article  PubMed  Google Scholar 

  27. Chang DT, Challacombe B, Lawrentschuk N (2013) Transperineal biopsy of the prostate—is this the future? Nat Rev Urol 10:690–702

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

    Sungmin Woo, Sang Youn Kim, Seung Hyup Kim & Jeong Yeon Cho

  2. Division of Clinical Epidemiology, Medical Research Collaborating Center, Biomedical Research Institution, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

    Joongyub Lee

  3. Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

    Seung Hyup Kim & Jeong Yeon Cho

Authors
  1. Sungmin Woo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sang Youn Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joongyub Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seung Hyup Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jeong Yeon Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeong Yeon Cho.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Woo, S., Kim, S.Y., Lee, J. et al. 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. Eur Radiol 26, 3580–3587 (2016). https://doi.org/10.1007/s00330-016-4230-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-016-4230-9

Keywords

Search

Navigation