Multifocality and prostate cancer detection by multiparametric magnetic resonance imaging: correlation with whole-mount histopathology.

BACKGROUND Multiparametric magnetic resonance imaging (mp-MRI) is increasingly used in prostate cancer (CaP). Understanding the limitations of tumor detection, particularly in multifocal disease, is important in its clinical application. OBJECTIVE To determine predictors of CaP detection by mp-MRI as confirmed by whole-mount histopathology. DESIGN, SETTING, AND PARTICIPANTS A retrospective study was performed of 122 consecutive men who underwent mp-MRI before radical prostatectomy at a single referral academic center. A genitourinary radiologist and pathologist collectively determined concordance. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The odds of tumor detection were calculated for clinical, MRI, and histopathologic variables using a multivariate logistic regression model. RESULTS AND LIMITATIONS The 122 patients had 283 unique histologically confirmed CaP tumor foci. Gleason score was 6 in 21 (17%), 7 in 88 (72%), and ≥8 in 13 (11%) patients. Of the 122 cases, 44 (36%) had solitary and 78 (64%) had multifocal tumors. Overall mp-MRI sensitivity for tumor detection was 47% (132/283), with increased sensitivity for larger (102/141 [72%] >1.0 cm), higher-grade (96/134 [72%] Gleason ≥7) tumors, and index tumors (98/122 [80%]). Index tumor status, size, and prostate weight were significant predictors of detection in a multivariate analysis, and multifocality did not adversely impact detection of index tumors. A prostatectomy population was necessary by design, which may limit the ability to generalize these results. CONCLUSIONS Sensitivity for tumor detection increased with tumor size and grade. Index tumor status and tumor size were the strongest predictors of tumor detection, regardless of tumor focality. Some 80% of index tumors were detected, but nonindex tumor detection, even of high-grade lesions, was poor. These findings have important implications for focal therapy. PATIENT SUMMARY We evaluated the ability of magnetic resonance imaging (MRI) to detect cancer in patients undergoing prostatectomy. We found that tumor size and grade were important predictors of tumor detection, and although cancer is often multifocal, MRI is often able to detect the worst focus of cancer.

[1]  Aytekin Oto,et al.  MR imaging-guided focal laser ablation for prostate cancer: phase I trial. , 2013, Radiology.

[2]  Shyam Natarajan,et al.  The role of magnetic resonance imaging in delineating clinically significant prostate cancer. , 2014, Urology.

[3]  F. Schröder,et al.  Prospective study of diagnostic accuracy comparing prostate cancer detection by transrectal ultrasound-guided biopsy versus magnetic resonance (MR) imaging with subsequent MR-guided biopsy in men without previous prostate biopsies. , 2014, European urology.

[4]  Shyam Natarajan,et al.  Value of targeted prostate biopsy using magnetic resonance-ultrasound fusion in men with prior negative biopsy and elevated prostate-specific antigen. , 2014, European urology.

[5]  D J Ruiter,et al.  HISTOLOGICAL GRADE HETEROGENEITY IN MULTIFOCAL PROSTATE CANCER. BIOLOGICAL AND CLINICAL IMPLICATIONS , 1996, The Journal of pathology.

[6]  Baris Turkbey,et al.  Multiparametric 3T prostate magnetic resonance imaging to detect cancer: histopathological correlation using prostatectomy specimens processed in customized magnetic resonance imaging based molds. , 2011, The Journal of urology.

[7]  Jun Luo,et al.  Copy Number Analysis Indicates Monoclonal Origin of Lethal Metastatic Prostate Cancer , 2009, Nature Medicine.

[8]  M. Soloway,et al.  Tumor focality is not associated with biochemical outcome after radical prostatectomy , 2012, The Prostate.

[9]  Steven S Raman,et al.  Use of MR imaging to determine preservation of the neurovascular bundles at robotic-assisted laparoscopic prostatectomy. , 2012, Radiology.

[10]  R. Shah,et al.  Characterization of TMPRSS2-ETS gene aberrations in androgen-independent metastatic prostate cancer. , 2008, Cancer research.

[11]  D. Margolis,et al.  Multiparametric Magnetic Resonance Imaging for Prostate Cancer , 2015 .

[12]  G. Andriole,et al.  Value of Targeted Prostate Biopsy Using Magnetic Resonance–Ultrasound Fusion in Men with Prior Negative Biopsy and Elevated Prostate-Specific Antigen: Sonn GA, Chang E, Natarajan S, et al (Univ of California, Los Angeles) Eur Urol 65:809-815, 2014 § , 2014 .

[13]  T. Stamey,et al.  Prognostic factors for multifocal prostate cancer in radical prostatectomy specimens: lack of significance of secondary cancers. , 2003, The Journal of urology.

[14]  A. Villers,et al.  Dynamic contrast enhanced, pelvic phased array magnetic resonance imaging of localized prostate cancer for predicting tumor volume: correlation with radical prostatectomy findings. , 2006, The Journal of urology.

[15]  T. Stamey,et al.  Biological determinants of cancer progression in men with prostate cancer. , 1999, JAMA.

[16]  A Fenster,et al.  Image guided photothermal focal therapy for localized prostate cancer: phase I trial. , 2009, The Journal of urology.

[17]  R. Jenkins,et al.  Chromosomal anomalies in stage D1 prostate adenocarcinoma primary tumors and lymph node metastases detected by fluorescence in situ hybridization. , 1997, The Journal of urology.

[18]  P Abel,et al.  Histological characteristics of the index lesion in whole-mount radical prostatectomy specimens: implications for focal therapy , 2011, Prostate Cancer and Prostatic Diseases.

[19]  Karin Haustermans,et al.  Multiparametric MRI for prostate cancer localization in correlation to whole‐mount histopathology , 2013, Journal of magnetic resonance imaging : JMRI.

[20]  F. Beuvon,et al.  Multiparametric MRI is helpful to predict tumor focality, stage, and size in patients diagnosed with unilateral low-risk prostate cancer , 2011, Prostate Cancer and Prostatic Diseases.

[21]  L. Kiemeney,et al.  The predictive value of endorectal 3 Tesla multiparametric magnetic resonance imaging for extraprostatic extension in patients with low, intermediate and high risk prostate cancer. , 2013, The Journal of urology.

[22]  Emilie Niaf,et al.  Influence of imaging and histological factors on prostate cancer detection and localisation on multiparametric MRI: a prospective study , 2013, European Radiology.

[23]  Hashim Uddin Ahmed,et al.  The index lesion and the origin of prostate cancer. , 2009, The New England journal of medicine.

[24]  Shugo Suzuki,et al.  Pitfalls with MRI Evaluation of Prostate Cancer Detection , 2006, Urologia Internationalis.

[25]  P. Choyke,et al.  Accuracy of multiparametric magnetic resonance imaging in confirming eligibility for active surveillance for men with prostate cancer , 2013, Cancer.

[26]  S. Mendrinos,et al.  Prostate cancer foci detected on multiparametric magnetic resonance imaging are histologically distinct from those not detected. , 2012, The Journal of urology.

[27]  J. Oxley,et al.  Suitability of PSA-detected localised prostate cancers for focal therapy: experience from the ProtecT study , 2011, British Journal of Cancer.

[28]  I. Sesterhenn,et al.  Clinicopathological behavior of single focus prostate adenocarcinoma. , 2009, The Journal of urology.

[29]  Baris Turkbey,et al.  Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy. , 2013, European urology.

[30]  A. D'Amico,et al.  Clinical utility of endorectal MRI in determining PSA outcome for patients with biopsy Gleason score 7, PSA , 2003, International Journal of Radiation Oncology, Biology, Physics.

[31]  François Cornud,et al.  Multiparametric magnetic resonance imaging for the detection and localization of prostate cancer: combination of T2‐weighted, dynamic contrast‐enhanced and diffusion‐weighted imaging , 2011, BJU international.

[32]  T. Stamey,et al.  Morphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens. , 2002, Urology.