Does suspicion of prostate cancer on integrated T2 and diffusion-weighted MRI predict more adverse pathology on radical prostatectomy?

Michael S. Borofsky, Andrew B. Rosenkrantz, Nitya Abraham, Rajat Jain, Samir S. Taneja

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: To determine whether suspicion for tumor on prostate MRI incorporating T2-weighted imaging (T2-WI) and diffusion-weighted imaging (DWI) predicts more adverse pathology on radical prostatectomy (RP). Methods: From 2007 to 2009, 154 patients underwent 1.5 Tesla pelvic-phased-array magnetic resonance imaging (MRI) of the prostate that included T2-WI and DWI before RP. MRI examinations were retrospectively reviewed and grouped by degree of suspicion for tumor: no suspicion for tumor (NST, n = 15), equivocal suspicion for tumor (EST, n = 60), or strong suspicion for tumor (SST, n = 79). The NST/EST groups were combined and compared to the SST group. Preoperative variables were used to assemble a multivariate model. Outcomes reflective of adverse pathology included primary Gleason grade ≥4, pathologic stage ≥T3 (≥pT3), and tumor upgrading. Subgroup analysis was performed for patients meeting eligibility criteria for active surveillance (n = 55). For this analysis, the NST group was compared to the EST/SST groups. Results: SST status was associated with adverse preoperative risk factors for aggressive disease. Univariate analysis demonstrated significant association between SST and primary Gleason ≥4 pathology and stage ≥pT3 (P <.05). On multivariate analysis, SST was independently predictive of primary Gleason ≥4 pathology (odds ratio [OR] 6.14, 95% confidence interval [CI] 1.97-19.2) and Gleason upgrading (OR 2.47, 95% CI 1.01-6.02). Among patients eligible for active surveillance, those in the NST group had decreased likelihood of Gleason ≥7 disease or stage ≥pT3 compared to the EST/SST groups (7.7% vs 47.6%, P =.01). Conclusion: Increased tumor suspicion on T2-WI/DWI MRI is indicative of adverse pathology on RP. These findings suggest a role for MRI in pretreatment risk assessment.

Original languageEnglish (US)
Pages (from-to)1279-1283
Number of pages5
JournalUrology
Volume81
Issue number6
DOIs
StatePublished - Jun 1 2013

Fingerprint

Diffusion Magnetic Resonance Imaging
Prostatectomy
Prostatic Neoplasms
Pathology
Magnetic Resonance Imaging
Neoplasms
Prostate
Odds Ratio
Confidence Intervals
Multivariate Analysis

Cite this

Does suspicion of prostate cancer on integrated T2 and diffusion-weighted MRI predict more adverse pathology on radical prostatectomy? / Borofsky, Michael S.; Rosenkrantz, Andrew B.; Abraham, Nitya; Jain, Rajat; Taneja, Samir S.

In: Urology, Vol. 81, No. 6, 01.06.2013, p. 1279-1283.

Research output: Contribution to journalArticle

Borofsky, Michael S. ; Rosenkrantz, Andrew B. ; Abraham, Nitya ; Jain, Rajat ; Taneja, Samir S. / Does suspicion of prostate cancer on integrated T2 and diffusion-weighted MRI predict more adverse pathology on radical prostatectomy?. In: Urology. 2013 ; Vol. 81, No. 6. pp. 1279-1283.
@article{e7ee83b2c3fd4fdea0d9ffaad1357e92,
title = "Does suspicion of prostate cancer on integrated T2 and diffusion-weighted MRI predict more adverse pathology on radical prostatectomy?",
abstract = "Objective: To determine whether suspicion for tumor on prostate MRI incorporating T2-weighted imaging (T2-WI) and diffusion-weighted imaging (DWI) predicts more adverse pathology on radical prostatectomy (RP). Methods: From 2007 to 2009, 154 patients underwent 1.5 Tesla pelvic-phased-array magnetic resonance imaging (MRI) of the prostate that included T2-WI and DWI before RP. MRI examinations were retrospectively reviewed and grouped by degree of suspicion for tumor: no suspicion for tumor (NST, n = 15), equivocal suspicion for tumor (EST, n = 60), or strong suspicion for tumor (SST, n = 79). The NST/EST groups were combined and compared to the SST group. Preoperative variables were used to assemble a multivariate model. Outcomes reflective of adverse pathology included primary Gleason grade ≥4, pathologic stage ≥T3 (≥pT3), and tumor upgrading. Subgroup analysis was performed for patients meeting eligibility criteria for active surveillance (n = 55). For this analysis, the NST group was compared to the EST/SST groups. Results: SST status was associated with adverse preoperative risk factors for aggressive disease. Univariate analysis demonstrated significant association between SST and primary Gleason ≥4 pathology and stage ≥pT3 (P <.05). On multivariate analysis, SST was independently predictive of primary Gleason ≥4 pathology (odds ratio [OR] 6.14, 95{\%} confidence interval [CI] 1.97-19.2) and Gleason upgrading (OR 2.47, 95{\%} CI 1.01-6.02). Among patients eligible for active surveillance, those in the NST group had decreased likelihood of Gleason ≥7 disease or stage ≥pT3 compared to the EST/SST groups (7.7{\%} vs 47.6{\%}, P =.01). Conclusion: Increased tumor suspicion on T2-WI/DWI MRI is indicative of adverse pathology on RP. These findings suggest a role for MRI in pretreatment risk assessment.",
author = "Borofsky, {Michael S.} and Rosenkrantz, {Andrew B.} and Nitya Abraham and Rajat Jain and Taneja, {Samir S.}",
year = "2013",
month = "6",
day = "1",
doi = "10.1016/j.urology.2012.12.026",
language = "English (US)",
volume = "81",
pages = "1279--1283",
journal = "Urology",
issn = "0090-4295",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Does suspicion of prostate cancer on integrated T2 and diffusion-weighted MRI predict more adverse pathology on radical prostatectomy?

AU - Borofsky, Michael S.

AU - Rosenkrantz, Andrew B.

AU - Abraham, Nitya

AU - Jain, Rajat

AU - Taneja, Samir S.

PY - 2013/6/1

Y1 - 2013/6/1

N2 - Objective: To determine whether suspicion for tumor on prostate MRI incorporating T2-weighted imaging (T2-WI) and diffusion-weighted imaging (DWI) predicts more adverse pathology on radical prostatectomy (RP). Methods: From 2007 to 2009, 154 patients underwent 1.5 Tesla pelvic-phased-array magnetic resonance imaging (MRI) of the prostate that included T2-WI and DWI before RP. MRI examinations were retrospectively reviewed and grouped by degree of suspicion for tumor: no suspicion for tumor (NST, n = 15), equivocal suspicion for tumor (EST, n = 60), or strong suspicion for tumor (SST, n = 79). The NST/EST groups were combined and compared to the SST group. Preoperative variables were used to assemble a multivariate model. Outcomes reflective of adverse pathology included primary Gleason grade ≥4, pathologic stage ≥T3 (≥pT3), and tumor upgrading. Subgroup analysis was performed for patients meeting eligibility criteria for active surveillance (n = 55). For this analysis, the NST group was compared to the EST/SST groups. Results: SST status was associated with adverse preoperative risk factors for aggressive disease. Univariate analysis demonstrated significant association between SST and primary Gleason ≥4 pathology and stage ≥pT3 (P <.05). On multivariate analysis, SST was independently predictive of primary Gleason ≥4 pathology (odds ratio [OR] 6.14, 95% confidence interval [CI] 1.97-19.2) and Gleason upgrading (OR 2.47, 95% CI 1.01-6.02). Among patients eligible for active surveillance, those in the NST group had decreased likelihood of Gleason ≥7 disease or stage ≥pT3 compared to the EST/SST groups (7.7% vs 47.6%, P =.01). Conclusion: Increased tumor suspicion on T2-WI/DWI MRI is indicative of adverse pathology on RP. These findings suggest a role for MRI in pretreatment risk assessment.

AB - Objective: To determine whether suspicion for tumor on prostate MRI incorporating T2-weighted imaging (T2-WI) and diffusion-weighted imaging (DWI) predicts more adverse pathology on radical prostatectomy (RP). Methods: From 2007 to 2009, 154 patients underwent 1.5 Tesla pelvic-phased-array magnetic resonance imaging (MRI) of the prostate that included T2-WI and DWI before RP. MRI examinations were retrospectively reviewed and grouped by degree of suspicion for tumor: no suspicion for tumor (NST, n = 15), equivocal suspicion for tumor (EST, n = 60), or strong suspicion for tumor (SST, n = 79). The NST/EST groups were combined and compared to the SST group. Preoperative variables were used to assemble a multivariate model. Outcomes reflective of adverse pathology included primary Gleason grade ≥4, pathologic stage ≥T3 (≥pT3), and tumor upgrading. Subgroup analysis was performed for patients meeting eligibility criteria for active surveillance (n = 55). For this analysis, the NST group was compared to the EST/SST groups. Results: SST status was associated with adverse preoperative risk factors for aggressive disease. Univariate analysis demonstrated significant association between SST and primary Gleason ≥4 pathology and stage ≥pT3 (P <.05). On multivariate analysis, SST was independently predictive of primary Gleason ≥4 pathology (odds ratio [OR] 6.14, 95% confidence interval [CI] 1.97-19.2) and Gleason upgrading (OR 2.47, 95% CI 1.01-6.02). Among patients eligible for active surveillance, those in the NST group had decreased likelihood of Gleason ≥7 disease or stage ≥pT3 compared to the EST/SST groups (7.7% vs 47.6%, P =.01). Conclusion: Increased tumor suspicion on T2-WI/DWI MRI is indicative of adverse pathology on RP. These findings suggest a role for MRI in pretreatment risk assessment.

UR - http://www.scopus.com/inward/record.url?scp=84878572298&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84878572298&partnerID=8YFLogxK

U2 - 10.1016/j.urology.2012.12.026

DO - 10.1016/j.urology.2012.12.026

M3 - Article

VL - 81

SP - 1279

EP - 1283

JO - Urology

JF - Urology

SN - 0090-4295

IS - 6

ER -