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Scand J Urol. 2018 Oct - Dec;52(5-6):333-339. doi: 10.1080/21681805.2018.1545799.

PI-RADS v2 and periprostatic fat measured on multiparametric magnetic resonance imaging can predict upgrading in radical prostatectomy pathology amongst patients with biopsy Gleason score 3 + 3 prostate cancer.

Zhai L1,2, Fan Y1,2, Sun S3, Wang H3, Meng Y1,2, Hu S4, Wang X3, Yu W1,2, Jin J1,2.

Author information

1
a Department of Urology , Peking University First Hospital , Beijing , China.
2
b Institute of Urology , Peking University, National Urological Cancer Center , Beijing , China.
3
c Department of Radiology , Peking University First Hospital , Beijing , China.
4
d Department of Genitourinary Pathology , Peking University First Hospital , Beijing , China.

Abstract

PURPOSE:

An underestimated biopsy Gleason score 3 + 3 can result in unfounded optimism amongst patients and cause physicians to miss the window for prostate cancer (PCa) cure. This study aims to evaluate the effectiveness of Prostate Imaging Reporting and Data System (PI-RADS) version 2 as well as periprostatic fat (PPF) measured on multiparametric magnetic resonance imaging (mp-MRI) at predicting pathological upgrading amongst patients with biopsy Gleason score 3 + 3 disease.

PATIENTS AND METHODS:

A retrospective analysis of 56 patients with biopsy Gleason score 6 PCa who underwent prebiopsy mp-MRI and radical prostatectomy (RP) between November 2013 and March 2018 was conducted. Two radiologists performed PI-RADS v2 score evaluation and different fat measurements on mp-MRI. The associations amongst clinical information, PI-RADS v2 score, different fat parameters and pathologic findings were analyzed. A nomogram predicting upgrading was established based on the results of logistic regression analysis.

RESULTS:

A total of 38 (67.9%) patients were upgraded to Gleason ≥7 disease on RP specimens. Prostate-specific antigen density (PSAD) (p < .001), positive core (p < .001), single-core positivity (p = .039), PI-RADS score (p < .001), front PPF area (p = .007) and front-to-total ratio (the ratio of front PPF area to total contour area) (p < .001) were risk factors for upgrading. On multivariate analysis, Epstein criteria (p = .02), PI-RADS score >3 (p = .024), and front-to-total ratio (p = .006) were independent risk factors for pathologic upgrading. The AUC value of the nomogram was 0.893 (95% CI, 0.787-0.999).

CONCLUSION:

The combination of PI-RADS v2 and periprostatic fat measured on mp-MRI can help predict pathologic upgrading amongst patients with biopsy Gleason score 3 + 3 PCa.

KEYWORDS:

PI-RADS v2; Prostate cancer; active surveillance; periprostatic fat

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