Ely R Felker1, Steven S Raman1, Daniel J Margolis2, David S K Lu1, Nicholas Shaheen1, Shyam Natarajan3,4, Devi Sharma4, Jiaoti Huang5, Fred Dorey4, Leonard S Marks4. 1. 1 Department of Radiology, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Ste 1638, Los Angeles, CA 90095. 2. 2 Department of Radiology, Weill Cornell Medical College, New York, NY. 3. 3 Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA. 4. 4 Department of Urology, Ronald Reagan UCLA Medical Center, Los Angeles, CA. 5. 5 Department of Pathology, Duke University, Durham, NC.
Abstract
OBJECTIVE: The objective of our study was to determine the clinical and MRI characteristics of clinically significant prostate cancer (PCA) (Gleason score ≥ 3 + 4) in men with Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) category 3 transition zone (TZ) lesions. MATERIALS AND METHODS: From 2014 to 2016, 865 men underwent prostate MRI and MRI/ultrasound (US) fusion biopsy (FB). A subset of 90 FB-naïve men with 96 PI-RADSv2 category 3 TZ lesions was identified. Patients were imaged at 3 T using a body coil. Images were assigned a PI-RADSv2 category by an experienced radiologist. Using clinical data and imaging features, we performed univariate and multivariate analyses to identify predictors of clinically significant PCA. RESULTS: The mean patient age was 66 years, and the mean prostate-specific antigen density (PSAD) was 0.13 ng/mL2. PCA was detected in 34 of 96 (35%) lesions, 14 of which (15%) harbored clinically significant PCA. In univariate analysis, DWI score, prostate volume, and PSAD were significant predictors (p < 0.05) of clinically significant PCA with a suggested significance for apparent diffusion coefficient (ADC) and prostate-specific antigen value (p < 0.10). On multivariate analysis, PSAD and lesion ADC were the most important covariates. The combination of both PSAD of 0.15 ng/mL2 or greater and an ADC value of less than 1000 mm2/s yielded an AUC of 0.91 for clinically significant PCA (p < 0.001). If FB had been restricted to these criteria, only 10 of 90 men would have undergone biopsy, resulting in diagnosis of clinically significant PCA in 60% with eight men (9%) misdiagnosed (false-negative). CONCLUSION: The yield of FB in men with PI-RADSv2 category 3 TZ lesions for clinically significant PCA is 15% but significantly improves to 60% (AUC > 0.9) among men with PSAD of 0.15 ng/mL2 or greater and lesion ADC value of less than 1000 mm2/s.
OBJECTIVE: The objective of our study was to determine the clinical and MRI characteristics of clinically significant prostate cancer (PCA) (Gleason score ≥ 3 + 4) in men with Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) category 3 transition zone (TZ) lesions. MATERIALS AND METHODS: From 2014 to 2016, 865 men underwent prostate MRI and MRI/ultrasound (US) fusion biopsy (FB). A subset of 90 FB-naïve men with 96 PI-RADSv2 category 3 TZ lesions was identified. Patients were imaged at 3 T using a body coil. Images were assigned a PI-RADSv2 category by an experienced radiologist. Using clinical data and imaging features, we performed univariate and multivariate analyses to identify predictors of clinically significant PCA. RESULTS: The mean patient age was 66 years, and the mean prostate-specific antigen density (PSAD) was 0.13 ng/mL2. PCA was detected in 34 of 96 (35%) lesions, 14 of which (15%) harbored clinically significant PCA. In univariate analysis, DWI score, prostate volume, and PSAD were significant predictors (p < 0.05) of clinically significant PCA with a suggested significance for apparent diffusion coefficient (ADC) and prostate-specific antigen value (p < 0.10). On multivariate analysis, PSAD and lesion ADC were the most important covariates. The combination of both PSAD of 0.15 ng/mL2 or greater and an ADC value of less than 1000 mm2/s yielded an AUC of 0.91 for clinically significant PCA (p < 0.001). If FB had been restricted to these criteria, only 10 of 90 men would have undergone biopsy, resulting in diagnosis of clinically significant PCA in 60% with eight men (9%) misdiagnosed (false-negative). CONCLUSION: The yield of FB in men with PI-RADSv2 category 3 TZ lesions for clinically significant PCA is 15% but significantly improves to 60% (AUC > 0.9) among men with PSAD of 0.15 ng/mL2 or greater and lesion ADC value of less than 1000 mm2/s.
Entities:
Keywords:
MRI; Prostate Imaging and Reporting System (PI-RADS); prostate; risk stratification; transition zone
Authors: Andrew B Rosenkrantz; Luke A Ginocchio; Daniel Cornfeld; Adam T Froemming; Rajan T Gupta; Baris Turkbey; Antonio C Westphalen; James S Babb; Daniel J Margolis Journal: Radiology Date: 2016-04-01 Impact factor: 11.105
Authors: Daniel I Glazer; Elmira Hassanzadeh; Andriy Fedorov; Olutayo I Olubiyi; Shayna S Goldberger; Tobias Penzkofer; Trevor A Flood; Paul Masry; Robert V Mulkern; Michelle S Hirsch; Clare M Tempany; Fiona M Fennessy Journal: Abdom Radiol (NY) Date: 2017-03
Authors: Berrend G Muller; Joanna H Shih; Sandeep Sankineni; Jamie Marko; Soroush Rais-Bahrami; Arvin Koruthu George; Jean J M C H de la Rosette; Maria J Merino; Bradford J Wood; Peter Pinto; Peter L Choyke; Baris Turkbey Journal: Radiology Date: 2015-06-18 Impact factor: 11.105
Authors: Rajan T Gupta; Christopher R Kauffman; Kirema Garcia-Reyes; Mark L Palmeri; John F Madden; Thomas J Polascik; Andrew B Rosenkrantz Journal: AJR Am J Roentgenol Date: 2015-08 Impact factor: 3.959
Authors: Christopher P Filson; Shyam Natarajan; Daniel J A Margolis; Jiaoti Huang; Patricia Lieu; Frederick J Dorey; Robert E Reiter; Leonard S Marks Journal: Cancer Date: 2016-01-07 Impact factor: 6.860
Authors: Ely R Felker; Jason Wu; Shyam Natarajan; Daniel J Margolis; Steven S Raman; Jiaoti Huang; Fred Dorey; Leonard S Marks Journal: J Urol Date: 2015-12-07 Impact factor: 7.450
Authors: Fabian Steinkohl; Leonhard Gruber; Jasmin Bektic; Udo Nagele; Friedrich Aigner; Thomas R W Herrmann; Michael Rieger; Daniel Junker Journal: World J Urol Date: 2017-12-14 Impact factor: 4.226
Authors: Ely R Felker; Steven S Raman; Sepideh Shakeri; Sohrab A Mirak; Amirhossein M Bajgiran; Lorna Kwan; Pooria Khoshnoodi; Fuad F ElKhoury; Daniel J A Margolis; David Karow; David S K Lu; Nate White; Leonard S Marks Journal: AJR Am J Roentgenol Date: 2019-04-30 Impact factor: 3.959
Authors: Nicolas Linder; Alexander Schaudinn; Tim-Ole Petersen; Nikolaos Bailis; Patrick Stumpp; Lars-Christian Horn; Jens-Uwe Stolzenburg; Thomas Kahn; Michael Moche; Harald Busse Journal: MAGMA Date: 2019-05-09 Impact factor: 2.310
Authors: Bashir Al Hussein Al Awamlh; Leonard S Marks; Geoffrey A Sonn; Shyam Natarajan; Richard E Fan; Michael D Gross; Elizabeth Mauer; Samprit Banerjee; Stefanie Hectors; Sigrid Carlsson; Daniel J Margolis; Jim C Hu Journal: Urol Oncol Date: 2020-04-17 Impact factor: 3.498
Authors: Hannes Engel; Benedict Oerther; Marco Reisert; Elias Kellner; August Sigle; Christian Gratzke; Peter Bronsert; Tobias Krauss; Fabian Bamberg; Matthias Benndorf Journal: In Vivo Date: 2022 Sep-Oct Impact factor: 2.406
Authors: Jorge Abreu-Gomez; Daniel Walker; Tareq Alotaibi; Matthew D F McInnes; Trevor A Flood; Nicola Schieda Journal: Eur Radiol Date: 2020-03-24 Impact factor: 5.315