Wan Song1, Seok Hwan Bang2, Hwang Gyun Jeon2, Byong Chang Jeong2, Seong Il Seo2, Seong Soo Jeon2, Han Yong Choi3, Chan Kyo Kim4, Hyun Moo Lee5. 1. Department of Urology, Ewha Womans University School of Medicine, Seoul, Korea. 2. Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 3. Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. 4. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: Chankyokim@skku.edu. 5. Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: hyunmoo.lee@samsung.com.
Abstract
INTRODUCTION: The objective of this study was to investigate the effect of Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) on prediction of postoperative Gleason score (GS) upgrading for patients with biopsy GS 6 prostate cancer. PATIENTS AND METHODS: We retrospectively reviewed 443 patients who underwent magnetic resonance imaging (MRI) and radical prostatectomy for biopsy-proven GS 6 prostate cancer between January 2011 and December 2013. Preoperative clinical variables and pathologic GS were examined, and all MRI findings were assessed with PI-RADSv2. Receiver operating characteristic curves were used to compare predictive accuracies of multivariate logistic regression models with or without PI-RADSv2. RESULTS: Of the total 443 patients, 297 (67.0%) experienced GS upgrading postoperatively. PI-RADSv2 scores 1 to 3 and 4 to 5 were identified in 157 (25.4%) and 286 (64.6%) patients, respectively, and the rate of GS upgrading was 54.1% and 74.1%, respectively (P < .001). In multivariate analysis, prostate-specific antigen density > 0.16 ng/mL2, number of positive cores ≥ 2, maximum percentage of cancer per core > 20, and PI-RADSv2 score 4 to 5 were independent predictors influencing GS upgrading (each P < .05). When predictive accuracies of multivariate models with or without PI-RADSv2 were compared, the model including PI-RADSv2 was shown to have significantly higher accuracy (area under the curve, 0.729 vs. 0.703; P = .041). CONCLUSION: Use of PI-RADSv2 is an independent predictor of postoperative GS upgrading and increases the predictive accuracy of GS upgrading. PI-RADSv2 might be used as a preoperative imaging tool to determine risk classification and to help counsel patients with regard to treatment decision and prognosis of disease.
INTRODUCTION: The objective of this study was to investigate the effect of Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) on prediction of postoperative Gleason score (GS) upgrading for patients with biopsy GS 6 prostate cancer. PATIENTS AND METHODS: We retrospectively reviewed 443 patients who underwent magnetic resonance imaging (MRI) and radical prostatectomy for biopsy-proven GS 6 prostate cancer between January 2011 and December 2013. Preoperative clinical variables and pathologic GS were examined, and all MRI findings were assessed with PI-RADSv2. Receiver operating characteristic curves were used to compare predictive accuracies of multivariate logistic regression models with or without PI-RADSv2. RESULTS: Of the total 443 patients, 297 (67.0%) experienced GS upgrading postoperatively. PI-RADSv2 scores 1 to 3 and 4 to 5 were identified in 157 (25.4%) and 286 (64.6%) patients, respectively, and the rate of GS upgrading was 54.1% and 74.1%, respectively (P < .001). In multivariate analysis, prostate-specific antigen density > 0.16 ng/mL2, number of positive cores ≥ 2, maximum percentage of cancer per core > 20, and PI-RADSv2 score 4 to 5 were independent predictors influencing GS upgrading (each P < .05). When predictive accuracies of multivariate models with or without PI-RADSv2 were compared, the model including PI-RADSv2 was shown to have significantly higher accuracy (area under the curve, 0.729 vs. 0.703; P = .041). CONCLUSION: Use of PI-RADSv2 is an independent predictor of postoperative GS upgrading and increases the predictive accuracy of GS upgrading. PI-RADSv2 might be used as a preoperative imaging tool to determine risk classification and to help counsel patients with regard to treatment decision and prognosis of disease.