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).
  
  
  CONCLUSIONS
  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.
authors: Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, NY 10016, USA.
authors: Michael S
authors: MS
authors: Borofsky
authors: Andrew B
authors: AB
authors: Rosenkrantz
authors: Nitya
authors: N
authors: Abraham
authors: Rajat
authors: R
authors: Jain
authors: Samir S
authors: SS
authors: Taneja
mesh_terms: D016001:Confidence Intervals; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment