title: Multiparametric 3T MRI for the prediction of pathological downgrading after radical prostatectomy in patients with biopsy-proven Gleason score 3 + 4 prostate cancer.
abstract: OBJECTIVE
  The aim of this study was to assess the diagnostic performance of pre-treatment 3-Tesla (3T) multiparametric magnetic resonance imaging (mpMRI) for predicting Gleason score (GS) downgrading after radical prostatectomy (RP) in patients with GS 3 + 4 prostate cancer (PCa) on biopsy.
  
  
  METHODS
  We retrospectively reviewed 304 patients with biopsy-proven GS 3 + 4 PCa who underwent mpMRI before RP. On T2-weighted imaging and three mpMRI combinations (T2-weighted imaging + diffusion-weighted imaging [DWI], T2-weighted imaging + dynamic contrast-enhanced-MRI [DCE-MRI], and T2-weighted imaging + DWI + DCE-MRI), two radiologists (R1/R2) scored the presence of a dominant tumour using a 5-point Likert scale (1 = definitely absent to 5 = definitely present). Diagnostic performance in identifying downgrading was evaluated via areas under the curves (AUCs). Predictive accuracies of multivariate models were calculated.
  
  
  RESULTS
  In predicting downgrading, T2-weighted imaging + DWI (AUC = 0.89/0.85 for R1/R2) performed significantly better than T2-weighted imaging alone (AUC = 0.72/0.73; p < 0.001/p = 0.02 for R1/R2), while T2-weighted imaging + DWI + DCE-MRI (AUC = 0.89/0.84 for R1/R2) performed no better than T2-weighted imaging + DWI (p = 0.48/p > 0.99 for R1/R2). On multivariate analysis, the clinical + mpMRI model incorporating T2-weighted imaging + DWI (AUC = 0.92/0.88 for R1/R2) predicted downgrading significantly better than the clinical model (AUC = 0.73; p < 0.001 for R1/R2).
  
  
  CONCLUSIONS
  mpMRI improves the ability to identify a subgroup of patients with Gleason 3 + 4 PCa on biopsy who are candidates for active surveillance. DCE-MRI (compared to T2 + DWI) offered no additional benefit to the prediction of downgrading.
  
  
  CONCLUSIONS
  Diagnostic performance of T2-weighted-imaging + DWI was better than T2-weighted-imaging alone. Diagnostic performance of T2-weighted-imaging + DWI was similar to T2-weighted-imaging + DWI + DCE-MRI. Combining clinical and T2-weighted-imaging + DWI features best predicted GS downgrading. mpMRI might prevent overtreatment by increasing eligibility for PCa active surveillance.
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Gondo
authors.forename: Hedvig
authors.initials: H
authors.lastname: Hricak
authors.forename: Evis
authors.initials: E
authors.lastname: Sala
authors.forename: Junting
authors.initials: J
authors.lastname: Zheng
authors.forename: Chaya S
authors.initials: CS
authors.lastname: Moskowitz
authors.forename: Melanie
authors.initials: M
authors.lastname: Bernstein
authors.forename: James A
authors.initials: JA
authors.lastname: Eastham
authors.forename: Hebert Alberto
authors.initials: HA
authors.lastname: Vargas
mesh_terms: D000368:Aged; D001706:Biopsy; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011159:Population Surveillance; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies
references.citation: J Urol. 2013 Jan;189(1 Suppl):S19-25; discussion S25
references.pmid: 23234624
references.citation: Urol Oncol. 2013 May;31(4):442-7
references.pmid: 21478037
references.citation: Curr Opin Endocrinol Diabetes Obes. 2013 Jun;20(3):204-9
references.pmid: 23609043
references.citation: AJR Am J Roentgenol. 2013 Oct;201(4):W612-8
references.pmid: 24059400
references.citation: Nat Rev Urol. 2011 Apr 26;8(6):312-20
references.pmid: 21519351
references.citation: Radiology. 2013 Aug;268(2):440-50
references.pmid: 23481164
references.citation: J Urol. 2013 Oct;190(4):1218-22
references.pmid: 23643603
references.citation: Psychol Bull. 1968 Oct;70(4):213-20
references.pmid: 19673146
references.citation: J Urol. 2012 Nov;188(5):1732-8
references.pmid: 23017866
references.citation: Radiology. 2013 Jul;268(1):144-52
references.pmid: 23468576
references.citation: Nat Rev Drug Discov. 2013 Oct;12(10):743-55
references.pmid: 24008432
references.citation: Radiology. 2012 Nov;265(2):478-87
references.pmid: 22952382
references.citation: Urology. 2007 Mar;69(3):495-9
references.pmid: 17382152
references.citation: J Clin Oncol. 2011 Jan 10;29(2):228-34
references.pmid: 21115873
references.citation: Jpn J Clin Oncol. 2013 May;43(5):553-8
references.pmid: 23580758
references.citation: Am J Surg Pathol. 2012 Sep;36(9):1346-52
references.pmid: 22531173
references.citation: J Urol. 2012 Apr;187(4):1247-52
references.pmid: 22335871
references.citation: Eur Radiol. 2012 Apr;22(4):746-57
references.pmid: 22322308
references.citation: AJR Am J Roentgenol. 2011 Feb;196(2):374-81
references.pmid: 21257890
references.citation: BJU Int. 2009 Jan;103(1):43-8
references.pmid: 18782303
references.citation: J Urol. 2014 Jul;192(1):97-101
references.pmid: 24518778
references.citation: J Clin Oncol. 2011 Jun 1;29(16):2185-90
references.pmid: 21464416
references.citation: Urology. 2013 Jun;81(6):1279-83
references.pmid: 23394882
references.citation: Radiology. 2011 May;259(2):453-61
references.pmid: 21502392
references.citation: Eur Urol. 2012 May;61(5):1019-24
references.pmid: 22336380
references.citation: J Urol. 2006 Sep;176(3):991-5
references.pmid: 16890678
references.citation: Nat Rev Urol. 2013 Aug;10(8):473-82
references.pmid: 23712205
references.citation: BJU Int. 2013 Jun;111(7):1037-45
references.pmid: 23464904
references.citation: J Urol. 2013 Jun;189(6):2039-46
references.pmid: 23485507
references.citation: BJU Int. 2012 Dec;110(11):1672-7
references.pmid: 22928973
references.citation: Biometrics. 1977 Mar;33(1):159-74
references.pmid: 843571