title: Apparent diffusion coefficient value is a strong predictor of unsuspected aggressiveness of prostate cancer before radical prostatectomy.
abstract: OBJECTIVE
  To evaluate the use of multiparametric MRI (mp MRI) parameters in order to predict prostate cancer aggressiveness as defined by pathological Gleason score or molecular markers in a cohort of patients defined with a Gleason score of 6 at biopsy.
  
  
  METHODS
  Sixty-seven men treated by radical prostatectomy (RP) for a low grade (Gleason 6) on biopsy and mp MRI before biopsy were selected. The cycle cell proliferation (CCP) score assessed by the Prolaris test and Ki-67/PTEN expression assessed by immunohistochemistry were quantified on the RP specimens.
  
  
  RESULTS
  49.25 % of the cancers were undergraded on biopsy compared to the RP specimens. Apparent diffusion coefficient (ADC) < 0.80 × 10(-3) mm(2)/s (P value 0.003), Likert score >4 (P value 0.003) and PSA density >0.15 ng/ml/cc (P value 0.035) were significantly associated with a higher RP Gleason score. Regarding molecular markers of aggressiveness, ADC < 0.80 × 10(-3) mm(2)/s and Likert score >4 were also significantly associated with a positive staining for Ki-67 (P value 0.039 and 0.01, respectively). No association was found between any analyzed MRI or clinical parameter and the CCP score.
  
  
  CONCLUSIONS
  Decreasing ADC value is a stronger indicator of aggressive prostate cancer as defined by molecular markers or postsurgical histology than biopsy characteristics.
authors.affiliation: Academic Department of Radiology, Pitie-Salpetriere Hospital, AP-HP, UPMC Univ Paris 06, 83 Boulevard de l'Hopital, 75013, Paris, France. raphaele.renardpenna@aphp.fr.|GRC n°5, ONCOTYPE-URO, Institut Universitaire de Cancerologie, UPMC Univ Paris 06, Paris, France. raphaele.renardpenna@aphp.fr.
authors.forename: Raphaele
authors.initials: R
authors.lastname: Renard Penna
authors.affiliation: GRC n°5, ONCOTYPE-URO, Institut Universitaire de Cancerologie, UPMC Univ Paris 06, Paris, France.|CeRePP, Paris, France.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Cancel-Tassin
authors.affiliation: GRC n°5, ONCOTYPE-URO, Institut Universitaire de Cancerologie, UPMC Univ Paris 06, Paris, France.|CeRePP, Paris, France.|Academic Department of Pathology, Pitie-Salpetriere Hospital, AP-HP, UPMC Univ Paris 06, Paris, France.
authors.forename: Eva
authors.initials: E
authors.lastname: Comperat
authors.affiliation: Academic Department of Urology, Pitie-Salpetriere Hospital, AP-HP, UPMC Univ Paris 06, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mozer
authors.affiliation: GRC n°5, ONCOTYPE-URO, Institut Universitaire de Cancerologie, UPMC Univ Paris 06, Paris, France.|Academic Department of Urology, Pitie-Salpetriere Hospital, AP-HP, UPMC Univ Paris 06, Paris, France.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Léon
authors.affiliation: GRC n°5, ONCOTYPE-URO, Institut Universitaire de Cancerologie, UPMC Univ Paris 06, Paris, France.|Academic Department of Pathology, Pitie-Salpetriere Hospital, AP-HP, UPMC Univ Paris 06, Paris, France.
authors.forename: Justine
authors.initials: J
authors.lastname: Varinot
authors.affiliation: GRC n°5, ONCOTYPE-URO, Institut Universitaire de Cancerologie, UPMC Univ Paris 06, Paris, France.|CeRePP, Paris, France.|Academic Department of Urology, Pitie-Salpetriere Hospital, AP-HP, UPMC Univ Paris 06, Paris, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Roupret
authors.affiliation: GRC n°5, ONCOTYPE-URO, Institut Universitaire de Cancerologie, UPMC Univ Paris 06, Paris, France.|Academic Department of Urology, Pitie-Salpetriere Hospital, AP-HP, UPMC Univ Paris 06, Paris, France.
authors.forename: Marc-Olivier
authors.initials: MO
authors.lastname: Bitker
authors.affiliation: Academic Department of Radiology, Pitie-Salpetriere Hospital, AP-HP, UPMC Univ Paris 06, 83 Boulevard de l'Hopital, 75013, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lucidarme
authors.affiliation: GRC n°5, ONCOTYPE-URO, Institut Universitaire de Cancerologie, UPMC Univ Paris 06, Paris, France.|CeRePP, Paris, France.|Academic Department of Urology, Pitie-Salpetriere Hospital, AP-HP, UPMC Univ Paris 06, Paris, France.|Academic Department of Urology, Tenon Hospital, AP-HP, UPMC Univ Paris 06, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Cussenot
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy / Q000379:methods*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D018450:Disease Progression; D019160:Endosonography / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000379:methods*; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D012007:Rectum; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: Biological markers; Biopsy; Diffusion magnetic resonance imaging; Prognosis; Prostatic neoplasms