Impact of Gleason Subtype on Prostate Cancer Detection Using Multiparametric Magnetic Resonance Imaging: Correlation with Final Histopathology.
We determined whether Gleason pattern 4 architecture impacts tumor visibility on multiparametric magnetic resonance imaging and correlates with final histopathology.



A total of 83 tumor foci were identified in 22 radical prostatectomy specimens from patients with a prior negative biopsy who underwent magnetic resonance/ultrasound fusion biopsy followed by radical prostatectomy from January 2015 to July 2016. A genitourinary pathologist rereviewed tumor foci for Gleason architectural subtype. Each prostate imaging reporting and data system category 3 to 5 lesion on multiparametric magnetic resonance imaging was paired with its corresponding pathological tumor focus. Univariable and multivariable analyses were performed to determine predictors of tumor visibility.



Of the 83 tumor foci identified 26 (31%) were visible on multiparametric magnetic resonance imaging, 33 (40%) were Gleason score 3+3 and 50 (60%) were Gleason score 3+4 or greater. Among tumor foci containing Gleason pattern 4, increasing tumor size and noncribriform predominant architecture were the only independent predictors of tumor detection on multivariable analysis (p = 0.002 and p = 0.011, respectively). For tumor foci containing Gleason pattern 4, 0.5 cm or greater, multiparametric magnetic resonance imaging detected 10 of 13 (77%), 5 of 14 (36%) and 9 of 10 (90%) for poorly formed, cribriform and fused architecture, respectively (p = 0.01). The size threshold for the detection of cribriform tumors was higher than that of other architectural patterns. Furthermore, cribriform pattern was identified more frequently on systematic biopsy than on targeted biopsy.



Reduced visibility of cribriform pattern on multiparametric magnetic resonance imaging has significant ramifications for prostate cancer detection, surveillance and focal therapy.
Department of Urology, University of Rochester Medical Center, Rochester, New York.
Matthew
M
Truong
Department of Radiology and Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Gary
G
Hollenberg
Department of Radiology and Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Eric
E
Weinberg
Department of Urology, University of Rochester Medical Center, Rochester, New York; Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York.
Edward M
EM
Messing
Department of Urology, University of Rochester Medical Center, Rochester, New York; Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York.
Hiroshi
H
Miyamoto
Department of Urology, University of Rochester Medical Center, Rochester, New York. Electronic address: Thomas_Frye@urmc.rochester.edu.
Thomas P
TP
Frye
D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy; D008279:Magnetic Resonance Imaging; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
biopsy; magnetic resonance imaging; prostatic neoplasms