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Lesion volume predicts prostate cancer risk and aggressiveness: validation of its value alone and matched with prostate imaging reporting and data system score
Author(s) -
Martorana Eugenio,
Pirola Giacomo Maria,
Scialpi Michele,
Micali Salvatore,
Iseppi Andrea,
Bonetti Luca Reggiani,
Kaleci Shaniko,
Torricelli Pietro,
Bianchi Giampaolo
Publication year - 2017
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13649
Subject(s) - medicine , prostate cancer , prostate , magnetic resonance imaging , prostatectomy , concordance , logistic regression , biopsy , radiology , prostate biopsy , nuclear medicine , cancer , urology
Objective To demonstrate the association between magnetic resonance imaging ( MRI ) estimated lesion volume ( LV ), prostate cancer detection and tumour clinical significance, evaluating this variable alone and matched with Prostate Imaging Reporting and Data System version 2 ( PI ‐ RADS v2) score. Patients and methods We retrospectively analysed 157 consecutive patients, with at least one prior negative systematic prostatic biopsy, who underwent transperineal prostate MRI /ultrasonography fusion‐targeted biopsy between January 2014 and February 2016. Suspicious lesions were delineated using a ‘region of interest’ and the system calculated prostate volume and LV . Patients were divided in groups considering LV (≤0.5, 0.5–1, ≥1 mL) and PI ‐ RADS score (1–5). We considered clinically significant prostate cancer as all cancers with a Gleason score of ≥3 + 4 as suggested by PI ‐ RADS v2. A direct comparison between MRI estimated LV ( MRI LV ) and histological tumour volume ( HTV ) was done in 23 patients who underwent radical prostatectomy during the study period. Differences between MRI LV and HTV were assessed using the paired sample t ‐test. MRI LV and HTV concordance was verified using a Bland–Altman plot. The chi‐squared test and logistic and ordinal regression models were used to evaluate difference in frequencies. Results The MRI LV and PI ‐ RADS score were associated both with prostate cancer detection (both P < 0.001) and with significant prostate cancer detection ( P < 0.001 and P = 0.008, respectively). When the two variables were matched, increasing LV increased the risk within each PI ‐ RADS group. Prostate cancer detection was 1.4‐times higher for LV s of 0.5–1 mL and 1.8‐times higher for LV s of ≥1 mL; significant prostate cancer detection was 2.6‐times for LV s of 0.5–1 mL and 4‐times for LV s of ≥1 mL. There was a positive correlation between MRI LV and HTV ( r = 0.9876, P < 0.001). Finally, Bland–Altman analysis showed that MRI LV was underestimated by 4.2% compared to HTV . Study limitations include its monocentric and retrospective design and the limited cohort. Conclusions This study demonstrates that PI ‐ RADS score and the MRI LV , independently and in combination, are associated with prostate cancer detection and with tumour clinical significance.