ORLANDO, FL USA (UroToday.com) - Prostate cancer is diagnosed more effectively by multiparametric magnetic resonance imaging (mp-MRI) when there is higher Gleason score. Even with this finding, Jesse Le and colleagues stated that some prostate cancers avoid detection by MRI. The authors presented their study in which their main goal was to assess the effectiveness of mp-MRI for detecting higher-grade prostate cancer. In addition, the authors discussed their attempt in identifying risk factors that can lead to poor tumor detection.
In their study, Jesse Le and colleagues presented on 122 male patients who underwent MRI prior to radical prostatectomy. A GU radiologist and pathologist reviewed each case and compared them with results of pathology specimens. Index tumor was defined as the highest Gleason score tumor, and in multifocal tumors, the authors set the largest tumors as the index.
They were able to identify 180 regions of interest and 283 tumors that were confirmed histologically. The sensitivity of detection was found to be 74% for patients with Gleason scores above 4+3. The authors also presented on the factors that allowed better tumor detection, some of which included index tumor status, size, and presence of extracapsular extension. In their data set, 84% of index tumors were successfully identified by mp-MRI, and 50% of the corresponding index tumors were detected by MRI if they were missed as non-index tumors.
They concluded that high Gleason score tumors avoided detection in only a fraction of cases. Some of the factors that would lead to decreased detection were concluded to be small size, non-index, and tumors that did not extend through the capsule. These findings, if confirmed, can be significant in clinical practice as they can be used in diagnostic decision-making. Considering rising health care costs, if one can assess the risk of missed findings on MRI, unnecessary scans can be avoided, resulting in a reduction of health care costs in prostate cancer patient cohorts.
Presented by Jesse Le, MD at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
Los Angeles, CA
Written by Garen Abedi, MD, University of California (Irvine), and medical writer for UroToday.com