An increase or 'upgrade' in Gleason Score (GS) in prostate cancer following Transrectal Ultrasound (TRUS) guided biopsies remains a significant challenge to overcome. to evaluate whether MRI has the potential to narrow the discrepancy of histopathological grades between biopsy and radical prostatectomy, three hundred and thirty men treated consecutively by laparoscopic radical prostatectomy (LRP) between July 2014 and January 2019 with localized prostate cancer were included in this study. Independent radiologists and pathologists assessed the MRI and histopathology of the biopsies and prostatectomy specimens respectively. A multivariate model was constructed using logistic regression analysis to assess the ability of MRI to predict upgrading in biopsy GS in a nomogram. A decision-analysis curve was constructed assessing impact of nomogram using different thresholds for probabilities of upgrading. PIRADS scores were obtained from MRI scans in all the included cases. In a multivariate analysis, the PIRADS v2.0 score significantly improved prediction ability of MRI scans for upgrading of biopsy GS (p = 0.001, 95% CI [0.06-0.034]), which improved the C-index of predictive nomogram significantly (0.90 vs. 0.64, p < 0.05). PIRADS v2.0 score was an independent predictor of postoperative GS upgrading and this should be taken into consideration while offering treatment options to men with localized prostate cancer.
Scientific reports. 2020 May 07*** epublish ***
Saeed Alqahtani, Cheng Wei, Yilong Zhang, Magdalena Szewczyk-Bieda, Jennifer Wilson, Zhihong Huang, Ghulam Nabi
Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK., School of Science and Engineering, University of Dundee, Dundee, UK., Department of Clinical Radiology, Ninewells Hospital, Dundee, UK., Department of Pathology, Ninewells Hospital, Dundee, UK., Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK. .