PURPOSE: Differentiating significant cancer from insignificant cancer is a major challenge in active surveillance (AS) for prostate cancer.
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We evaluated whether the apparent diffusion coefficient (ADC) grade from 3-T diffusion-weighted magnetic resonance imaging (DW-MRI) is useful to exclude men with unfavorable pathological features from men meeting current AS eligibility criteria.
METHODS: Among patients who underwent radical prostatectomy, 117 potential AS candidates defined according to 2013 European Association of Urology guidelines who had undergone preoperative 3-T DW-MRI were included. A blinded uro-radiologist graded the level of suspicion from the ADC map using the Likert scale from 1 to 5. The rate of unfavorable pathological features was evaluated according to ADC grade. Unfavorable pathological features were defined as non-organ-confined disease or pathological Gleason score≥7 (4+3). The associations between unfavorable pathological features and clinical variables including ADC grade (>3 vs. ≤ 3) were evaluated using logistic regression analysis.
RESULTS: The rates of unfavorable pathological features were 0.0% (0/14), 2.9% (1/34), 5.4% (2/37), 25.0% (6/24), and 37.5% (3/8) from grades 1 to 5 (P=0.002). The predictive accuracy was as high as 0.804. The rates were significantly different between low (≤ 3, 3.5%) and high (>3, 28.1%, P< 0.001) grades. The sensitivity, specificity, and positive and negative predictive values were 75.0%, 78.1%, 28.1%, and 96.5%. ADC grade (odds ratio [OR], 10.696; 95% confidence interval [CI], 2.675-42.773) was significantly associated with unfavorable pathological features, even after adjusting for other variables (OR, 11.274; 95% CI, 2.622-48.471).
CONCLUSIONS: ADC grade from 3-T DW-MRI is useful to predict men with unfavorable pathologic features from AS candidates.
Jeong CW, Park YH, Hwang SI, Lee S, Jeong SJ, Hong SK, Byun SS, Lee HJ, Lee SE. Are you the author?
Departments of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Reference: Prostate Int. 2014 Dec;2(4):169-75.