Multiparametric MRI strongly predicts post-surgical pathology, but misses aggressive prostate cancers as assessed by cell cycle progression (CCP) score.

PURPOSE - To identify prognostic biomarkers in prostate cancer (PCa) by means of a radio-genomics strategy that integrates gene expression (CCP score) and medical images.

MATERIALS AND METHODS - Institutional Review Board approval and written informed consent of 106 PCa (mainly low risk: 60%) men, who had multiparametric (mp) MRI before radical prostatectomy (RP) and a CCP score, were obtained. Correlation between results of mpMRI and the Gleason grade or the CCP score was assessed by logistic regression.

RESULTS - Patients with primary Gleason grade >3 had a longer median Tmax (13 vs 10 mm, P = .0001), and a lower median ADC value (0.745 vs 0.88 x 10(-3) mm(2)/s, P = .0001) than those with primary Gleason grade ≤3. A Tmax ≥10 mm (OR = 4.9; 95% CI, 1.7 to 14.0; P = .0012) and an ADC value ≤.80 x 10(-3) mm(2)/s (OR = 7.5; 95% CI, 3.0 to 18.7; P < .0001) were significantly associated with primary Gleason grade >3. The combined measure of Tmax 0.80 x 10(-3) mm(2)/s identified only index lesions harbouring primary Gleason grade 3. However, 7 of those lesions showed molecular pattern of high risk of lethal prostate cancer (CCP score >0).

CONCLUSIONS - Multiparametric MRI is able to predict low and high risk Gleason score in the tumour. However, CCP score did not completely match with mpMRI result. These results suggest that the management of early stages PCa could strongly benefit by employing MRI-targeted biopsy coupled with molecular analysis.

J Urol. 2015 Aug 10. pii: S0022-5347(15)04528-0. doi: 10.1016/j.juro.2015.06.107. [Epub ahead of print]

Renard-Penna R1, Cancel-Tassin G2, Comperat E3, Varinot J4, Léon P5, Roupret M6, Mozer P5, Vaessen C5, Lucidarme O7, Bitker MO5, Cussenot O8.

1 UPMC Univ Paris 06, GRC n°5, ONCOTYPE-URO, Institut Universitaire de Cancérologie; Department of Radiology.
2 UPMC Univ Paris 06, GRC n°5, ONCOTYPE-URO, Institut Universitaire de Cancérologie; CeRePP, Paris, France.
3 UPMC Univ Paris 06, GRC n°5, ONCOTYPE-URO, Institut Universitaire de Cancérologie; Department of Pathology; CeRePP, Paris, France.
4 UPMC Univ Paris 06, GRC n°5, ONCOTYPE-URO, Institut Universitaire de Cancérologie; Department of Pathology.
5 UPMC Univ Paris 06, GRC n°5, ONCOTYPE-URO, Institut Universitaire de Cancérologie; AP-HP, Pitie-Salpetriere Hospital, Department of Urology.
6 UPMC Univ Paris 06, GRC n°5, ONCOTYPE-URO, Institut Universitaire de Cancérologie; AP-HP, Pitie-Salpetriere Hospital, Department of Urology; CeRePP, Paris, France.
7 Department of Radiology.
8 UPMC Univ Paris 06, GRC n°5, ONCOTYPE-URO, Institut Universitaire de Cancérologie; AP-HP, Pitie-Salpetriere Hospital, Department of Urology; CeRePP, Paris, France.