Predictors of Upgrading from Low-grade Cancer at Prostatectomy in Men with Biparametric Magnetic Resonance Imaging

Overview

Journal Cent European J Urol

Specialty Urology

Date 2022 May 20

PMID 35591966

Authors

Ola Christiansen

Ola Bratt

Oyvind Kirkevold

Jurate Saltyte Benth

Pathmakulendran Manoharan

Anders Selnes

Erik Skaaheim Haug

Marit Slaaen

Affiliations

Soon will be listed here.

Abstract

Introduction: Prostate-specific antigen (PSA) density has previously been identified as a predictor of histological upgrading at radical prostatectomy, but how information from pre-treatment biparametric magnetic resonance imaging (bpMRI) contributes needs further clarification. The objective of this register-based study was to identify predictors of upgrading at prostatectomy in men with Grade group (GG) 1 and pre-treatment bpMRI.

Material And Methods: This single-center study included men with GG 1 cancer on prediagnostic biopsy, who underwent bpMRI and robotic-assisted radical prostatectomy (RARP) between March 2014 and September 2019. We estimated logistic regression models to explore predictors for upgrading. The explored potential predictors were age, PSA density, tumor stage and Prostate Imaging Reporting and Data System (PI-RADS) score (dichotomised 1-3 versus 4-5).

Results: Upgrading was observed in 56% (73/130) of the men. PSA density was the only significant predictor for upgrading (unadjusted OR = 1.7, 95% CI 1.2; 2.4 adjusted OR = 1.7, 95% CI 1.2; 2.5). The probability of upgrading was lower for men with a PIRADS 1-3 than for PIRADS 4-5, but the difference was not statistically significant (adjusted OR 0.4, 95% CI 0.2; 1.1, p = 0.082). Among men with PI-RADS 1-3, the probability increased with increasing PSA density (p = 0.036). With PI-RADS 4-5 the probability of upgrading was high over the entire PSA density range.

Conclusions: PSA density is a clinically important factor to predict upgrading from GG1 when bpMRI shows PI-RADS 1-3. In men with PI-RADS 4-5 on bpMRI, the probability of an undetected GG 2-5 cancer is high regardless of the PSA density.

Citing Articles

Determination of Whether Apex or Non-Apex Prostate Cancer Is the Best Candidate for the Use of Prostate-Specific Antigen Density to Predict Pathological Grade Group Upgrading and Upstaging after Radical Prostatectomy.

Huang C, He S, He Q, Gong Y, Song G, Zhou L J Clin Med. 2023; 12(4).

PMID: 36836195 PMC: 9967179. DOI: 10.3390/jcm12041659.

References

Magheli A, Hinz S, Hege C, Stephan C, Jung K, Miller K . Prostate specific antigen density to predict prostate cancer upgrading in a contemporary radical prostatectomy series: a single center experience. J Urol. 2009; 183(1):126-31. DOI: 10.1016/j.juro.2009.08.139. View

Girometti R, Giannarini G, Greco F, Isola M, Cereser L, Como G . Interreader agreement of PI-RADS v. 2 in assessing prostate cancer with multiparametric MRI: A study using whole-mount histology as the standard of reference. J Magn Reson Imaging. 2018; 49(2):546-555. DOI: 10.1002/jmri.26220. View

de Rooij M, Hamoen E, Witjes J, Barentsz J, Rovers M . Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis. Eur Urol. 2015; 70(2):233-45. DOI: 10.1016/j.eururo.2015.07.029. View

Nyk L, Tayara O, Zabkowski T, Kryst P, Andrychowicz A, Malewski W . The role of mpMRI in qualification of patients with ISUP 1 prostate cancer on biopsy to radical prostatectomy. BMC Urol. 2021; 21(1):82. PMC: 8130114. DOI: 10.1186/s12894-021-00850-3. View

Turkbey B, Rosenkrantz A, Haider M, Padhani A, Villeirs G, Macura K . Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2. Eur Urol. 2019; 76(3):340-351. DOI: 10.1016/j.eururo.2019.02.033. View

Athanazio D, Gotto G, Shea-Budgell M, Yilmaz A, Trpkov K . Global Gleason grade groups in prostate cancer: concordance of biopsy and radical prostatectomy grades and predictors of upgrade and downgrade. Histopathology. 2017; 70(7):1098-1106. DOI: 10.1111/his.13179. View

Boesen L, Norgaard N, Logager V, Balslev I, Bisbjerg R, Thestrup K . Prebiopsy Biparametric Magnetic Resonance Imaging Combined with Prostate-specific Antigen Density in Detecting and Ruling out Gleason 7-10 Prostate Cancer in Biopsy-naïve Men. Eur Urol Oncol. 2019; 2(3):311-319. DOI: 10.1016/j.euo.2018.09.001. View

Kaye D, Qi J, Morgan T, Linsell S, Ginsburg K, Lane B . Pathological upgrading at radical prostatectomy for patients with Grade Group 1 prostate cancer: implications of confirmatory testing for patients considering active surveillance. BJU Int. 2018; 123(5):846-853. PMC: 6944205. DOI: 10.1111/bju.14554. View

Song W, Bang S, Jeon H, Jeong B, Seo S, Jeon S . Role of PI-RADS Version 2 for Prediction of Upgrading in Biopsy-Proven Prostate Cancer With Gleason Score 6. Clin Genitourin Cancer. 2018; 16(4):281-287. DOI: 10.1016/j.clgc.2018.02.015. View

10.

Tamada T, Kido A, Yamamoto A, Takeuchi M, Miyaji Y, Moriya T . Comparison of Biparametric and Multiparametric MRI for Clinically Significant Prostate Cancer Detection With PI-RADS Version 2.1. J Magn Reson Imaging. 2020; 53(1):283-291. DOI: 10.1002/jmri.27283. View

11.

Norris J, Carmona Echeverria L, Bott S, Brown L, Burns-Cox N, Dudderidge T . What Type of Prostate Cancer Is Systematically Overlooked by Multiparametric Magnetic Resonance Imaging? An Analysis from the PROMIS Cohort. Eur Urol. 2020; 78(2):163-170. PMC: 7397509. DOI: 10.1016/j.eururo.2020.04.029. View

12.

Verep S, Erdem S, Ozluk Y, Kilicaslan I, Sanli O, Ozcan F . The pathological upgrading after radical prostatectomy in low-risk prostate cancer patients who are eligible for active surveillance: How safe is it to depend on bioptic pathology?. Prostate. 2019; 79(13):1523-1529. DOI: 10.1002/pros.23873. View

13.

Distler F, Radtke J, Bonekamp D, Kesch C, Schlemmer H, Wieczorek K . The Value of PSA Density in Combination with PI-RADS™ for the Accuracy of Prostate Cancer Prediction. J Urol. 2017; 198(3):575-582. DOI: 10.1016/j.juro.2017.03.130. View

14.

Cantiello F, Russo G, Kaufmann S, Cacciamani G, Crocerossa F, Ferro M . Role of multiparametric magnetic resonance imaging for patients under active surveillance for prostate cancer: a systematic review with diagnostic meta-analysis. Prostate Cancer Prostatic Dis. 2018; 22(2):206-220. DOI: 10.1038/s41391-018-0113-2. View

15.

Ferro M, Lucarelli G, de Cobelli O, Vartolomei M, Damiano R, Cantiello F . Circulating preoperative testosterone level predicts unfavourable disease at radical prostatectomy in men with International Society of Urological Pathology Grade Group 1 prostate cancer diagnosed with systematic biopsies. World J Urol. 2020; 39(6):1861-1867. PMC: 8217017. DOI: 10.1007/s00345-020-03368-9. View

16.

Boesen L, Norgaard N, Logager V, Balslev I, Bisbjerg R, Thestrup K . Assessment of the Diagnostic Accuracy of Biparametric Magnetic Resonance Imaging for Prostate Cancer in Biopsy-Naive Men: The Biparametric MRI for Detection of Prostate Cancer (BIDOC) Study. JAMA Netw Open. 2019; 1(2):e180219. PMC: 6324414. DOI: 10.1001/jamanetworkopen.2018.0219. View

17.

Oh J, Hong S, Lee J, Lee B, Lee S, Kwon O . Prostate-specific antigen vs prostate-specific antigen density as a predictor of upgrading in men diagnosed with Gleason 6 prostate cancer by contemporary multicore prostate biopsy. BJU Int. 2012; 110(11 Pt B):E494-9. DOI: 10.1111/j.1464-410X.2012.11182.x. View

18.

Epstein J, Egevad L, Amin M, Delahunt B, Srigley J, Humphrey P . The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. Am J Surg Pathol. 2015; 40(2):244-52. DOI: 10.1097/PAS.0000000000000530. View

19.

Vellekoop A, Loeb S, Folkvaljon Y, Stattin P . Population based study of predictors of adverse pathology among candidates for active surveillance with Gleason 6 prostate cancer. J Urol. 2013; 191(2):350-7. DOI: 10.1016/j.juro.2013.09.034. View

20.

Boesen L . Multiparametric MRI in detection and staging of prostate cancer. Dan Med J. 2017; 64(2). View