IS UPGRADE IN GLEASON SCORE AFTER RADICAL PROSTATECTOMY PREDICTABLE WITH PREOPERATIVE MULTIPARAMETRIC PROSTATE MRI?: COMPARISON OF ADC, K-TRANS, TUMOR SIZE AND PI-RADS SCORE

Abstract

Aim: In this study, the relationship between MRI parameters and upgrade in Gleason score after radical prostatectomy was investigated. Materials and Methods: Between November 2017 and July 2020, 112 patients who underwent multiparametric MRI with suspected prostate cancer, TRUS systematic and cognitive fusion biopsy and subsequent radical prostatectomy were involved this study. The patients were evaluated in two groups as those with and without the Gleason score upgrade after surgery. These two groups was compared in terms of ADC, k-trans, tumor size and PI-RADS score. Radiological evaluation was consensus using PI-RADS version 2.1 by two radiologists who lacked clinical knowledge. ADC and k-trans were measured in the MR workstation. ISUP scoring system was used in pathological evaluation. Results: Upgrade in Gleason score was found in 51/112 of the cases. Only 2/51 cases were PI-RADS score 1. Upgrade rate of Gleason score were 15,6% for PI-RADS score <4; and 84,3% for score ≥4. The most frequent upgrade was from ISUP 1 to ISUP 2. There was no significant difference in PSA, PSAd tumor size, k-trans and ADC in comparing between two groups. Upgrade was significantly higher in cases with PI-RADS score ≥4 and the transitional zone involvement on MRI (p<0.05). Conclusion: mpMRI is an effective method of predicting upgrade in Gleason score after radical prostatectomy. PI-RADS score ≥4 or transitional zone involvement has an independent predictive value.