MP53-04 HOW ACCURATELY CAN WE DETECT SIGNIFICANT PROSTATE CANCER WITH DIFFUSION-WEIGHTED MRI?

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening II1 Apr 2014MP53-04 HOW ACCURATELY CAN WE DETECT SIGNIFICANT PROSTATE CANCER WITH DIFFUSION-WEIGHTED MRI? Gianluca Giannarini, Urs E. Studer, Johannes M. Froehlich, Lauren J. Bains, Frederik De Keyzer, Maria Triantafyllou, Achim Fleischmann, and Harriet C. Thoeny Gianluca GiannariniGianluca Giannarini More articles by this author , Urs E. StuderUrs E. Studer More articles by this author , Johannes M. FroehlichJohannes M. Froehlich More articles by this author , Lauren J. BainsLauren J. Bains More articles by this author , Frederik De KeyzerFrederik De Keyzer More articles by this author , Maria TriantafyllouMaria Triantafyllou More articles by this author , Achim FleischmannAchim Fleischmann More articles by this author , and Harriet C. ThoenyHarriet C. Thoeny More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1635AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives A main concern of current prostate cancer (PCa) screening is the substantial overdiagnosis of tumors that are not life-threatening. The most commonly used tests (i.e. PSA and transrectal ultrasound-guided prostate biopsy) are largely inaccurate to identify significant disease, the only form of PCa that merits immediate curative treatment. The aim of our study was to prospectively assess the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) for detection of significant PCa. Methods Our prospective trial enrolled 111 consecutive men with primary prostate and/or bladder cancer undergoing 3T DW-MRI prior to radical prostatectomy (n=78) or cystoprostatectomy (n=33). A qualitative 3-grade PCa suspicion score (»positive«, »uncertain« or »negative«) was assigned to the largest lesion visible on DW-MRI (»index lesion«) by three independent readers, who were blinded to clinical and pathological data. Prostates with »uncertain» and »negative« lesions were considered as having no PCa. The »index lesion« was then correlated with the »index tumor« at definitive pathology as the reference standard. Primary outcomes were sensitivity and specificity of DW-MRI for detection of significant PCa, which was defined as largest diameter of the »index tumor« ≥ 1 cm or extraprostatic extension or Gleason score ≥ 7 at definitive pathology. Secondary outcome was inter-reader agreement assessed with Fleiss′ kappa coefficient. DW-MRI reading time was also calculated. Results Of the 111 patients, 93 had PCa (80 significant and 13 insignificant disease) and 18 had no PCa at definitive pathology. Correlation between location of the »index lesion« at DW-MRI and of the »index tumor« at definitive pathology was perfect for true positive cases. Sensitivity and specificity of DW-MRI for detection of significant PCa ranged from 89% to 91% and 77% to 81%, respectively, for the three readers. Fleiss′ kappa coefficient ranged from 0.65 to 0.74, indicating good inter-reader agreement. Median reading time was 7 min (full range 4-18 min). Conclusions In our study, 3T DW-MRI was an accurate method to detect significant PCa based on definitive pathology of entire prostates with and without PCa. Inter-reader agreement was good, reading time was short and neither contrast medium nor endorectal coil was used. This technique should be further evaluated as a new screening tool for PCa and for stratification of PCa patients for individualized treatment options. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e589 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Gianluca Giannarini More articles by this author Urs E. Studer More articles by this author Johannes M. Froehlich More articles by this author Lauren J. Bains More articles by this author Frederik De Keyzer More articles by this author Maria Triantafyllou More articles by this author Achim Fleischmann More articles by this author Harriet C. Thoeny More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...