PD06-07 AGGRESSIVENESS OF PROSTATE CANCER: CORRELATION BETWEEN PROSPECTIVELY ASSIGNED APPARENT DIFFUSION COEFFICIENT VALUES AND ISUP GRADE GROUP

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You have accessJournal of UrologyProstate Cancer: Detection & Screening I1 Apr 2018PD06-07 AGGRESSIVENESS OF PROSTATE CANCER: CORRELATION BETWEEN PROSPECTIVELY ASSIGNED APPARENT DIFFUSION COEFFICIENT VALUES AND ISUP GRADE GROUP Daniel Costa, Yin Xi, Muhammad Aziz, Franto Francis, Claus Roehrborn, Kenneth Goldberg, Niccolo Passoni, Nabeel Shakir, Alberto Diaz de Leon, and Ivan Pedrosa Daniel CostaDaniel Costa More articles by this author , Yin XiYin Xi More articles by this author , Muhammad AzizMuhammad Aziz More articles by this author , Franto FrancisFranto Francis More articles by this author , Claus RoehrbornClaus Roehrborn More articles by this author , Kenneth GoldbergKenneth Goldberg More articles by this author , Niccolo PassoniNiccolo Passoni More articles by this author , Nabeel ShakirNabeel Shakir More articles by this author , Alberto Diaz de LeonAlberto Diaz de Leon More articles by this author , and Ivan PedrosaIvan Pedrosa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.427AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Non-invasive quantitative markers of prostate cancer (PCa) aggressiveness have the potential to improve pre-treatment risk stratification. Previous investigations have shown an inverse correlation between Gleason score and apparent diffusion coefficient (ADC) values derived from diffusion-weighted MRI. Most of these investigations, however, were retrospective. The goal of this study was to determine the ability to use prospectively assigned mean ADC values to discriminate between ISUP grade groups. METHODS Using a prospectively maintained database, we identified all men with abnormal 3T endorectal coil mpMRI examinations (PIRADS v2 score ≥3) between Nov/16-Jul/17, without prior treatment, who subsequently had a positive targeted biopsy or radical prostatectomy. One of 9 radiologists prospectively assigned a mean ADC value for each lesion during clinical image interpretation. The index lesion on MRI - one per patient - was correlated with the site-concordant lesion on biopsy or whole-mount histopathology. Fusion or in-bore targeted biopsy and 3D-printed whole-mount histopathology enabled strict imaging-histology correlation. Logistic regression was used to evaluate the association between mean ADC values in discriminating International Society of Urological Pathology (ISUP) group 1 vs. grade group 2-5. Impact of lesion location (PZ vs. TZ) was also evaluated by stratification. Interquartile ranges (IQRs) were calculated. Diagnostic performances were determined using ROC curve and area under the curve (AUC) with 95% confidence intervals (CIs). Youden′s J statistic was used to determine optimal cutoff values. RESULTS Among the 218 eligible men, 41% underwent surgery and 59% had targeted biopsies. Mean PSA, age, prostate volume and lesion size were 10.2 ng/mL, 65y, 43 cc and 15 mm, respectively. ISUP grade groups 1-5 accounted for, respectively, 21%, 48%, 19%, 7% and 5% of cases. Overall and per-zone mean ADC values were lower for ISUP 2-5 than ISUP 1 (p<0.001,Fig.1). AUCs for the discrimination between ISUP group 1 vs. 2 or higher using mean ADC values were 0.85 (PZ+TZ), 0.91 (PZ) and 0.70 (TZ). Optimal cutoff values were 0.682 for PZ and 0.638 for TZ, resulting in a sensitivity and specificity of 78% and 94% for PZ, 72% and 67% for TZ, respectively. CONCLUSIONS ADC values can be used to predict ISUP grade groups, particularly in PZ lesions, facilitating pre-treatment risk stratification in men undergoing mpMRI and targeted prostate biopsies. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e153 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Daniel Costa More articles by this author Yin Xi More articles by this author Muhammad Aziz More articles by this author Franto Francis More articles by this author Claus Roehrborn More articles by this author Kenneth Goldberg More articles by this author Niccolo Passoni More articles by this author Nabeel Shakir More articles by this author Alberto Diaz de Leon More articles by this author Ivan Pedrosa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...