Prediction of prostate cancer Gleason score upgrading from biopsy to radical prostatectomy using pre-biopsy multiparametric MRI PIRADS scoring system

Saeed Alqahtani,Yilong Zhang,Ghulam Nabi,Zhihong Huang,Cheng Wei,Jennifer Wilson,Magdalena Szewczyk-Bieda

doi:10.1038/s41598-020-64693-y

Saeed Alqahtani, Yilong Zhang + Show 5 more

Open Access

https://doi.org/10.1038/s41598-020-64693-y

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Abstract

An increase or ‘upgrade’ in Gleason Score (GS) in prostate cancer following Transrectal Ultrasound (TRUS) guided biopsies remains a significant challenge to overcome. to evaluate whether MRI has the potential to narrow the discrepancy of histopathological grades between biopsy and radical prostatectomy, three hundred and thirty men treated consecutively by laparoscopic radical prostatectomy (LRP) between July 2014 and January 2019 with localized prostate cancer were included in this study. Independent radiologists and pathologists assessed the MRI and histopathology of the biopsies and prostatectomy specimens respectively. A multivariate model was constructed using logistic regression analysis to assess the ability of MRI to predict upgrading in biopsy GS in a nomogram. A decision-analysis curve was constructed assessing impact of nomogram using different thresholds for probabilities of upgrading. PIRADS scores were obtained from MRI scans in all the included cases. In a multivariate analysis, the PIRADS v2.0 score significantly improved prediction ability of MRI scans for upgrading of biopsy GS (p = 0.001, 95% CI [0.06–0.034]), which improved the C-index of predictive nomogram significantly (0.90 vs. 0.64, p < 0.05). PIRADS v2.0 score was an independent predictor of postoperative GS upgrading and this should be taken into consideration while offering treatment options to men with localized prostate cancer.

Highlights

Histology from biopsies categorised into Gleason score is the only confirmatory test for cancer diagnosis and is most commonly used for risk stratification of men with a recent diagnosis of prostate cancer
Corcoran et al.[6] have shown that even after adjusting for known preoperative variables (including clinical stage, prostate-specific antigen (PSA), number of positive cores and percentage of positive cores) upgrade to a higher Gleason Score (GS) remained a strong and independent predictor of biochemical recurrence after attempted local curative therapy, this underscores the importance of gaining more information to predict upgrading of biopsy GS in men diagnosed with prostate cancer as this may serve as a marker of biologically aggressive disease
Between July 2014 and January 2019, 330 men consecutively treated by laparoscopic radical prostatectomy (LRP) who were diagnosed with localised prostate cancer with raised PSA or/and abnormal digital rectal examination were included in this study

Summary

Introduction

Histology from biopsies categorised into Gleason score is the only confirmatory test for cancer diagnosis and is most commonly used for risk stratification of men with a recent diagnosis of prostate cancer. Under calling of Gleason cribriform Gleason pattern 4 as pattern 3 or the presence of borderline grades due to barely appreciable glandular differentiation under microscope and lack of sampling of tertiary grade disease on biopsies are known contributors. Factors such as age, size of prostate, extent of cancer on biopsy needle and number of biopsy samples (extended/ or mapping) have been known to impact on the incidence of upgrading[2]. This is the first report describing predictive accuracy of pre-biopsy MRI in upgrading biopsy GS following LRP using patient-specific 3D moulds to ensure permitted alignment of excised prostates with MRI scans

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