Role of DWI/ADC in the Assessment of Prostate Cancer Aggressiveness and Its Correlation to Gleason Score

Abstract

Background Cancer prostate represents a major health problem. it is one of the most common solid malignancies among male population. Prostate cancer (PCa) is considered one of the most common cancers among male population. Its incidence increases with age, ranging from 34% in the fifth decade, to 70% over the 80 years. Aim of the Work The objective of the study is to correlate and compare the DWI and ADC values of prostate cancer with the histopathological grading via Gleason score. Patients and Methods During a period of 6 months duration thirty patients were enrolled in the study. All patients with elevated PSA values greater than 4 ng/ml underwent sextant TRUS guided biopsies. MRI examination was done either prior to the TRUS biopsy or at least 3 weeks after the TRUS biopsy. Results In our study, we found that the ADC values correlated significantly with Gleason score of prostate cancer based on TRUS biopsy with significant p value < 0.001 and were significantly predictive of high-grade prostate cancer. This outcome agrees with recent reports that found an inverse correlation between ADC and Gleason score. They confrmed the correlation between ADC derived DWI and tumor alteration. ADC analysis seems to show a high capability in defining the tumor aggressiveness, as in monitoring radiation therapy effect or surgical recurrence. Conclusion ADC values showed a negative correlation with GS. This study suggests that ADC values may allow the noninvasive assessment of biological aggressiveness of prostate cancer, which may contribute in targeting biopsy to MRI-positive foci using a fusion of MRI and transrectal ultrasound. Incorporating the GS on targeted biopsy with the ADC value will further improve the detection of highgrade cancer foci also plays a role in planning initial treatment strategies.