Transition Zone Cancers Research Articles

Diagnostic performance of ADC and ADCratio in MRI-based prostate cancer assessment: Asystematic review and meta-analysis.

To identify factors influencing the diagnostic performance of the quantitative imaging biomarkers ADC and ADCratio in prostate cancer (PCa) detection. A systematic literature search was conducted in Embase, Medline and Web of Science, for studies evaluating ADC values and ADCratio for PCa diagnosis, using the same patient cohorts and using histopathological references as ground truth. Pooled sensitivities, specificities, summary ROC curves and AUCs were calculated from constructed contingency data tables. Diagnostic performance (AUC) was quantitatively pooled using a bivariate mixed effects model. For identifying influencing factors, subgroup analysis, publication bias and heterogeneity assessment were investigated. Thirteen studies, involving 1038 patients and 1441 lesions, were included. For ADC, the pooled sensitivity and specificity was 80% (95% CI: 74-85%) and 78% (95% CI: 70-85%), respectively. For ADCratio pooled sensitivity and specificity was 80% (95% CI: 74-84%) and 80% (95% CI: 71-87%). Summary ROC analysis revealed AUCs of 0.86 (95% CI: 0.83-0.89) and 0.86 (95% CI: 0.83-0.89), respectively. Meta-regression showed heterogeneity between both imaging biomarkers. Subgroup analysis showed that ADCratio improved diagnostic performance in comparison to ADC when including both peripheral and transitional zone lesions (AUC: 0.87 [95% CI: 0.84-0.90] and 0.82 [95% CI: 0.79-0.85], respectively). Both ADC and ADCratio imaging biomarkers showed good and comparable diagnostic performance in PCa diagnosis. However, ADCratio shows better diagnostic performance than ADC in diagnosing transition zone cancers. In quantitative MRI-based PCa diagnosis, the imaging biomarker ADCratio is useful in challenging MRI readings of lesions. Understanding the performance of quantitative imaging biomarkers better can aid diagnostic MRI protocols, enhancing the precision of PCa assessments. MRI diffusion-weighted imaging-based ADC and ADCratio have comparable diagnostic performance in PCa assessment. In contrast to ADC, the ADCratio improves diagnostic performance, when assessing whole gland lesions. Compared to ADCratio, the ADC demonstrates enhanced diagnostic performance when evaluating peripheral zone lesions.

Morphologic perfusion patterns and PI-RADSv2.1 in transition zone prostate cancer

PurposeTo evaluate morphologic perfusion patterns in transition zone prostate cancer in multiparametric MRI controlled by in-bore MRI-guided prostate biopsy.MethodsTwo experienced radiologists evaluated MRI perfusion patterns in consensus from 321 biopsy cores from the transition zone in 141 patients. Transition zone cancer was present in 77 cores in 36 patients. Single early-phase perfusion images were evaluated separately for the presence of a transition zone prostate cancer (consensus tumor early perfusion). The proposed criteria for the perfusion pattern (asymmetry, signal strength, and homogeneity) were rated in consensus for each biopsy position in the presence of the T2w images including the markers of the biopsy trace. We analyzed receiver operating characteristic curves for the PI-RADSv2.1 score and the proposed perfusion pattern.ResultsA logistic regression model with PI-RADSv2.1 and perfusion patterns in early perfusion imaging improved the model fit significantly compared to a model containing only PI-RADSv2.1 (Likelihood Ratio Test, LR = 14.5, p < .001). The AUC was 0.96 for the multiple regression model compared to 0.92 for the PI-RADSv2.1 alone. The evaluation of homogeneity in single early-enhancement images is not inferior compared to the conventional DCE parameter of PI-RADSv2.1 (AUC 0.84 versus 0.83).ConclusionMorphologic perfusion patterns significantly improve the diagnostic performance of PI-RADSv2.1 in TZ prostate cancer.Graphical abstract

Objective Value of the Apparent Diffusion Coefficient (ADC) Map from Ultrahigh b-value Diffusion-weighted Imaging (DWI) in 3T MRI could be a Non-invasive Specific Biomarker for Prostate Cancer.

This article aims to explore the ADC value of ultrahigh b-value DWI and the diagnostic cutoff point in prostate cancer. A total of 78 patients were included in this study. T2 weighted imaging (T2WI), conventional diffusion-weighted imaging (DWI) (1000 s/mm2), and DWI with ultrahigh b-values of 2000 s/mm2 and 3000 s/mm2 were performed in each patient. With reference biopsy as the gold standard, the apparent diffusion coefficient (ADC)s of each b-value DWI image were analyzed. According to different b-value receiver operating characteristic (ROC) curves, the ADC diagnostic cutoff point for prostate cancer was determined. A total of 154 lesions were identified as prostate cancer. The ADC values for conventional DWI and ultrahigh b-value DWI with 2000 s/mm2 and 3000 s/mm2 were 1.097×10-3 mm2/s (1.040-1.153), 0.809×10-3 mm2/s (0.766-0.851) and 0.622×10-3 mm2/s (0.591-0.652), respectively, in the peripheral zone and 1.085×10-3 mm2/s (1.022-1.147), 0.815×10-3 mm2/s (0.770-0.861) and 0.651×10-3 mm2/s (0.617-0.685) in the transition zone. The area under the curve (AUC)s of the ADC values from ultrahigh b-value DWI (2000 s/mm2 and 3000 s/mm2) were 0.824 and 0.852 in the peripheral zone and 0.905 for the ADC values from ultrahigh b-value DWI (3000 s/mm2) in the transition zone. In the peripheral zone, the ADC diagnostic cutoff values for prostate cancer were 0.75×10-3 mm2/s and 0.685×10-3 mm2/s in DWI at 2000 s/mm2 and 3000 s/mm2, respectively, and the diagnosis of transition zone cancer was 0.8×10-3 mm2/s and 0.634×10-3 mm2/s, respectively. The ADC values from ultrahigh b-value DWI demonstrated better consistency and diagnostic efficacy in the diagnosis of prostate cancer.

Zonal origin of prostate cancer: comparison of long-term outcomes after radical prostatectomy

PurposeTo assess the impact of zonal origin on positive bladder neck (BN) margins and prostate-specific antigen (PSA) failure or early adjuvant therapy in the patients with complete long-term follow-up after radical prostatectomy (RP).MethodsA set of 4512 men were identified who underwent RP in Western Australia (WA) from March 2000 to December 2016 and had complete long-term follow-up. The t-test, Pearson chi-square test and Kaplan–Meier method with the log-rank test were used to evaluate differences between the transition zone (TZ) and peripheral/central zone (PZ/CZ) cancer. Univariate and multivariable Cox proportional hazard regression models were applied to assess parameters on PSA failure and early treatment.ResultsThe positive BN margin rate for TZ cancer fell significantly over the study period. However, BN margin rates increased for PZ/CZ cancer over the time. Data of 4512 patients with median follow-up of 9.1 years confirmed that the high-risk TZ tumours with negative margins had a significant lower rate of PSA failure or early treatment compared to those high-risk PZ/CZ tumours with negative margins.ConclusionProstate cancer zonal origin significantly impacts long-term biochemical outcomes in high-risk and margin-negative patients. BN invasion with margin involvement is more frequent in the TZ cancer and can be reduced by pre-operative identification of cancer zonal origin and adjustment of surgical procedures.

Clinicopathologic Significance of Anterior Prostate Cancer: Comparison With Posterior Prostate Cancer in the Era of Multiparametric Magnetic Resonance Imaging.

Anterior prostate cancer (APC) has been considered an indolent tumor, most commonly arising in the transition zone (TZ). More recently, detection of APC has been facilitated through multiparametric magnetic resonance imaging and improved biopsy techniques, enabling earlier detection. The pathologic features and clinical significance of pure APC in a large contemporary series of well-characterized tumors have, to date, not been elucidated. Cases with APC defined as cancer present anterior to the urethra only were identified from 1761 consecutive radical prostatectomy specimens accessioned between January 2015 and August 2016. The clinicopathologic features of these cases were compared with those of pure posterior prostate cancer (PPC) and the features of anterior peripheral zone (APZ) cancers were compared with those of TZ cancers. In addition, the tumor series from 2015 to 2016 was compared with a cohort of 1054 patients accessioned before the utilization of multiparametric magnetic resonance imaging in the routine workup of patients with prostate cancer. In the 2015-2016 series, there were 188 (10.7%) patients with APC compared with 5.4% in the series from the pre-multiparametric magnetic resonance imaging era. No difference was observed between APC and PPC with regards to patient age or mean serum prostate-specific antigen at presentation. Mean tumor volume and positive surgical margin (PSM) rates were significantly higher in APC. In contrast, PPC was more commonly high grade with more frequent extraprostatic extension (EPE). None of the cases of APC had infiltration of the seminal vesicle or lymph node involvement, in contrast to PPC, with almost 14% of cases in each category. The 3- and 5-year biochemical recurrence-free survival was significantly higher in APC when compared with PPC, although this was not retained on multivariable analysis which included tumor location. On division of APCs according to anatomic zone of origin, 45% were APZ cancer and 37% TZ cancer. On comparison of APZ and TZ cancers, there were no significant differences in mean age and serum prostate-specific antigen at presentation as well as tumor volume, Gleason score, and PSM rate. High-grade malignancy (Gleason score >3 + 4=7) was seen in 26% of TZ cancers which compared with 44% of APZ cancers and 56% of PPC cancers. The rate of EPE was significantly higher in APZ when compared with TZ cancer ( P< 0.0005); however, the biochemical recurrence rate was not significantly different between the groups. The prevalence of APC in radical prostatectomy specimens has increased in recent times, in association with earlier detection at a stage amenable to curative surgical treatment. APC, when compared with PPC, is less commonly high grade with less frequent EPE, despite the APC group having larger tumors and a higher PSM rate at presentation. However, not all anterior cancers are indolent. Anterior cancers are more commonly seen in the APZ than the TZ and APZ cancers appear more locally aggressive than TZ cancers.

Differentiation of Prostate Cancer and Stromal Hyperplasia in the Transition Zone With Monoexponential, Stretched-Exponential Diffusion-Weighted Imaging and Diffusion Kurtosis Imaging in a Reduced Number of b Values: Correlation With Whole-Mount Pathology.

The aims of the study were to explore the feasibility of generating a monoexponential model (MEM), stretched-exponential model (SEM) based diffusion-weighted imaging (DWI), and diffusion kurtosis imaging (DKI) by applying the same set of reduced b values and to compare their effectiveness in distinguishing prostate cancer from stromal hyperplasia (SH) in the transition zone (TZ) area. An analysis of 75 patients who underwent preoperative DWI ( b values of 0, 700, 1400, 2000 s/mm 2 ) was performed. All lesions were localized on magnetic resonance images according to whole-mount histopathological correlations. The apparent diffusion coefficient (ADC), water molecular diffusion heterogeneity index (α), distributed diffusion coefficient (DDC), mean diffusivity (MD), and mean kurtosis (MK) values were calculated and compared between the TZ cancer and SH groups. Receiver operating characteristic analysis and areas under the receiver operating characteristic curve (AUCs) were carried out for all parameters. Compared with the SH group, the ADC, DDC, α, and MD values of the TZ cancer group were significantly reduced, while the MK value was significantly increased (all P < 0.05). The AUCs of the ADC, DDC, α, MD, and MK were 0.828, 0.801, 0.813, 0.822, and 0.882, respectively. The AUC of MK was significantly higher than that of the other parameters (all P < 0.05). When using the reduced b -value set, all parameters from MEM, SEM, based DWI, and DKI can effectively distinguish TZ cancer from SH. Among them, DKI demonstrated potential clinical superiority over the others in TZ cancer diagnosis.

The role of spatial transcriptomic profiling to determine androgen receptor signaling and immune infiltration in prostate cancer

272 Background: Prostate cancer (PCa) in the transition zone (TZ) accounts for approximately 30% of disease and tends to present with higher PSAs with a lower risk of seminal vesicle invasion, extra-capsular extension, and risk of biochemical recurrence compared with peripheral zone (PZ) tumors. The underlying biological mechanism for these differences is poorly understood. Here, we performed spatial transcriptomic profiling to elucidate the molecular differences between TZ and PZ PCa. Methods: We identified three patients who underwent radical prostatectomy for PCa (one each with PZ only, TZ only, and both PZ and TZ tumors) and used the NanoString’s Digital Spatial Profiling (DSP) platform to quantify whole transcriptomic gene expression data (17,128 genes) in multiple regions of interest (ROI) per patient (42 cancer and 8 normal samples). Four morphology markers to facilitate ROI selection in both cancer and normal areas (SYTO13 for nucleus, PanCK for epithelium, SMA for stroma and CD45 for immune cells) were selected. Raw counts for 17,128 genes were imported to R v.4.1.0 for downstream data analyses. Counts were Q3 normalized and scaled (Z-score) to enable plotting of all genes on the same axes. Differential gene expression analysis using a linear model fit by empirical Bayes moderation, gene set enrichment analysis (GSEA) by cancer hallmarks, XCell gene sets for pathway enrichment and immune cell deconvolution using CIBERSORT was performed. Results: There were grade group (GG) 4 (n=10) and 5 (n=10) tumors in PZ and GG 3 (n=10), 4 (n=11) and 5 (n=1) cancers in TZ regions. We observed distinct gene expression profiles between PZ (n = 20) and TZ (n=22) tumors. Interestingly, androgen receptor (AR) signaling was significantly higher in TZ PCa ROIs compared to PZ ROIs in both GSEA (false discovery rate &lt; 5%) and the androgen subcomponent of the genomic prostate score (p&lt;0.001), regardless of grade, epithelial, stromal or immune component of the region. To standardize the comparison, CIBERSORT’s absolute immune signature scores were only computed for GG4 tumors and found to be significantly higher in PZ GG4 tumors compared to TZ GG4 tumors. Notably, CD4+ memory T cells were significantly higher in PZ GG4 regions compared to TZ GG4 tumor regions (p&lt;0.05). Conclusions: Here, we demonstrate distinct gene expression profiles of PZ and TZ PCa. Specifically, we observed higher AR signaling in TZ cancers and higher levels of immune infiltration on PZ cancers. This is in concordance with prior knowledge that TZ tumors may be associated with higher serum PSA and PZ tumors may be associated with inflammation. Further studies are needed to discern the biological and clinical significance of the different molecular features of PZ and TZ PCa.

Classification of Prostate Transitional Zone Cancer and Hyperplasia Using Deep Transfer Learning From Disease-Related Images.

PurposeThe diagnosis of prostate transition zone cancer (PTZC) remains a clinical challenge due to their similarity to benign prostatic hyperplasia (BPH) on MRI. The Deep Convolutional Neural Networks (DCNNs) showed high efficacy in diagnosing PTZC on medical imaging but was limited by the small data size. A transfer learning (TL) method was combined with deep learning to overcome this challenge.Materials and methodsA retrospective investigation was conducted on 217 patients enrolled from our hospital database (208 patients) and The Cancer Imaging Archive (nine patients). Using T2-weighted images (T2WIs) and apparent diffusion coefficient (ADC) maps, DCNN models were trained and compared between different TL databases (ImageNet vs. disease-related images) and protocols (from scratch, fine-tuning, or transductive transferring).ResultsPTZC and BPH can be classified through traditional DCNN. The efficacy of TL from natural images was limited but improved by transferring knowledge from the disease-related images. Furthermore, transductive TL from disease-related images had comparable efficacy to the fine-tuning method. Limitations include retrospective design and a relatively small sample size.ConclusionDeep TL from disease-related images is a powerful tool for an automated PTZC diagnostic system. In developing regions where only conventional MR scans are available, the accurate diagnosis of PTZC can be achieved via transductive deep TL from disease-related images.

Transition zone prostate cancer is associated with better clinical outcomes than peripheral zone cancer.

ObjectivesTo determine the biological significance of zonal origins in prostate cancer.Patients and methodsAltogether, 270 consecutive radical prostatectomy cases from 2009 to 2012 were adopted. Cases were divided into those having transition zone (TZ) cancer or peripheral zone (PZ) cancer. Cases with indeterminate tumor location and central zone cancers were excluded from the analyses. Prognosis and clinicopathological features were compared between the two tumor locations. Biochemical recurrence (BCR) and clinical progression (CP) were adopted as prognostic outcome measures. Immunohistochemical features of the v‐ets avian erythroblastosis virus E26 oncogene homolog (ERG)/serine peptidase inhibitor, Kazal‐type 1 (SPINK1) status, and loss of phosphatase and tensin homolog (PTEN‐loss), as well as conventional preoperative and postoperative characteristics, were analyzed.ResultsThis cohort comprised 93 cases of TZ cancer and 160 cases of PZ cancer. TZ cancer cases showed significantly higher BCR and CP‐free survival rate than PZ cancer cases. Notably, no TZ cancer cases developed CP during the 7.8 years of median follow‐up time. Tumor location was an independent predictive factor for BCR in the multivariate analysis. Additionally, TZ cancer cases showed a significantly lower prevalence of ERG‐overexpression and PTEN‐loss than PZ cancer cases (3.2% vs 20.1% and 2.2% vs 18.2%, respectively).ConclusionTZ cancer cases showed a better prognosis and different immunohistochemical features. Conservative treatment strategies could be considered for TZ cancer cases.

Optimizing size thresholds for detection of clinically significant prostate cancer on MRI: Peripheral zone cancers are smaller and more predictable than transition zone tumors

PurposeTo evaluate if size-based cut-offs based on MR imaging can successfully assess clinically significant prostate cancer (csPCA). The goal was to improve the currently applied size-based differentiation criterion in PI-RADS. Methods and materialsMRIs of 293 patients who had undergone 3 T MR imaging with subsequent confirmation of prostate cancer on systematic and targeted MRI/TRUS-fusion biopsy were re-read by three radiologists. All identifiable tumors were measured on T2WI for lesions originating in the transition zone (TZ) and on DWI for lesions from the peripheral zone (PZ) and tabulated against their Gleason grade. Results309 lesions were analyzed, 213 (68.9 %) in the PZ and 96 (31.1 %) in the TZ. ROC-Analysis showed a stronger correlation between lesion size and clinically significant (defined as Gleason Grade Group ≥ 2) prostate cancer (PCa) for the PZ (AUC = 0.73) compared to the TZ (AUC = 0.63). The calculated Youden index resulted in size cut-offs of 14 mm for PZ and 21 mm for TZ tumors. ConclusionSize cut-offs can be used to stratify prostate cancer with different optimal size thresholds in the peripheral zone and transition zone. There was a clearer separation of clinically significant tumors in peripheral zone cancers compared to transition zone cancers. Future iterations of PI-RADS could therefore take different size-based cut-offs for peripheral zone and transition zone cancers into account.

MRI phenotype of the prostate: Transition zone radiomics analysis improves explanation of prostate-specific antigen (PSA) serum level compared to volume measurement alone

PurposeTo determine the value of a radiomics MRI phenotype of the transition zone to explain PSA level in patients with low suspicion for clinically significant cancer to confirm hyperplastic changes. Materials and methodsT2 weighted images from 36 consecutive PI-RADS 2 and 3 cases with volume adapted systematic transperineal biopsy as reference standard (all biopsies negative, 34.8 biopsy cores per patient in average, mean PSA level 10.77 ng/mL) are manually segmented to define transition zone (TZ) volume. 54 radiomic features (RF) are derived for each TZ. RF are tested for significant correlation with PSA level, Bonferroni correction is applied. We build regression models to explain PSA level with a) TZ volume b) RF c) TZ volume+RF. We apply all models to a control group with clinically significant transition zone cancer. ResultsTZ volume is moderately correlated with PSA level (r = 0.44). 5/54 RF are significantly correlated with PSA level (r: 0.53−0.69, p < 0.05). Inclusion of each of these five features into the regression model significantly improves the explanatory value for PSA level (p < 0.05). Furthermore, RF alone better explain PSA level compared to TZ volume alone (p < 0.01). A systematic and significant trend for positive residuals is observed when regression models are applied to the malignant control group. ConclusionA radiomics analysis of the transition zone has the potential to improve explanation of corresponding PSA level in patients with low suspicion. This knowledge may reassure radiologists to read prostate MRI cases as unremarkable, despite present hyperplastic changes.

Tumour location determined by preoperative MRI is an independent predictor for positive surgical margin status after Retzius-sparing robot-assisted radical prostatectomy.

To investigate the influence of tumour location zone on positive surgical margin (PSM) status after Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). A total of 203 consecutive patients with prostate cancer (PCa) who underwent RS-RARP at our centre were divided into three cohorts according to the tumour zonal origin described on preoperative magnetic resonance imaging (MRI). Clinical and pathological characteristics were compared among the three groups. The associations of clinicopathological variables with PSM status after RS-RARP were also evaluated. The rates of PSM in patients with transition zone (TZ) and mixed origin tumours were significantly higher than in patients with peripheral zone tumours (P < 0.01). Of the PSMs in patients with TZ and mixed origin cancers, 42.0% and 40.9%, respectively, were located at the anterior part of the gland. On multivariate analysis, presence of a TZ tumour was significantly associated with a higher PSM rate after RS-RARP (P < 0.01). Sub-analysis showed that high-risk patients with TZ tumours had a higher risk of PSM after RS-RARP (P < 0.01). Presence of a TZ tumour is an independent risk factor for PSMs after RS-RARP. Preoperative identification of TZ tumours might aid surgical planning for the Retzius-sparing technique, especially in high-risk patients.

Diagnostic Performance of Multiparametric MR Imaging According to the Location of Prostate Cancer

Background/Objectives: Most prostate cancers occur in the peripheral zone (PZ) of prostate and a few in the transition zone (TZ). We compared MRI findings and clinicobiologic findings among PZ, TZ and PZ+TZ prostate cancers to determine if cancer location is independently associated with outcomes.Methods/Statistical analysis: A retrospective study was performed of 70 men who underwent multiparametric-MRI prior to radical prostatectomy from 2014.03~2018.02. Fifty-two prostate cancers were included in this study. We investigated the comparison serum-PSA, tumor size, prostate weight, Gleason score, presence of extracapsular extension, ADC value on DWI, PIRADS category and pathologic tumor stage, according to the location of prostate cancer (PZ, TZ, and PZ+TZ prostate cancers), using statistical methods.Findings: 30/52(58%) were PZ in location, 14/52(27%) were in TZ, and 8/52(15%) were with PZ+TZ prostate cancer. Patients with PZ+TZ cancer presented with large total cancer size (≥ 1.5cm), MRI evidence of presence of extracapsular invasion (p <0.001), seminal vesicle invasion (p = 0.026) and lymph node invasion (p < 0.001). The mean ADC value was significantly lower in the PZ+TZ cancer (mean ADC 0.455 – 0.83 (median 0.643)) than in PZ (0.4555 – 1.342 (median 0.90)) and TZ cancer (0.579 – 1.211 (median 0.895)) (p=0.005). There was no significant difference related to serum PSA (p value 0.065), Gleason score (p value 0.235) between PZ, TZ and PZ+TZ lesion.Improvements/Applications: PZ+TZ prostate cancer is associated with tumor, ECE, seminal vesicle invasion and low ADC value. So, tumor location should be taken into account in the process of evaluation, and mp-MRI can be a good tool to staging prostate cancer.

MP62-04 ONCOLOGICAL PROGNOSIS AND PATHOLOGICAL FEATURE AFTER RADICAL PROSTATECTOMY ACCORDING TO THE ZONAL ORIGIN OF HIGH GRADE PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Staging I (MP62)1 Apr 2020MP62-04 ONCOLOGICAL PROGNOSIS AND PATHOLOGICAL FEATURE AFTER RADICAL PROSTATECTOMY ACCORDING TO THE ZONAL ORIGIN OF HIGH GRADE PROSTATE CANCER Jung Jun Kim*, Sung Kyu Hong, and Seok Soo Byun Jung Jun Kim*Jung Jun Kim* More articles by this author , Sung Kyu HongSung Kyu Hong More articles by this author , and Seok Soo ByunSeok Soo Byun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000937.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We assessed the impact of prostatic zone tumor origin on pathological prognostic features and subsequent biochemical outcomes after radical prostatectomy. METHODS: A total of 3,823 patients who underwent radical prostatectomy between 2003 and 2018 were divided into two grade group. A high grade group was defined as Gleason sum ≥ 4+3 and ISUP (International Society of Urological Pathology) groups 3 to 5. A low grade group was defined as Gleason sum ≤ 3+4, and ISUP groups 1/2. The patients was also classified according to the location of index lesion which is transition zone and peripheral zone. The Kaplan-Meier method was used to determine differences in biochemical recurrence-free survival. RESULTS: The presence of high grade index lesion at transition zone cancer was associated with significantly increased prostate specific antigen, tumor volume and incidence of positive surgical margins but a lower incidence of extraprostatic extension, seminal vesicle invasion, lymph node involvement and biochemical failure after radical prostatectomy compared with high grade peripheral zone cancer (Table 1&2). And the outcome was consisitent regardless of surgical margin (Figure). The zonal origin could not differ the recurrence of low grade cases(Table 2). however, the patients with low grade prostate cancer demonstrated good pathology and decent oncological prognosis regardless of tumor origin. CONCLUSIONS: Among high grade cancer, high grade transition zone index lesion independently impact better biochemical outcome in spite of some worse clinical and pathological prognostic factors. To predict prognosis of high grade cancer patients after prostatectomy, the location of index lesion is definitely one of the factor to consider. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e946-e947 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jung Jun Kim* More articles by this author Sung Kyu Hong More articles by this author Seok Soo Byun More articles by this author Expand All Advertisement PDF downloadLoading ...

Tumor Location and Pathological Features of Latent and Incidental Prostate Cancer in Contemporary Japanese Men.

The incidence of prostate cancer is increasing in Asian countries. Studies using prostatectomy specimens have reported a racial difference in tumor location within the prostate, with a greater incidence of transition zone cancer in Asian men compared with Caucasian men. However, there may be potential biases in studies based on surgical specimens. We describe the pathological features of subclinical prostate cancer, such as latent cancer and incidental cancer, to elucidate tumor location of contemporary Japanese patients. We also compare the prevalence of latent and incidental prostate cancer to determine whether the incidence of prostate cancer is higher in patients with bladder cancer. Overall 182 men autopsied and 148 who underwent cystoprostatectomy for bladder cancer were included in the study. Each prostate gland was fixed and sliced in step sections. Histological evaluation was performed by a single genitourinary pathologist. The index tumor location was categorized into transition zone or peripheral zone. Prostate cancer was found in 39.0% of the autopsy specimens and 31.6% of the cystoprostatectomy specimens. The prevalence and pathological characteristics were not significantly different between latent and incidental cancer. The prevalence of transition zone cancer was 39.0% (46 of 118). In elderly men peripheral zone cancer was more frequently diagnosed than transition zone cancer (p=0.049). The pathological characteristics of transition and peripheral zone cancers were similar except for the pT stage. Transition zone cancer was prevalent in contemporary Japanese men. The incidence of prostate cancer in men with bladder cancer might not be higher than that in healthy men.

Apical periurethral transition zone lesions: MRI and histology findings.

Apical periurethral transition zone (TZ) cancers can pose unique problems for surgery and radiation therapy. Here, we describe the appearance of such cancers on multiparametric MRI (mpMRI) and correlate this with histopathology derived from MRI-targeted biopsy. Between May 2011 and January 2019, a total of 4381 consecutive patients underwent 3T mpMRI. Of these, 53 patients with 58 apical periurethral TZ lesions underwent TRUS/MRI fusion-guided biopsy and 12-core systematic TRUS-guided biopsy. Correlation was made with patient age, PSA, PSA density, whole prostate volume, and Gleason scores. A total 53 men (median age 68years, median PSA 7.94ng/ml) were identified as having at least one apical periurethral TZ lesion on mpMRI and 5 (9%) patients had more than one apical periurethral lesion. Thus, 58 lesions were identified in 53 patients. Of these 37/53 patients (69%) and 40/58 lesions were positive at biopsy for prostate cancer. Seven were diagnosed by 12-core systematic TRUS-guided biopsy and 34 were diagnosed by TRUS/MRI fusion-guided biopsy. Gleason score was ≥ 3 + 4 in 34/58 (58%) lesions. Identification of apical periurethral TZ prostate cancers is important to help guide surgical and radiation therapy as these tumors are adjacent to critical structures. Because of the tendency to undersample the periurethral zone during TRUS biopsy, MRI-guided biopsy is particularly helpful for detecting apical periurethral TZ prostate cancers many of which prove to be clinically significant.

The prognostic value of zonal origin and extraprostatic extension of prostate cancer for biochemical recurrence after radical prostatectomy

ObjectiveTo investigate the influence of the zonal origin of prostate cancer and extraprostatic extension on biochemical recurrence (BCR). Patients and methodsWe included 638 consecutive patients undergoing radical prostatectomy between 2005 and 2015 who did not receive neoadjuvant/adjuvant therapy. The largest lesion was defined as the index tumor. We categorized each patient into the transition zone (TZ) or peripheral zone (PZ) group based on the lesion where the index tumor existed. Differences in the BCR defined as increasing prostate-specific antigen rate between groups were examined by Kaplan-Meier analysis and the Cox proportional hazards model. ResultsThere were 293 (46%) patients with TZ cancer and 345 (54%) with PZ cancer. TZ cancer was significantly associated with a higher prostate-specific antigen (P = 0.012), lower biopsy positive core rate (P = 0.020), lower pathological Gleason score (P = 0.017), lower pathological stage (P = 0.002), and lower rate of seminal vesicle invasion (P = 0.002). During a median follow-up period of 59 months, 79 patients (12%) developed BCR. In the entire cohort, the PZ origin (hazard ratio: 1.68, P = 0.033) and extraprostatic extension were independent risk factors for BCR. The 3-, 5-, and 7-year BCR-free survival rates of patients with pT3a TZ cancer were 89%, 88%, and 86%, respectively, which were significantly better than those of patients with pT3a PZ cancer (80%, 74%, and 62%, P = 0.012), but were similar to those of the pT2 cancer cohort (92%, 91%, and 90%, P = 0.376). ConclusionTZ cancer had more favorable pathological characteristics and oncological outcome than PZ cancer especially in pT3a cases.

Revisiting quantitative multi-parametric MRI of benign prostatic hyperplasia and its differentiation from transition zone cancer.

This study investigates the multiparametric MRI (mpMRI) appearance of different types of benign prostatic hyperplasia (BPH) and whether quantitative mpMRI is effective in differentiating between prostate cancer (PCa) and BPH. Patients (n = 60) with confirmed PCa underwent preoperative 3T MRI. T2-weighted, multi-echo T2-weighted, diffusion weighted and dynamic contrast enhanced images (DCE) were obtained prior to undergoing prostatectomy. PCa and BPH (cystic, glandular or stromal) were identified in the transition zone and matched with MRI. Quantitative mpMRI metrics: T2, ADC and DCE-MRI parameters using an empirical mathematical model were measured. ADC values were significantly lower (p < 0.001) in PCa compared to all BPH types and can differentiate between PCa and BPH with high accuracy (AUC = 0.87, p < 0.001). T2 values were significantly lower (p < 0.001) in PCa compared to cystic BPH only, while glandular (p = 0.27) and stromal BPH (p = 0.99) showed no significant difference from PCa. BPH mimics PCa in the transition zone on DCE-MRI evidenced by no significant difference between them. mpMRI values of glandular (ADC = 1.31 ± 0.22µm2/ms, T2 = 115.7 ± 37.3ms) and cystic BPH (ADC = 1.92 ± 0.43µm2/ms, T2 = 242.8 ± 117.9ms) are significantly different. There was no significant difference in ADC (p = 0.72) and T2 (p = 0.46) between glandular and stromal BPH. Multiparametric MRI and specifically quantitative ADC values can be used for differentiating PCa and BPH, improving PCa diagnosis in the transition zone. However, DCE-MRI metrics are not effective in distinguishing PCa and BPH. Glandular BPH are not hyperintense on ADC and T2 as previously thought and have similar quantitative mpMRI measurements to stromal BPH. Glandular and cystic BPH appear differently on mpMRI and are histologically different.

Differentiating Transition Zone Cancers From Benign Prostatic Hyperplasia by Histogram Analysis of Apparent Diffusion Coefficient Maps With Standard and Ultrahigh b-value Diffusion-weighted MR Imaging.

To compare the diagnostic performance of standard and ultrahigh b-value Diffusion-weighted Imaging (DWI) using volumetric histogram analysis in differentiating transition zone (TZ) cancer from benign prostatic hyperplasia (BPH). 57 TZ cancer and 61 BPH patients received standard (1000 s/mm) and ultrahigh b-value (2000 s/mm) DWI. The diagnostic ability of ADC histogram parameters derived from two DWI for differentiating TZ cancer from BPH was determined by receiver operating characteristic curve. Median, minimum, the 10th, 25th percentile ADC in both ADC1000 and ADC2000 and skewness in ADC2000 had significant differences between TZ cancer and BPH (for all, P < 0.05).The 10th percentile ADC showed highest area under the ROC curve (AUC) in both ADC1000 and ADC2000.The 10th percentile ADC of ADC2000 showed significantly higher AUC than did ADC1000 (P = 0.0385). The 10th percentile ADC obtained from ultrahigh b-value DWI performed better for differentiating TZ cancer from BPH.

Diagnostic value of ultra-high b-value diffusion-weighted imaging in prostate cancer

Objective To explore the value of ultra-high b-value diffusion-weighted imaging (DWI) in diagnosis of prostate cancer. Methods According to inclusion and exclusion criteria, 73 consecutive examinees in Chinese PLA General Hospital from June 2014 to May 2015 were screened. Written informed consent was obtained from all patients. T2WI, conventional DWI with b-value of 1 000 s/mm2 and ultra-high b-value DWI with 2 000 s/mm2 and 3 000 s/mm2 were performed in each examinee. Images were interpreted and were corresponding to histological results conducted by ultrasound guided prostate systematic biopsy. Reference biopsy as the gold standard, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each image. Sensitivity and specificity differences between ultra-high b-value DWI and conventional DWI were analyzed. The areas under the curves (AUCs) between ultra-high b-value DWI and other modalities were compared. Results The sensitivity and specificity for ultra-high b-value DWI were 92.5% and 68.8% with b-value of 3 000 s/mm2, and they were 88.1% and 53.1% for 2 000 s/mm2 in peripheral zone. The sensitivity and specificity for ultra-high b-value DWI were 88.0% and 88.2% with a b-value of 3 000 s/mm2, and they were 80.0% and 52.9% for 2 000 s/mm2 in transition zone. The values of sensitivity for ultra-high b-value DWI were significantly higher than those for conventional DWI both in peripheral zone and transition zone (all P 0.05), whereas the value of specificity for 3 000 s/mm2 were significantly higher than that for 2 000 s/mm2 in transition zone (P <0.000 1). PPV and NPV for 3 000 s/mm2 were significantly higher than those for the other three modalities both in peripheral zone (86.1% and 81.5%) and transition zone (91.7% and 83.3%). In peripheral zone, the AUCs were 0.591, 0.553, 0.698 and 0.806 in T2WI, conventional DWI and ultra-high b-value DWI at 2 000 s/mm2 and 3 000 s/mm2 respectively, for the diagnosis of transition zone cancer were 0.693, 0.506, 0.665 and 0.881 respectively, and the AUCs for the ultra-high b-value with 3 000 s/mm2 were the largest. Conclusion Ultra-high b-value DWI is an accurate and reliable method in the diagnosis of prostate cancer. Key words: Prostatic neoplasms; Magnetic resonance imaging; Ultra-high b-value diffusion-weighted imaging