Percentage of Positive Biopsy Cores Predicts Presence of a Dominant Lesion on MRI in Patients with Intermediate Risk Prostate Cancer
Article Sidebar
Main Article Content
Abstract
Background: Biopsy findings of percentage of positive biopsy cores, percentage of cancer volume, and maximum involvement of biopsy cores have been shown to have prognostic value and correlate with magnetic resonance imaging (MRI) findings of extracapsular extension and seminal vesicle invasion. The relationship of these prognostic biopsy factors to MRI findings of the presence of a dominant lesion, has not yet been investigated.
Methods: Sixty-five patients with intermediate risk prostate cancer were included in a retrospective cohort. MRI was acquired using either 1.5 Tesla (T) with endorectal coil or a 3 T MRI unit. Findings of extracapsular extension, seminal vesicle invasion, and presence and number of dominant lesions were noted. T-test and Cox regression statistical analyses were performed.
Results: Patients with one or more dominant lesions on MRI had a significantly higher mean percentage of positive biopsy cores (56.7% vs 39.8%, p=0.004), percentage of cancer volume (23.5% vs 14.5%, p=0.011) and maximum involvement of biopsy cores (62.9% vs 47.3%, p=0.027) than those without a dominant lesion on MRI. On multivariate analysis, only percentage of positive biopsy cores remained a statistically significant predictor for a dominant lesion on MRI (Hazard Ratio 1.06 [95% CI 1.01-1.12; p=0.02]), whereas prostate-specific antigen, clinical T-stage, Gleason score, percentage of cancer volume, and maximum involvement of biopsy cores were not significant predictors of a dominant lesion on MRI. Receiver-operator characteristic analysis was done and a cutoff value of >=50% was chosen for percentage of positive biopsy cores, >=15% for percentage of cancer volume, >=50% for maximum involvement of biopsy cores.
Conclusion: Percentage of positive biopsy cores was found to be a significant predictor for the presence of a dominant lesion on MRI. This finding is hypothesis-generating and should be confirmed with a prospective trial.
Article Details
Copyright (c) 2018 Slater JM, et al.
This work is licensed under a Creative Commons Attribution 4.0 International License.
D'Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998; 280: 969-974. Ref.: https://goo.gl/1yqNnc
Vance SM, Stenmark MH, Blas K, Halverson S, Hamstra DA, et al. Percentage of cancer volume in biopsy cores is prognostic for prostate cancer death and overall survival in patients treated with dose-escalated external beam radiotherapy. Int J Radiat Oncol Biol Phys. 2012; 83: 940-946. Ref.: https://goo.gl/M2foMH
Slater JM, Bush DA, Grove R, Slater JD. The prognostic value of percentage of positive biopsy cores, percentage of cancer volume, and maximum involvement of biopsy cores in prostate cancer patients receiving proton and photon beam therapy. Technol Cancer Res Treat. 2014; 13: 227-231. Ref.: https://goo.gl/A1EFXG
Murgic J, Stenmark MH, Halverson S, Blas K, Feng FY, et al. The role of the maximum involvement of biopsy core in predicting outcome for patients treated with dose-escalated radiation therapy for prostate cancer. Radiat Oncol. 2012; 7: 127. Ref.: https://goo.gl/q9RhKq
Nelson CP, Rubin MA, Strawderman M, Montie JE, Sanda MG. Preoperative parameters for predicting early prostate cancer recurrence after radical prostatectomy. Urology. 2002; 59: 740-745. Ref.: https://goo.gl/yrtDCL
Feng TS, Sharif-Afshar AR, Wu J, Li Q, Luthringer D, et al. Multiparametric MRI improves accuracy of clinical nomograms for predicting extracapsular extension of prostate cancer. Urology. 2015; 86: 332-337. Ref.: https://goo.gl/o54Y1i
Fuchsjager MH, Pucar D, Zelefsky MJ, Zhang Z, Mo Q, et al. Predicting post-external beam radiation therapy PSA relapse of prostate cancer using pretreatment MRI. Int J Radiat Oncol Biol Phys. 2010; 78: 743-750. Ref.: https://goo.gl/iY3yzh
Nguyen PL, Whittington R, Koo S, Schultz D, Cote KB, et al. Quantifying the impact of seminal vesicle invasion identified using endorectal magnetic resonance imaging on PSA outcome after radiation therapy for patients with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys. 2004; 59: 400-405. Ref.: https://goo.gl/nMXL1v
Zakian KL, Hricak H, Ishill N, Reuter VE, Eberhardt S, et al. An exploratory study of endorectal magnetic resonance imaging and spectroscopy of the prostate as preoperative predictive biomarkers of biochemical relapse after radical prostatectomy. J Urol. 2010; 184: 2320-2327. Ref.: https://goo.gl/hXborX
Clarke DH, Banks SJ, Wiederhorn AR, Klousia JW, Lissy JM, et al. The role of endorectal coil MRI in patient selection and treatment planning for prostate seed implants. Int J Radiat Oncol Biol Phys. 2002; 52: 903-910. Ref.: https://goo.gl/AgXF9h
Pugh TJ, Frank SJ, Achim M, Kuban DA, Lee AK, et al. Endorectal magnetic resonance imaging for predicting pathologic T3 disease in Gleason score 7 prostate cancer: implications for prostate brachytherapy. Brachytherapy. 2013; 12: 204-209. Ref.: https://goo.gl/LmruXi
Gondo T, Hricak H, Sala E, Zheng J, Moskowitz CS, et al. Multiparametric 3T MRI for the prediction of pathological downgrading after radical prostatectomy in patients with biopsy-proven Gleason score 3 + 4 prostate cancer. Eur Radiol. 2014; 24: 3161-3170. Ref.: https://goo.gl/SdCDT9
Wang L, Hricak H, Kattan MW, Chen HN, Kuroiwa K, et al. Prediction of seminal vesicle invasion in prostate cancer: incremental value of adding endorectal MR imaging to the Kattan nomogram. Radiology. 2007; 242: 182-188. Ref.: https://goo.gl/3k8DKb
Qian Y, Feng FY, Halverson S, Blas K, Sandler HM, et al. The percent of positive biopsy cores improves prediction of prostate cancer-specific death in patients treated with dose-escalated radiotherapy. Int J Radiat Oncol Biol Phys. 2011; 81: e135-142. Ref.: https://goo.gl/t5wviF
Chang ST, Westphalen AC, Jha P, Jung AJ, Carroll PR, et al. Endorectal MRI and MR spectroscopic imaging of prostate cancer: developing selection criteria for MR-guided focal therapy. J Magnetic Res Imag: JMRI. 2014; 39: 519-525. Ref.: https://goo.gl/coQzPL
Rischke HC, Nestle U, Fechter T, Doll C, Volegova-Neher N, et al. 3 Tesla multiparametric MRI for GTV-definition of dominant intraprostatic lesions in patients with prostate cancer--an interobserver variability study. Radiat Oncol. 2013; 8: 183. Ref.: https://goo.gl/ME3bpg
von Eyben FE, Kiljunen T, Kangasmaki A, Kairemo K, von Eyben R, et al. Radiotherapy boost for the dominant intraprostatic cancer lesion - a systematic review and meta-analysis. Clin Genitourin Cancer. 2016; 14: 189-197. Ref.: https://goo.gl/Jwv4sV
Zumsteg ZS, Spratt DE, Pei I, Zhang Z, Yamada Y, et al. A new risk classification system for therapeutic decision making with intermediate-risk prostate cancer patients undergoing dose-escalated external-beam radiation therapy. European urology. 2013; 64: 895-902. Ref.: https://goo.gl/KCmuZi
Mouraviev V, Villers A, Bostwick DG, Wheeler TM, Montironi R, et al. Understanding the pathological features of focality, grade and tumour volume of early-stage prostate cancer as a foundation for parenchyma-sparing prostate cancer therapies: active surveillance and focal targeted therapy. BJU Int. 2011; 108: 1074-1085. Ref.: https://goo.gl/kqUfs6
Gomez-Iturriaga A, Casquero F, Urresola A, Ezquerro A, Lopez JI, et al. Dose escalation to dominant intraprostatic lesions with MRI-transrectal ultrasound fusion high-dose-rate prostate brachytherapy. Prospective phase II trial. Radiother and Oncol. 2016; 119: 91-96. Ref.: https://goo.gl/6JP1JP
Vigneault E, Mbodji K, Racine LG, Chevrette E, Lavallee MC, et al. Image-Guided high-dose-rate (HDR) boost localization using MRI/MR spectroscopy: a correlation study with biopsy. Cureus. 2016; 8: e795. Ref.: https://goo.gl/Tvjdvi
Gomez-Iturriaga A, Casquero F, Lopez JI, Urresola A, Ezquerro A, et al. Transperineal biopsies of MRI-detected aggressive index lesions in low- and intermediate-risk prostate cancer patients: Implications for treatment decision. Brachytherapy. 2016; 16: 201–206. Ref.: https://goo.gl/QvGkVn