Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr;32(4):2351-2359.
doi: 10.1007/s00330-021-08332-8. Epub 2021 Nov 8.

MRI grading for the prediction of prostate cancer aggressiveness

M Boschheidgen  1 , L Schimmöller  2 , C Arsov  3 , F Ziayee  1 , J Morawitz  1 , B Valentin  1 , K L Radke  1 , M Giessing  3 , I Esposito  4 , P Albers  3 , G Antoch  1 , T Ullrich  1
Affiliations

MRI grading for the prediction of prostate cancer aggressiveness

M Boschheidgen et al. Eur Radiol. 2022 Apr.

Abstract

Objectives: T o evaluate the value of multiparametric MRI (mpMRI) for the prediction of prostate cancer (PCA) aggressiveness.

Methods: In this single center cohort study, consecutive patients with histologically confirmed PCA were retrospectively enrolled. Four different ISUP grade groups (1, 2, 3, 4-5) were defined and fifty patients per group were included. Several clinical (age, PSA, PSAD, percentage of PCA infiltration) and mpMRI parameters (ADC value, signal increase on high b-value images, diameter, extraprostatic extension [EPE], cross-zonal growth) were evaluated and correlated within the four groups. Based on combined descriptors, MRI grading groups (mG1-mG3) were defined to predict PCA aggressiveness.

Results: In total, 200 patients (mean age 68 years, median PSA value 8.1 ng/ml) were analyzed. Between the four groups, statistically significant differences could be shown for age, PSA, PSAD, and for MRI parameters cross-zonal growth, high b-value signal increase, EPE, and ADC (p < 0.01). All examined parameters revealed a significant correlation with the histopathologic biopsy ISUP grade groups (p < 0.01), except PCA diameter (p = 0.09). A mixed linear model demonstrated the strongest prediction of the respective ISUP grade group for the MRI grading system (p < 0.01) compared to single parameters.

Conclusions: MpMRI yields relevant pre-biopsy information about PCA aggressiveness. A combination of quantitative and qualitative parameters (MRI grading groups) provided the best prediction of the biopsy ISUP grade group and may improve clinical pathway and treatment planning, adding useful information beyond PI-RADS assessment category. Due to the high prevalence of higher grade PCA in patients within mG3, an early re-biopsy seems indicated in cases of negative or post-biopsy low-grade PCA.

Key points: • MpMRI yields relevant pre-biopsy information about prostate cancer aggressiveness. • MRI grading in addition to PI-RADS classification seems to be helpful for a size independent early prediction of clinically significant PCA. • MRI grading groups may help urologists in clinical pathway and treatment planning, especially when to consider an early re-biopsy.

Keywords: Diffusion magnetic resonance imaging; Magnetic resonance imaging, interventional; Multiparametric magnetic resonance imaging; Neoplasm grading; Prostatic neoplasms.

PubMed Disclaimer

Conflict of interest statement

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Figures

Fig. 1
Fig. 1
MRI grading groups 1 to 3 and estimated risk of higher grade prostate cancer with examples of mpMRI. The first column shows T2w sequences, second column ADC-maps (rs-EPI), third column high b-value DWI (b1800), fourth column DCE, and last column the risk of ISUP grade group ≥ 2 or ≥ 3 PCA. In the first line of images, a representative patient within mG1 is shown and the second line presents a patient within mG2 with focally PCA and only moderate ADC value reduction (rs-EPI). The last patient in line 3 was graded within mG3 with marked reduction in ADC value, dark focal appearance on T2w images, and bright signal on high b-value DWI
See this image and copyright information in PMC

References

    1. Kasivisvanathan V, Rannikko AS, Borghi M, et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med. 2018;378(19):1767–1777. doi: 10.1056/NEJMoa1801993. - DOI - PMC - PubMed
    1. Kim M, Ryu H, Lee HJ, Hwang SI, Choe G, Hong SK. Who can safely evade a magnetic resonance imaging fusion-targeted biopsy (MRIFTB) for prostate imaging reporting and data system (PI-RADS) 3 lesion? World J Urol. 2020 doi: 10.1007/s00345-020-03352-3. - DOI - PubMed
    1. Litwin MS, Tan H-J. The diagnosis and treatment of prostate cancer: a review. JAMA. 2017;317(24):2532–2542. doi: 10.1001/jama.2017.7248. - DOI - PubMed
    1. Briganti A, Fossati N, Catto JWF, et al. Active surveillance for low-risk prostate cancer: the European Association of Urology Position in 2018. Eur Urol. 2018;74(3):357–368. doi: 10.1016/j.eururo.2018.06.008. - DOI - PubMed
    1. Pompe RS, Beyer B, Haese A, et al. Postoperative complications of contemporary open and robot-assisted laparoscopic radical prostatectomy using standardised reporting systems. BJU Int. 2018;122(5):801–807. doi: 10.1111/bju.14369. - DOI - PubMed

Supplementary concepts