Is prostatic adenocarcinoma with cribriform architecture more difficult to detect on prostate MRI?

Abstract

Background: Cribriform (CBFM) pattern on prostate biopsy has been implicated as a predictor for high-risk features, potentially leading to adverse outcomes after definitive treatment. This study aims to investigate whether the CBFM pattern containing prostate cancers (PCa) were associated with false negative magnetic resonance imaging (MRI) and determine the association between MRI and histopathological disease burden.

Methods: Patients who underwent multiparametric magnetic resonance imaging (mpMRI), combined 12-core transrectal ultrasound (TRUS) guided systematic (SB) and MRI/US fusion-guided biopsy were retrospectively queried for the presence of CBFM pattern at biopsy. Biopsy cores and lesions were categorized as follows: C0 = benign, C1 = PCa with no CBFM pattern, C2 = PCa with CBFM pattern. Correlation between cancer core length (CCL) and measured MRI lesion dimension were assessed using a modified Pearson correlation test for clustered data. Differences between the biopsy core groups were assessed with the Wilcoxon-signed rank test with clustering.

Results: Between 2015 and 2022, a total of 131 consecutive patients with CBFM pattern on prostate biopsy and pre-biopsy mpMRI were included. Clinical feature analysis included 1572 systematic biopsy cores (1149 C0, 272 C1, 151 C2) and 736 MRI-targeted biopsy cores (253 C0, 272 C1, 211 C2). Of the 131 patients with confirmed CBFM pathology, targeted biopsy (TBx) alone identified CBFM in 76.3% (100/131) of patients and detected PCa in 97.7% (128/131) patients. SBx biopsy alone detected CBFM in 61.1% (80/131) of patients and PCa in 90.8% (119/131) patients. TBx and SBx had equivalent detection in patients with smaller prostates (p = 0.045). For both PCa lesion groups there was a positive and significant correlation between maximum MRI lesion dimension and CCL (C1 lesions: p < 0.01, C2 lesions: p < 0.001). There was a significant difference in CCL between C1 and C2 lesions for T2 scores of 3 and 5 (p ≤ 0.01, p ≤ 0.01, respectively) and PI-RADS 5 lesions (p ≤ 0.01), with C2 lesions having larger CCL, despite no significant difference in MRI lesion dimension.

Conclusions: The extent of disease for CBFM-containing tumors is difficult to capture on mpMRI. When comparing MRI lesions of similar dimensions and PIRADS scores, CBFM-containing tumors appear to have larger cancer yield on biopsy. Proper staging and planning of therapeutic interventions is reliant on accurate mpMRI estimation. Special considerations should be taken for patients with CBFM pattern on prostate biopsy.

Keywords: cancer core length; cribriform pattern; multiparametric MRI; prostate cancer.

Figure 1:

Patient selection flowchart. C0 = Benign biopsy, C1 = PCa+ CBFM-, C2 = PCa+ CBFM+, TBx = targeted biopsy, SBx = systematic biopsy, Bx = biopsy

Figure 2:

(A) Spatial distribution of PCa and CBFM on transrectal systematic biopsy reconstructed using the template map. (B) Result of transrectal core reconstruction RCC = relative cribriform contribution, C0 = Benign biopsy, C1 = PCa+ CBFM-, C2 = PCa+ CBFM+

Figure 3:

Patient-level CBFM detection on TBx and SBx. C0 = Benign biopsy, C1 = PCa+ CBFM-, C2 = PCa+ CBFM+

Figure 4:. Part I.

Three different definitions of CCL include (S1) average CCL from all targeted cores, (S2) Max CCL from all targeted cores, (S3) CCL from the core with the highest GS. Core example (A) shows GS 4+5 with CBFM measuring 9mm, (B) shows GS 3+4 adenocarcinoma measuring 3mm, and (C) shows GS 4+5 adenocarcinoma measuring 5mm. Part II. Modified clustered Pearson correlation test comparing maximum MRI lesion dimension versus CCL. (A-C) are plots and regression fits comparing C2 and C1. (A) compares dimension versus average CCL, (B) compares dimension versus maximum CCL, (C) compares dimension versus CCL from highest Gleason score core. Part III Demonstration of the observed discrepancy between CCL and lesion dimension. C0 = Benign biopsy, C1 = PCa+ CBFM-, C2 = PCa+ CBFM+

Figure 5:

Visually paired lesions according to their T2 score, DWI score, and PIRADS score. Lesions from core class 1 (C1) and core class 2 (C2) were paired according to their T2 score, DWI score, and PIRADS scores. This visual pairing was performed for all three cancer core length strategies (S1 – average CCL, S2 – maximum CCL, and S3- highest GS CCL). Measured MRI dimensions were also compared between C1 and C2 lesions for each visual comparison (T2 score, DWI score, and PIRADS score).