Apical periurethral transition zone lesions: MRI and histology findings
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Apical periurethral transition zone lesions: MRI and histology findings Sena Tuncer1 · Sherif Mehralivand2 · Stephanie A. Harmon3 · Thomas Sanford2 · G. Thomas Brown4 · Lindsay S. Rowe5 · Maria J. Merino6 · Bradford J. Wood7 · Peter A. Pinto8 · Peter L. Choyke2 · Baris Turkbey2
© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019
Abstract Purpose 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. Materials and methods Between May 2011 and January 2019, a total of 4381 consecutive patients underwent 3 T 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. Results A total 53 men (median age 68 years, median PSA 7.94 ng/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. Conclusion 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. Keywords Prostate cancer · Apical periurethral TZ lesion · 12-Core systematic TRUS-guided biopsy · TRUS/MRI fusionguided biopsy
Introduction * Baris Turkbey [email protected] 1
Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
2
Molecular Imaging Program, NCI, NIH, 10 Center Drive, Room B3B85, Bethesda, MD 20892, USA
3
Clinical Research Directorate, Frederick National Laboratory for Cancer Research, NCI, NIH, Bethesda, MD, USA
4
Cognitive Science Branch, National Library of Medicine, Bethesda, MD, USA
5
Radiation Oncology Branch, NCI, NIH, Bethesda, MD, USA
6
Laboratory of Pathology, NCI, NIH, Bethesda, MD, USA
7
Center for Interventional Oncology, NCI and Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, MD, USA
8
Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA
Prostate cancer is the second leading cause of cancer-related deaths for men in the United States with an estimated 29,000 deaths in 2018 [1]. Patients with elevated PSA or abnormal digital rectal e
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