Role of multiparametric magnetic resonance imaging to predict postoperative Gleason score upgrading in prostate cancer w
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ORIGINAL ARTICLE
Role of multiparametric magnetic resonance imaging to predict postoperative Gleason score upgrading in prostate cancer with Gleason score 3 + 4 Hwanik Kim1,3 · Jung Kwon Kim1,3 · Sung Kyu Hong1,3 · Chang Wook Jeong2,3 · Ja Hyeon Ku2,3 · Cheol Kwak2,3 Received: 12 June 2020 / Accepted: 21 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background To evaluate the role of multiparametric magnetic resonance imaging (mpMRI) in Gleason score (GS) 3 + 4 prostate cancer (PCa) and evaluate independent factors in mpMRI that can predict GS upgrading, we compared the outcomes of GS upgrading group and GS non-upgrading group. Patients and methods We analyzed the data of 539 patients undergoing radical prostatectomy (RP) for biopsy GS 3 + 4 PCa from two tertiary referral centers. Univariate and multivariate analyses were performed to determine significant predictors of GS upgrading. GS upgrading, the study outcome, was defined as GS ≥ 4 + 3 at definitive pathology at RP specimen. Results GS upgrading rate was 35.3% and biochemical recurrence (BCR) rate was 8.0%. GS upgrading group was significantly older (p = 0.015), had significantly higher prebiopsy serum prostate-specific antigen (PSA) level (p = 0.001) and PSA density (p = 0.003), had a higher number of prostate biopsy (p = 0.026). There were 413 lesions (76.6%) of PI-RADS lesion ≥ 4, 236 (57.1%) for PI-RADS 4 and 177 (42.9%) for PI-RADS 5 lesion. Multivariate logistic regression analysis revealed that age (p = 0.045), initial prebiopsy PSA level (p = 0.002) and presence of PI-RADS lesion ≥ 4 (p = 0.044) are independent predictors of GS upgrading. Conclusion MpMRI can predict postoperative Gleason score upgrading in prostate cancer with Gleason score 3 + 4. Especially, presence of clinically significant PI-RADS lesion ≥ 4, the significant predictor of GS upgrading, in preoperative mpMRI needs to be paid attention and can be helpful for patient counseling on prostate cancer treatment. Keywords Prostate cancer · Multiparametric MRI · Gleason score 3 + 4 · Radical prostatectomy · Gleason score upgrading · Prostate biopsy
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03421-7) contains supplementary material, which is available to authorized users. * Sung Kyu Hong [email protected] 1
Department of Urology, Seoul National University Bundang Hospital, 82 Gumi‑ro, 173 Beon‑gil, Bundang‑gu, Seongnam, Gyeonggi‑do 13620, South Korea
2
Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak‑ro, Jongno‑gu, Seoul 110‑744, South Korea
3
Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
Prostate cancer (Pca) is the second most frequent cancer diagnosis in men and the fifth leading cause of death worldwide [1]. An accurate prediction of the prognosis of PCa patients has become more important clinically to guide appropriate treatment choices. Th
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