MP30-04 DETECTION OF INDIVIDUAL PROSTATE CANCER FOCI BY MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING (2019)

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV (MP30)1 Apr 2019MP30-04 DETECTION OF INDIVIDUAL PROSTATE CANCER FOCI BY MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING David Johnson*, Steven Raman, Sohrab Mirak, Lorna Kwan, Amirhossein Bajgiran, Izak Faeina, Aydin Pooli, Amirali Salmasi, Anthony Sisk, Ely Felker, David Lu, and Robert Reiter David Johnson*David Johnson* More articles by this author , Steven RamanSteven Raman More articles by this author , Sohrab MirakSohrab Mirak More articles by this author , Lorna KwanLorna Kwan More articles by this author , Amirhossein BajgiranAmirhossein Bajgiran More articles by this author , Izak FaeinaIzak Faeina More articles by this author , Aydin PooliAydin Pooli More articles by this author , Amirali SalmasiAmirali Salmasi More articles by this author , Anthony SiskAnthony Sisk More articles by this author , Ely FelkerEly Felker More articles by this author , David LuDavid Lu More articles by this author , and Robert ReiterRobert Reiter More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557559.05361.8aAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Multiparametric magnetic resonance imaging (mpMRI) undoubtedly affects the diagnosis and treatment of localized prostate cancer (CaP). However, clinicians need a better understanding of its accuracy and limitations detecting individual CaP foci to optimize management. We determined the per-lesion detection rate of CaP foci by mpMRI and identify predictors of tumor detection. METHODS: Retrospective analysis of 588 consecutive patients with biopsy-proven CaP and mpMRI prior to radical prostatectomy at a single tertiary institution from June 2010 to February 2018. We correlated co-registered mpMRI lesions with whole mount prostatectomy specimens. We calculated mpMRI sensitivity detecting individual CaP and clinically significant CaP foci (any Gleason Grade greater than 1) and predictors of tumor detection using multivariate analysis. RESULTS: Final analysis included 1213 pathologically-confirmed tumor foci in 588 patients with primarily intermediate (75%) or high risk (12%) CaP. mpMRI detected 45% (95% CI; 42-47%) of all lesions, including 65% (95% CI; 61-69%) of clinically significant lesions. 74% and 31% of missed solitary and multifocal tumors were clinically significant, respectively. While the majority of missed lesions were small (61.1% ≤ 1 cm), 28.3% were between 1-2 cm, and 10.4% > 2cm. mpMRI missed at least one clinically significant foci in 34% of patients, including in 45% with multifocal lesions. On multivariate analysis, smaller, low-grade, multi-focal, non-index tumors in men with lower PSA-density were more likely to be missed. Limitations include imperfect co-registration process and uncertain clinical significance of undetected lesions. CONCLUSIONS: mpMRI detects less than half of all and less than two-thirds of clinically significant CaP foci. The moderate per-lesion sensitivity and significant proportion with undetected tumor foci demonstrate the current limitations of mpMRI. Source of Funding: Department of Radiology and Pathology Integrated Diagnostics (IDx) program and the specialized program of research excellence (SPORE) in prostate cancer. Los Angeles, CA; San Diego, CA; Los Angeles, CA© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e423-e424 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Johnson* More articles by this author Steven Raman More articles by this author Sohrab Mirak More articles by this author Lorna Kwan More articles by this author Amirhossein Bajgiran More articles by this author Izak Faeina More articles by this author Aydin Pooli More articles by this author Amirali Salmasi More articles by this author Anthony Sisk More articles by this author Ely Felker More articles by this author David Lu More articles by this author Robert Reiter More articles by this author Expand All Advertisement PDF downloadLoading ...