MP53-02 IMPACT OF MULTIFOCALITY ON PROSTATE CANCER DETECTION BY MULTI-PARAMETRIC MRI (2014)

You have accessJournal of UrologyProstate Cancer: Detection & Screening II1 Apr 2014MP53-02 IMPACT OF MULTIFOCALITY ON PROSTATE CANCER DETECTION BY MULTI-PARAMETRIC MRI Nelly Tan, Jesse Le, Daniel Margolis, David Lu, Kevin King, Steven Raman, and Robert Reiter Nelly TanNelly Tan More articles by this author , Jesse LeJesse Le More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , David LuDavid Lu More articles by this author , Kevin KingKevin King More articles by this author , Steven RamanSteven Raman More articles by this author , and Robert ReiterRobert Reiter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1633AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Multi-parametric magnetic resonance imaging (mp-MRI) and targeted biopsy of prostate cancer (CaP) have improved diagnostic accuracy, but CaP is often multifocal. The objective of this study was to determine the impact of multifocality in CaP detection by mp-MRI. Methods A HIPAA-compliant, IRB-approved retrospective study was performed of 122 consecutive men who underwent mp-MRI prior to radical prostatectomy from 10/2010-2/2013. Clinical, MRI, and pathologic (e.g. Gleason score (GS), tumor size) features were obtained. Multifocality was defined as ≥2 tumors identified on whole mount pathology (WMP). The index tumor was defined as the lesion with the highest GS; if multiple tumors had the same GS, the largest was considered the index. A genitourinary radiologist and pathologist collectively reviewed each case and matched each lesion identified by MRI to WMP. Chi-square analysis was performed for categorical and t-test for continuous variables. Multivariate logistic regression was performed to determine the impact of multifocality on prostate cancer. Results 122 patients had 283 unique CaP lesions confirmed by WMP. Of 283 lesions, 149 (53%) were GS 3+3, 77 (27%) GS 3+4, 38 (13%) GS 4+3, and 19 (7%) GS ≥8. Mean tumor size was 1.3 cm (range 0.1-4.6 cm). 44/122 (36%) men had solitary and 78/122 (64%) had multifocal lesions [29/122 (24%) had 2 lesions, 24/122 (20%) had 3 lesions, and 25/122 (20%) had ≥4 lesions]. Of multifocal tumors, 140/239 (59%) were GS 3+3. 135/283 (48%) of lesions were detected by MRI. Of 148/283 (52%) lesions missed by MRI, 110/148 (74%) were GS 3+3. A higher proportion of solitary lesions were detected compared to multifocal [39/44 (89%) vs 96/239 (40%), p<0.01], respectively. On multivariate logistic regression using lesion size and GS as covariates, the odds reduction of CaP detection of multifocal lesions was 86% compared to solitary lesions after adjusting for size and grade (p<0.01). However, there was no difference in CaP detection between solitary index and index lesions with concomitant multifocal tumors (88.3% vs 78.4%, p=0.17). After adjusting for lesion size and grade, the odds of detection of solitary index lesions compared to index lesions with concomitant multifocal tumors was not significantly reduced (p=0.09). Conclusions The detection of the index tumor by mp-MRI was not affected by multifocality when adjusting for tumor size and grade, although overall tumor detection was lower in multifocal disease than for solitary tumors. These findings have important implications for future applications of mp-MRI such as focal therapy of CaP. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e588-e589 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Nelly Tan More articles by this author Jesse Le More articles by this author Daniel Margolis More articles by this author David Lu More articles by this author Kevin King More articles by this author Steven Raman More articles by this author Robert Reiter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...