Prostate Cancer Diagnosis Accuracy of Bi-Parametric MRI Versus Histological Outcome of Needle Biopsy

Dr. Ibrahim Mudhafar  Saadoon; Dr. Ahmed  Nooruddin

doi:10.17605/cajmns.v6i4.2854

Dr. Ibrahim Mudhafar Saadoon Urologist, Al Bayan University
Dr. Ahmed Nooruddin Radiologist, Dept. of Radiology, Sheikh Zayed Hosp.

DOI: https://doi.org/10.17605/cajmns.v6i4.2854

Keywords: DW (Diffusion Weighted), ADC (Apparent Diffusion Coefficient), Prostate Cancer (Pca).

Abstract

Aim: To assess the association between DW MRI images of the prostate and the pathological features of the Tru-Cut (core) biopsy of the prostate's lesions. Methods: A total of 55 patients were involved in this investigation. The patients had a mean age of 62.5 years, with PSA levels that were greater than 4 ng/ml, and both DRE and transabdominal pelvic ultrasound exhibited increased prostate size, DRE demonstrated a suspicious, palpable mass, and ultrasound exhibited a hyperactive, enlarged prostate. All patients had a DW MRI of the prostate followed by 12 needle biopsies that were conducted under transrectal ultrasound guidance. Only biopsy samples that were visible on MRI (87 cases) were considered for this study, these cases were divided into prostate cancer, BPH, NSI, and CIG. Multiple lesions from the same patient were also studied. Results: There was a significant difference in the apparent diffusion coefficient of DW-MRI (ADC) between cancerous and non-cancerous lesions in the prostate (BPH, NSI, CIG) (P < 0.001).Conclusion: DW-MRI is a reliable tool to determine the presence of cancerous lesions of prostate before commencing with prostate biopsies.

References

Tobias Penzkofer, Clare M. Tempany-Afdhal. Prostate Cancer Detection and Diagnosis: The Role of MR and its Comparison to Other Diagnostic Modalities – A Radiologist's Perspective. NMR Biomed, 2014 Jan;27(1):3-15.

Courtney M. Chang, Andrew G. McIntosh, et al. Does a screening digital rectal exam provide actionable clinical utility in patients with an elevated PSA and positive MRI? BJUI (British Journal of Urology International) Compass. 2021 May; 2(3): 188–193

Kasivisvanathan V., Rannikko A.S., Borghi M., et al. MRI-targeted or standard biopsy for prostate cancer diagnosis. N Engl J Med. 2018;378:1767–1777.

Rouvière O., Puech P., Renard-Penna R., et al. Use of prostate systematic and targeted biopsy based on multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol. 2019;20:100–109.

Armando Stabile, Francesco Giganti, et al. Multiparametric MRI for prostate cancer diagnosis: current status and future directions. Nature Reviews Urology (2020) Volume 17, pages 41–61.

EDUARDO THADEU DE OLIVEIRA CORREIA, ANDREI S PURYSKO, ET AL. PI-RADS UPGRADING RULES: IMPACT ON PROSTATE CANCER DETECTION AND BIOPSY AVOIDANCE OF MRI-DIRECTED DIAGNOSTIC PATHWAYS. AMERICAN JOURNAL OF ROENTGENOLOGY. 2024 MAR; 6(2).

Martin H. Maurer, Johannes T. Heverhagen. Diffusion-weighted imaging of the prostate—principles, application, and advances. Transitional Andrology and Urology. 2017 Jun; 6(3): 490–498.

John T. Wei. Limitations of a Contemporary Prostate Biopsy: The Blind March Forward. Urologic Oncology. 2010 Sep–Oct; 28(5): 546–549.

Ashley Kieran Clift, Carol AC Coupland, Julia Hippisley-Cox. Prostate-specific antigen testing and opportunistic prostate cancer screening: a cohort study in England, 1998–2017. British Journal of General Practice. 2021 Jan 28;71(703): e157-e165.

Pound CR, Partin AW, Epstein JI, Walsh PC. Prostate-specific antigen after anatomic radical retropubic prostatectomy: patterns of recurrence and cancer control. Urologic Clinics of North America. 1997;24(2):395–406.

Tanimoto A, Nakashima J, Kohno H, Shinmoto H, Kuribayashi S. Prostate cancer screening: the clinical value of diffusion-weighted imaging and dynamic MR imaging in combination with T2-weighted imaging. Journal of Magnetic Resonance Imaging.

Kumar V, Jagannathan NR, Kumar R, et al. Apparent diffusion coefficient of the prostate in men before biopsy: determination of a cut-off value to predict malignancy of the peripheral zone. NMR in Biomedicine. 2007;20(5):505–511.

Kılıçkesmez Ö, Cimilli T, İnci E, et al. Diffusion-weighted MRI of urinary bladder and prostate cancers. Diagnostic and Interventional Radiology. 2009 Jun;15(2):104-10.

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA, A Cancer Journal for Clinicians. 2021 May;71(3):209-249.

Ashutosh Tewari, Jay D Raman, et al. Long-term survival probability in men with clinically localized prostate cancer treated either conservatively or with definitive treatment (radiotherapy or radical prostatectomy). Urology. 2006 Dec;68(6):1268-74.

Pound CR, Partin AW, Epstein JI, Walsh PC. Prostate-specific antigen after anatomic radical retropubic prostatectomy: patterns of recurrence and cancer control. Urologic Clinics of North America. 1997;24(2):395–406.

Richie JP, Catalona WJ, Ahmann FR, et al. Effect of patient age on early detection of prostate cancer with serum prostate-specific antigen and digital rectal examination. Urology. 1993;42(4):365–374.

Carter HB, Partin W. Diagnosis and Staging of Prostate Cancer. In: Walsh PC, Retik AB, Wein AJ, Vaughan ED, editors. Campbell’s Urology. 8th edition. Philadelphia, Pa, USA: Elsevier Saunders; 2002. pp. 3055–3079.

Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level ≤4 ng per milliliter. The New England Journal of Medicine. 2004;350(22):2239–2246.

Yuan-Fei Lu, MD, Qian Zhang, et al. Improving the detection rate of prostate cancer in the gray zone of PI-RADS v2 and serum tPSA by using prostate-specific antigen–age volume. Medicine (Baltimore). 2019 Jun; 98(26): e16289.

Jean-Luc Descotes. Diagnosis of prostate cancer. Asian J Urol. 2019 Apr; 6(2): 129–136.

Padhani AR, Liu G, Koh DM, et al. Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia. 2009;11:102–125.

Issa B. In vivo measurement of the apparent diffusion coefficient in normal and malignant prostatic tissues using echo-planar imaging. Journal of Magnetic Resonance Imaging. 2002;16(2):196–200.

Sato C, Naganawa S, Nakamura T, et al. Differentiation of noncancerous tissue and cancer lesion by apparent diffusion coefficient values in transition and peripheral zones of the prostate. Journal of Magnetic Resonance Imaging. 2005;21(3):258–262

Cher Heng Tan, Wei Wei, et al. Diffusion Weighted Magnetic Resonance Imaging in Prostate Cancer, Meta-analysis. American Journal of Roentgenology. 2012;199 (4): 822-829.