Abstract
Introduction/Background
Magnetic resonance imaging (MRI) misses a proportion of “clinically significant” prostate
cancers (csPC) as defined by histopathology criteria. The aim of this study was to
analyze whether long-term oncologic outcomes differ between MRI-detectable and MRI-occult
csPC.
Patients and Methods
Retrospective analysis of 1449 patients with pre-prostatectomy MRI and csPC on prostatectomy
specimens (ie, Grade group ≥2 or extraprostatic spread) between 2001-2006. T2-weighted
MRIs were classified according to the Prostate Imaging Reporting and Data System into
MRI-occult (categories 1, 2), MRI-equivocal (category 3), and MRI-detectable (categories
4, 5). Cumulative incidence of biochemical recurrence (BCR), metastatic disease, and
cancer-specific mortality, estimated with competing risk models. The median follow-up
in survivors was 11.0 years (IQR: 8.9-13.1).
Results
In 188 (13%) cases, csPC was MRI-occult, 435 (30%) MRIs were equivocal, and 826 (57%)
csPC were MRI-detectable. The 15-year cumulative incidence [95% CI] of BCR was 8.3%
[2.2, 19.5] for MRI-occult cases, 17.4% [11.1, 24.8] for MRI-equivocal cases, and
43.3% [38.7, 47.8] for MRI-detectable cases (P < .001). The cumulative incidences of metastases were 0.61% [0.06, 3.1], 3.5% [1.5,
6.9], and 19.6% [15.4, 24.2] for MRI-occult, MRI-equivocal, and MRI-detectable cases,
respectively (P < .001). There were no deaths from prostate cancer observed in patients with MRI-occult
csPC, compared to an estimated 1.9% [0.54, 4.9], and 7.1 % [4.5, 10.6] for patients
with MRI-equivocal and MRI-detectable cancer, respectively (P < .001).
Conclusion
Oncologic outcomes after prostatectomy for csPC differ between MRI-occult and MRI-detectable
lesions. Judging the clinical significance of a negative prostate MRI based on histopathologic
surrogates alone might be misleading.
Microabstract
Among 1449 patients with pre-prostatectomy MRI and clinically significant prostate
cancer on prostatectomy histopathology, MRI-occult cancers (n = 188, 13%) were less
likely to recur biochemically (8% vs. 43%, P < .001), metastasize (0.6% vs. 20%, P < .001), or lead to prostate cancer mortality (0% vs. 7%, P < .001) than MRI-detectable cancers (n = 826, 57%). MRI-occult cancers constitute
a prognostically distinct subgroup among higher-grade prostate cancers.
Keywords
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Article info
Publication history
Published online: April 14, 2022
Accepted:
April 10,
2022
Received:
October 26,
2021
Identification
Copyright
© 2022 Published by Elsevier Inc.
