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New prostate cancer prognostic grade group (PGG): Can multiparametric MRI (mpMRI) accurately separate patients with low-, intermediate-, and high-grade cancer?

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Abstract

Purpose

Our objective is to determine the accuracy of multiparametric MRI (mpMRI) in predicting pathologic grade of prostate cancer (PCa) after radical prostatectomy (RP) using simple apparent diffusion coefficient metrics and, specifically, whether mpMRI can accurately separate disease into one of two risk categories (low vs. higher grade) or one of three risk categories (low, intermediate, or high grade) corresponding to the new prognostic grade group (PGG) criteria.

Methods

This retrospective, HIPAA-compliant, IRB-approved study included 140 patients with PCa who underwent 3 T mpMRI with endorectal coil and transrectal ultrasound-guided (TRUS-G) biopsy before RP. MpMRI was used to classify lesions using a two-tier (low-grade/PGG 1 vs. high-grade/PGG 2–5) or a three-tier system (low-grade/PGG 1 vs. intermediate-grade/PGG 2 vs. high-grade/PGG 3–5). Accuracy of mpMRI was compared against RP for each system.

Results

The predictive accuracy of mpMRI using the two-tier system is higher than when using three-tier system (0.77 and 0.45, respectively). There were similar rates of undergrading between mpMRI and TRUS-G biopsy compared to RP (16% & 21%; respectively); rate of overgrading was higher for mpMRI vs. TRUS-G biopsy compared to RP (42% & 17%, respectively). When mpMRI and TRUS-G biopsy are combined, rate of undergrading is 1.4% and overgrading is 11%.

Conclusions

MpMRI predictive accuracy is higher when using a two-tier vs. a three-tier system, suggesting that advanced metrics may be necessary to delineate intermediate- from high-grade disease. Rates of under- and overgrading decreased when mpMRI and TRUS-G biopsy are combined, suggesting that these techniques may be complementary in predicting tumor grade.

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Acknowledgments

The authors gratefully acknowledge the contributions of John Madden, M.D., Ph.D., to the manuscript.

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Authors and Affiliations

  1. Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC, 27710, USA

    Jamie N. Holtz & Rajan T. Gupta

  2. Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, 3101 McGavran-Greenberg Hall, CB #7420, Chapel Hill, NC, 27599, USA

    Rachel Kloss Silverman

  3. Duke Cancer Institute, DUMC Box 3917, Durham, NC, 27710, USA

    Kae Jack Tay, Thomas J. Polascik & Rajan T. Gupta

  4. Department of Surgery, Division of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, DUMC Box 2804, Durham, NC, 27710, USA

    Kae Jack Tay, Thomas J. Polascik & Rajan T. Gupta

  5. Department of Pathology, Duke University Medical Center, DUMC Box 3712, Durham, NC, 27710, USA

    Jill T. Browning & Jiaoti Huang

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  1. Jamie N. Holtz
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  2. Rachel Kloss Silverman
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  3. Kae Jack Tay
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  7. Rajan T. Gupta
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Corresponding author

Correspondence to Rajan T. Gupta.

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Funding

There is no internal or external funding for this study. This manuscript is not under consideration elsewhere. This is a HIPAA-compliant, IRB-approved study with waiver of informed consent granted by the local institutional review board.

Financial disclosures/Conflict of interest relevant to this submitted work

Rajan T. Gupta, MD has no financial disclosures or conflicts of interest related to this work; he does serve as a consultant to Bayer Pharma AG, Invivo Corp., and Halyard Health; he also serves on the Speakers Bureau for Bayer Pharma AG. Ms. Holtz, Ms. Silverman, Dr. Tay, Dr. Browning, Dr. Huang, and Dr. Polascik have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study is retrospective in its design and for this type of study formal consent is not required.

Appendix

Appendix

See Tables 5 and 6.

Table 5 Classification of prostate cancer lesions using two-tier vs. three-tier systems with systematic TRUS-guided biopsy and final surgical pathology from radical prostatectomy
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Table 6 TRUS-guided biopsy vs. surgical pathology after radical prostatectomy in two-tier and three-tier systems
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Holtz, J.N., Silverman, R.K., Tay, K.J. et al. New prostate cancer prognostic grade group (PGG): Can multiparametric MRI (mpMRI) accurately separate patients with low-, intermediate-, and high-grade cancer?. Abdom Radiol 43, 702–712 (2018). https://doi.org/10.1007/s00261-017-1255-8

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