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Diffusion-weighted magnetic resonance imaging for prediction of insignificant prostate cancer in potential candidates for active surveillance

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Abstract

Objectives

To investigate whether the apparent diffusion coefficient (ADC) from diffusion-weighted magnetic resonance imaging (DW-MRI) could help improve the prediction of insignificant prostate cancer in candidates for active surveillance (AS).

Methods

Enrolled in this retrospective study were 287 AS candidates who underwent DW-MRI before radical prostatectomy. Patients were stratified into two groups; Group A consisted of patients with no visible tumour or a suspected tumour ADC value > 0.830 × 10-3 mm2/sec and Group B consisted of patients with a suspected tumour ADC value < 0.830 × 10-3 mm2/sec. We compared pathological outcomes in each group.

Results

Group A had 243 (84.7 %) patients and Group B had 44 (15.3 %) patients. The proportion of organ-confined Gleason ≤ 6 disease and insignificant prostate cancer was significantly higher in Group A than Group B (61.3 % vs. 38.6 %, p = 0.005 and 47.7 % vs. 25.0 %, p = 0.005, respectively). On multivariate analysis, a high ADC value was the independent predictor of organ-confined Gleason ≤ 6 disease and insignificant prostate cancer (odds ratio = 2.43, p = 0.011 and odds ratio = 2.74, p = 0.009, respectively).

Conclusion

Tumour ADC values may be a useful marker for predicting insignificant prostate cancer in candidates for AS.

Key points

• ADC from DW-MRI can help assess prostate cancer aggressiveness in potential AS candidates.

• There was a closed correlation between higher ADC values and insignificant prostate cancer.

• The absence of lesions on DWI/DWI can help select potential AS candidates.

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Abbreviations

ADC:

Apparent diffusion coefficient

DWI:

Diffusion-weighted imaging

MP-MRI:

Multiparametric magnetic resonance imaging

PRIAS:

Prostate Cancer Research International: Active Surveillance

PSA:

Prostate-specific antigen

PSAD:

Prostate-specific antigen density

ROIs:

Regions of interest

RP:

Radical prostatectomy

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Acknowledgments

The scientific guarantor of this publication is Seong Soo Jeon MD, Ph.D. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained (Samsung medical center IRB 2014-04-016). Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, performed at one institution.

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Authors and Affiliations

  1. Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, # 81 Irwon-Ro, Gangnam-gu, Seoul, 135-710, Republic of Korea

    Tae Heon Kim, Jae Yong Jeong, Sin Woo Lee, Hyun Hwan Sung, Hwang Gyun Jeon, Byong Chang Jeong, Seong Il Seo, Hyun Moo Lee, Han Yong Choi & Seong Soo Jeon

  2. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Chan Kyo Kim & Byung Kwan Park

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  1. Tae Heon Kim
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Correspondence to Seong Soo Jeon.

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Kim, T.H., Jeong, J.Y., Lee, S.W. et al. Diffusion-weighted magnetic resonance imaging for prediction of insignificant prostate cancer in potential candidates for active surveillance. Eur Radiol 25, 1786–1792 (2015). https://doi.org/10.1007/s00330-014-3566-2

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  • DOI: https://doi.org/10.1007/s00330-014-3566-2

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