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Apparent diffusion coefficient value is a strong predictor of unsuspected aggressiveness of prostate cancer before radical prostatectomy

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Abstract

Purpose

To evaluate the use of multiparametric MRI (mp MRI) parameters in order to predict prostate cancer aggressiveness as defined by pathological Gleason score or molecular markers in a cohort of patients defined with a Gleason score of 6 at biopsy.

Methods

Sixty-seven men treated by radical prostatectomy (RP) for a low grade (Gleason 6) on biopsy and mp MRI before biopsy were selected. The cycle cell proliferation (CCP) score assessed by the Prolaris test and Ki-67/PTEN expression assessed by immunohistochemistry were quantified on the RP specimens.

Results

49.25 % of the cancers were undergraded on biopsy compared to the RP specimens. Apparent diffusion coefficient (ADC) < 0.80 × 10−3 mm2/s (P value 0.003), Likert score >4 (P value 0.003) and PSA density >0.15 ng/ml/cc (P value 0.035) were significantly associated with a higher RP Gleason score. Regarding molecular markers of aggressiveness, ADC < 0.80 × 10−3 mm2/s and Likert score >4 were also significantly associated with a positive staining for Ki-67 (P value 0.039 and 0.01, respectively). No association was found between any analyzed MRI or clinical parameter and the CCP score.

Conclusion

Decreasing ADC value is a stronger indicator of aggressive prostate cancer as defined by molecular markers or postsurgical histology than biopsy characteristics.

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Acknowledgments

The authors thank Cecile Gaffory for helpful assistance in manuscript preparation. The authors thank Patrick Korman, Myriad Genetics SAS, France and Steve Stone, Myriad Genetics, Salt Lake City, UT, for blinded evaluation of gene expression signatures.

Author’s contribution

RRenard-Penna was involved in protocol/project development and data collection, analyzed the data and wrote the manuscript; G. Cancel-Tassin analyzed the data and wrote the manuscript; E. Comperat was involved in data collection, analyzed the data and wrote the manuscript; P. Mozer, P. Léon, J. Varinot and M. Roupret were involved in data collection; M. O. Bitker and O. Lucidarme were involved in data management; and O. Cussenot was involved in protocol/project development and data management, analyzed the data and wrote the manuscript.

Funding

Supported by Myriad Genetics which performed genetic tests. No author received any personal compensation for the study, financial or otherwise, nor does any investigator stand to benefit financially from the publication of this study.

Author information

Authors and Affiliations

  1. Academic Department of Radiology, Pitie-Salpetriere Hospital, AP-HP, UPMC Univ Paris 06, 83 Boulevard de l’Hopital, 75013, Paris, France

    Raphaele Renard Penna & Olivier Lucidarme

  2. GRC n°5, ONCOTYPE-URO, Institut Universitaire de Cancerologie, UPMC Univ Paris 06, Paris, France

    Raphaele Renard Penna, Geraldine Cancel-Tassin, Eva Comperat, Priscilla Léon, Justine Varinot, Morgan Roupret, Marc-Olivier Bitker & Olivier Cussenot

  3. CeRePP, Paris, France

    Geraldine Cancel-Tassin, Eva Comperat, Morgan Roupret & Olivier Cussenot

  4. Academic Department of Pathology, Pitie-Salpetriere Hospital, AP-HP, UPMC Univ Paris 06, Paris, France

    Eva Comperat & Justine Varinot

  5. Academic Department of Urology, Pitie-Salpetriere Hospital, AP-HP, UPMC Univ Paris 06, Paris, France

    Pierre Mozer, Priscilla Léon, Morgan Roupret, Marc-Olivier Bitker & Olivier Cussenot

  6. Academic Department of Urology, Tenon Hospital, AP-HP, UPMC Univ Paris 06, Paris, France

    Olivier Cussenot

Authors
  1. Raphaele Renard Penna
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  2. Geraldine Cancel-Tassin
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  3. Eva Comperat
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  4. Pierre Mozer
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  5. Priscilla Léon
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  6. Justine Varinot
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  7. Morgan Roupret
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  9. Olivier Lucidarme
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Corresponding author

Correspondence to Raphaele Renard Penna.

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Conflict of interest

Olivier Cussenot has received a speaker honorarium and financial support for attending symposia from Myriad Genetics SAS, France. The other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study 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.

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Renard Penna, R., Cancel-Tassin, G., Comperat, E. et al. Apparent diffusion coefficient value is a strong predictor of unsuspected aggressiveness of prostate cancer before radical prostatectomy. World J Urol 34, 1389–1395 (2016). https://doi.org/10.1007/s00345-016-1789-3

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  • DOI: https://doi.org/10.1007/s00345-016-1789-3

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