Presentation Authors: Mustafa Deebajah*, Kanika Taneja, Shadi Fakhouri, Daniel Cole, James Peabody, Mani Menon, Sean Williamson, Nilesh Gupta, Ali Dabaja, Shaheen Alanee, Detroit, MI
Introduction: We previously presented post prostatectomy pathology results from a small number of prostate cancer (PCa) patients who did not have findings suggestive of cancer on pre-operative pelvic magnetic resonance imaging (MRI). We update our series with findings from more patients with the same imaging characteristics.
Methods: An institutional retrospective study for our database of mpMRI for clinical suspicion of prostate cancer from 2015 to 2018 was performed. Patients who underwent prostatectomy for prostate cancer were identified and further analysis of their imaging and pathology findings were done. MRI was read by fellowship trained radiologist. Pathology was reviewed by fellowship trained pathologist.
Results: 850 men underwent pelvic/prostate MRI performed between 2015 and 2018, and 156 patients underwent robotic assisted radical prostatectomy. Thirty three (21%) men (22 white, 9 black, 2 other) had negative MRI for PIRAD 3 or greater. Their mean (range) age, PSA, and PSA density were 62.7 (50 - 86) years, 6.85 (0.2 - 32) ng/mL and 0.13 (0.06 â€“ 0.22) ng/mL/cm2, respectively. On prostatectomy pathology, 27/33 (82%) men had PCA of Gleason score (GS) 7 or greater. These included 18 Grade Group 2, 5 Grade Group 3, 3 Grade Group 4 (2 with 4+4 and 1 with 3+5), and 1 Grade Group 5 (Gleason 5+5). The most common pattern was infiltrative growth with cancer glands intermingling between benign glands. Nine men had extra prostatic extension including 1 who had seminal vesicle extension.
Conclusions: With increasing the number of patients with prostate cancer not seen on MRI, we show an even higher percentage of clinically significant prostate cancer on final surgical pathology. This validates our previous findings that negative MRI should not be used in isolation of other clinical variables to decide on whether to perform a prostate biopsy or not.