MRI-invisible prostate cancer: clinical and morphological characteristics

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Abstract

Aim. To determine clinical and morphological characteristics of the tumors invisible on magnetic resonance imaging (MRI) in patients with prostate cancer (PCa) who underwent robot-assisted radical prostatectomy.

Materials and methods. Retrospective analysis of MRI images of 151 patients with PCa after robot-assisted radical prostatectomy between 2022 and 2023 was performed. Series of T2-weighted, diffusion-weighted and dynamic contrast-enhanced images in accordance with the PI-RADS v.2.1 (Prostate Imaging Reporting and Data System) protocol were obtained. All MRI scans were interpreted by two radiologists with more than 20 years of experience. Statistical analysis was performed using IBM SPSS Statistics 25.0 software.

Results. Among 151 patients of the study cohort, 25 (17 %) patients did not have PI-RADS 3–5 lesions, while 126 (83 %) had them (р = 0.121). The patients had statistically significant differences in the prostate-specific antigen levels: in the group with lesions confirmed by multiparametric MRI (mpMRI) compared to the group without lesions the level of this tumor marker was significantly higher (median 7.15 [5.0–11.6] ng/mL; 95 % confidence interval (CI) 8.51–11.86 and 5.9 [4.13–8.1] ng/mL; 95 % CI 4.19–12.05, respectively; р = 0.034). The incidence of tumors with Gleason score 6 and 7 depending on the type of prostate cancer on mpMRI was determined. For focal lesions, the incidence of neoplasms with Gleason score 7 was higher (n = 92) than in the group without lesions (n = 14). Prostatic lesions per mpMRI were significantly more common in patients with potentially more aggressive forms of PCa (high prostate-specific antigen level, Gleason score ≥7, high tumor volume per morphological examination). In the absence of confirmed prostatic lesions by mpMRI, in 72 % of patients, tumor volume did not exceed 37.5 % of the resected organ per morphological examination. Additionally, in this case less aggressive characteristics and smaller volume of the tumor were observed compared to lesional disease.

Conclusion. The results confirmed high incidence of aggressive forms of the disease in MRI-visible PCa. In the group of MRI-invisible tumors, more than half of neoplasms had Gleason score 7. These data do not allow to unequivocally classify patients with MRI-invisible cancer into the favorable prognosis group.

About the authors

I. A. Aboyan

Clinical and Diagnostics Center “Health” in Rostov-on-Don

Email: polyakov.andrey.00@mail.ru
ORCID iD: 0000-0002-2798-368X
Russian Federation, 70/3 Dolomanovskiy Pereulok, Rostov-on-Don 344011

S. M. Pakus

Clinical and Diagnostics Center “Health” in Rostov-on-Don

Email: polyakov.andrey.00@mail.ru
ORCID iD: 0000-0001-6468-5983
Russian Federation, 70/3 Dolomanovskiy Pereulok, Rostov-on-Don 344011

Andrey S. Polyakov

Clinical and Diagnostics Center “Health” in Rostov-on-Don

Author for correspondence.
Email: polyakov.andrey.00@mail.ru
ORCID iD: 0009-0007-9589-5458
Russian Federation, 70/3 Dolomanovskiy Pereulok, Rostov-on-Don 344011

V. A. Redkin

Clinical and Diagnostics Center “Health” in Rostov-on-Don

Email: polyakov.andrey.00@mail.ru
Russian Federation, 70/3 Dolomanovskiy Pereulok, Rostov-on-Don 344011

K. I. Badyan

Clinical and Diagnostics Center “Health” in Rostov-on-Don

Email: polyakov.andrey.00@mail.ru
Russian Federation, 70/3 Dolomanovskiy Pereulok, Rostov-on-Don 344011

K. A. Shiranov

Clinical and Diagnostics Center “Health” in Rostov-on-Don

Email: polyakov.andrey.00@mail.ru
Russian Federation, 70/3 Dolomanovskiy Pereulok, Rostov-on-Don 344011

A. V. Khasigov

North Ossetian State Medical Academy, Ministry of Health of Russia

Email: polyakov.andrey.00@mail.ru
ORCID iD: 0000-0003-1103-4532
Russian Federation, 40 Pushkinskaya St., Vladikavkaz 362019, North Ossetia – Alania Republic

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