MP81-19 WHICH PROSTATE CANCERS ARE OVERLOOKED BY MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING? AN ANALYSIS FROM PROMIS

You have accessJournal of UrologyProstate Cancer: Detection & Screening VIII (MP81)1 Apr 2020MP81-19 WHICH PROSTATE CANCERS ARE OVERLOOKED BY MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING? AN ANALYSIS FROM PROMIS Joseph Norris*, Lina Carmona Echeverria, Simon Bott, Louise Brown, Louise Brown, Nicholas Burns-Cox, Timothy Dudderidge, Ahmed El-Shater Bosaily, Elena Frangou, Alex Freeman, Maneesh Ghei, Alastair Henderson, Richard Hindley, Richard Kaplan, Alex Kirkham, Robert Oldroyd, Christopher Parker, Raj Persad, Shonit Punwani, Derek Rosario, Iqbal Shergill, Vasilis Stavrinides, Mathias Winkler, Hayley Whitaker, Hashim Ahmed, and Mark Emberton Joseph Norris*Joseph Norris* More articles by this author , Lina Carmona EcheverriaLina Carmona Echeverria More articles by this author , Simon BottSimon Bott More articles by this author , Louise BrownLouise Brown More articles by this author , Louise BrownLouise Brown More articles by this author , Nicholas Burns-CoxNicholas Burns-Cox More articles by this author , Timothy DudderidgeTimothy Dudderidge More articles by this author , Ahmed El-Shater BosailyAhmed El-Shater Bosaily More articles by this author , Elena FrangouElena Frangou More articles by this author , Alex FreemanAlex Freeman More articles by this author , Maneesh GheiManeesh Ghei More articles by this author , Alastair HendersonAlastair Henderson More articles by this author , Richard HindleyRichard Hindley More articles by this author , Richard KaplanRichard Kaplan More articles by this author , Alex KirkhamAlex Kirkham More articles by this author , Robert OldroydRobert Oldroyd More articles by this author , Christopher ParkerChristopher Parker More articles by this author , Raj PersadRaj Persad More articles by this author , Shonit PunwaniShonit Punwani More articles by this author , Derek RosarioDerek Rosario More articles by this author , Iqbal ShergillIqbal Shergill More articles by this author , Vasilis StavrinidesVasilis Stavrinides More articles by this author , Mathias WinklerMathias Winkler More articles by this author , Hayley WhitakerHayley Whitaker More articles by this author , Hashim AhmedHashim Ahmed More articles by this author , and Mark EmbertonMark Emberton More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000973.019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: All risk stratification strategies in cancer overlook a spectrum of disease. The Prostate MRI Imaging Study (PROMIS) provides a unique opportunity to explore prostate cancers that are overlooked by multiparametric magnetic resonance imaging (mpMRI). The objective of this study is to summarise the attributes of cancers that are systematically overlooked by mpMRI. METHODS: PROMIS tested performance of mpMRI and TRUS-guided biopsy, using 5mm template mapping biopsy as the reference standard. Outcomes were overall and maximum Gleason scores, maximum cancer core length (MCCL), and prostate specific antigen density (PSAD). Cancer attributes were compared between cancers that were overlooked and those that were detected. RESULTS: Of men with cancer, 7% (17/230) had significant disease overlooked by mpMRI according to definition 1 (Gl >/= 4+3 of any length OR MCCL >/= 6mm of any grade), and 13% (44/331) according to definition 2 (Gl >/= 3+4 of any length OR MCCL >/= 4mm of any grade). In comparison, TRUS-guided biopsy overlooked 52% (119/230) of significant disease by definition 1 and 40% (132/331) by definition 2. Cancers that were undetected by mpMRI had significantly lower overall and maximum Gleason scores (p=0.03; p=0.01; Fig.1A) and shorter MCCL (5mm vs. 8mm, p<0.0001; Fig.1B), compared to cancers that were detected. No tumour with overall Gleason score >3+4 (Gleason Grade Groups 3–5) or a maximum Gleason score >4+3 (Gleason Grade Groups 4-5) on transperineal mapping biopsy, was undetected by mpMRI. Application of PSAD threshold of 0.15 reduced the proportion of men with undetected cancer to 5% (12/230) for definition 1, and 9% (30/331) for definition 2. Application of a PSAD threshold of 0.10 to negative mpMRI lowered the proportion of men with undetected disease to 3% (6/230) for definition 1 cancer, and to 3% (11/331) for definition 2 cancer. CONCLUSIONS: A small proportion of cancers are overlooked by mpMRI. Those that are undetected are of lower Grade Group and shorter cancer length, compared to cancers that are detected. Source of Funding: PROMIS was funded by the UK Government Department of Health, National Institute of Health Research–Health Technology Assessment Programme (Project no.: 09/22/67) and by the UCLH/UCL Biomedical Research Centre and the Royal Marsden and Institute for Cancer Research Biomedical Research Centre. The post hoc analysis presented here was funded by the MRC through an MRC Clinical Research Training Fellowship awarded to Joseph M. Norris (Ref: MR/S00680X/1). © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1243-e1244 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Norris* More articles by this author Lina Carmona Echeverria More articles by this author Simon Bott More articles by this author Louise Brown More articles by this author Louise Brown More articles by this author Nicholas Burns-Cox More articles by this author Timothy Dudderidge More articles by this author Ahmed El-Shater Bosaily More articles by this author Elena Frangou More articles by this author Alex Freeman More articles by this author Maneesh Ghei More articles by this author Alastair Henderson More articles by this author Richard Hindley More articles by this author Richard Kaplan More articles by this author Alex Kirkham More articles by this author Robert Oldroyd More articles by this author Christopher Parker More articles by this author Raj Persad More articles by this author Shonit Punwani More articles by this author Derek Rosario More articles by this author Iqbal Shergill More articles by this author Vasilis Stavrinides More articles by this author Mathias Winkler More articles by this author Hayley Whitaker More articles by this author Hashim Ahmed More articles by this author Mark Emberton More articles by this author Expand All Advertisement PDF downloadLoading ...