Combination of Prostate Health Index with mpMRI for better assessment of true tumor boundary in prostate cancer
Tzung-Ruei Li, Po-Fan, Hsieh, Chi-Ping, Huang, Chao-Hsiang, Chang, Hsi-Chin, Wu, Han Chang
Department of Urology, China Medical University Hospital, Taichung, Taiwan
Department of Pathology, China Medical University Hospital, Taichung, Taiwan1
mpMRI shows a good performance for evaluation of the prostate cancer boundary and serves as a pre-operation (radical prostatectomy) survey. However, there was consensus that MRI would underestimate the actual tumor diameter. With an increase trend of focal treatment, which might be due to old age or high co-morbidity, we would like to identity the possible factors that could improve the performance of mpMRI.
Materials and Methods:
This retrospective study recruited 47 patients from April 2018 to August 2020, who had PHI examination, TRUS biopsy to prove malignancy and received mpMRI. All the patient received robotic radical prostatectomy. We analyzed the deviation of longest diameter of tumor between pathology and mpMRI, in the combination of PHI, PSA, PIRADS and Gleason score.
Among the 47 patients, the mean age was 65.35±6.75. The median PSA was 15.36±19.36. The median PHI was 68.86±32.53. The maximal diameter of tumor from mpMRI and pathology sample were 1.70±0.93cm, 2.28±1.25cm, respectively. There were 2, 3, 16, 26 patients belonged to PIRADS 2, 3, 4, 5, respectively. Boundary underestimation of tumor (pathology sample-mpMRI) showed larger in PIRADS 4-5 ( 6.55±7.28 mm, -0.2±0.8mm p<0.001) and in larger PHI (6.84±7.76mm in PHI>60, 5.20±6.58mm in 30<PHI≦60, and -0.50±0.71mm in PHI≦30), and biopsy Gleason sum above >6 (7.0±6.3mm, 3.8±9.1mm, p=0.233, though 10 of 18 patients with GS 3+3 had upgrade shown from the pathological Gleason score). The deviations difference between subgroups were prominent when shown in the Box plots.
We could combine the tumor boundary shown from mpMRI along with PIRADS, with the PHI, which had shown good performance than other PSA derivatives, together for the better predict of the maximal tumor diameter. Based on our analysis, the focal treatment should be widened if high PIRADS and high PHI; meanwhile the prostate could be preserved more in low PIRADS and low PHI.