The Characteristics of Prostate Cancer on Final Pathology in Men Undergo Radical Prostatectomy with a Negative Multiparametric Magnetic Resonance Imaging
Despite advancements in radiological imagining of the prostate with Multiparametric (mp)MRI, clinically significant cancer lesions can still be missed. The objective was to characterize the final pathology in men with negative mpMRI findings for PI-RADS 3 or greater but positive findings of prostate adenocarcinoma after prostatectomy.
An institutional retrospective study of all patients who received a prostate mpMRI for clinical suspicion of prostate cancer from 2015 to 2017 was performed. Patients who had a negative mpMRI for PI-RAD lesions of 3 or greater were identified and of this sub-population, patients who underwent a prostatectomy the final pathology were analyzed.
592 men had prostate mpMRI performed between 2015 and 2017, 100 of these men had a prostatectomy. 14 men (9 white, 3 black, 2 other) had negative mpMRI for PIRAD 3 or greater but had a prostatectomy with final pathology positive for prostate adenocarcinoma. The mean (range) for age, PSA, and PSA density was 60 (40 - 72) years, 6.6 (2.3 - 22) ng/mL and 0.15 (0.07- 0.15) ng/mL/cm2, respectively. On final surgical pathology, 11/14 (79%)men had prostate cancer of Gleason 7 or greater (8 had a Gleason 7 (3+4), 1 had Gleason 7 (4+3), 1 Gleason 8 (4+4), 1 Gleason 9 (3+5). Six men (43%) upgraded on surgical pathology from prostate biopsy pathology, and 6 men had extra prostatic extension including 1 who had seminal vesicle extension.
79% of men with prostate cancer diagnosis and negative mpMRI had clinically significant prostate cancer on final surgical pathology. Our study underscores the importance of obtaining a prostate biopsy despite negative mpMRI findings in patients with suspicion for prostate cancer.