IS UPGRADE IN GLEASON SCORE AFTER RADICAL PROSTATECTOMY PREDICTABLE WITH PREOPERATIVE MULTIPARAMETRIC PROSTATE MRI?: COMPARISON OF ADC, K-TRANS, TUMOR SIZE AND PI-RADS SCORE

Yıl 2022, Cilt: 5 Sayı: 3, 786 - 804, 26.12.2022

Merve Horoz , Kürşad Dönmez , Mehmet Coskun , Cesur Gümüş , Yiğit Akın , İrfan Öcal , Orhan Oyar

https://doi.org/10.52538/iduhes.1218619

Öz

Aim: In this study, the relationship between MRI parameters and upgrade in Gleason score after radical prostatectomy was investigated.
Materials and Methods: Between November 2017 and July 2020, 112 patients who underwent multiparametric MRI with suspected prostate cancer, TRUS systematic and cognitive fusion biopsy and subsequent radical prostatectomy were involved this study. The patients were evaluated in two groups as those with and without the Gleason score upgrade after surgery. These two groups was compared in terms of ADC, k-trans, tumor size and PI-RADS score. Radiological evaluation was consensus using PI-RADS version 2.1 by two radiologists who lacked clinical knowledge. ADC and k-trans were measured in the MR workstation. ISUP scoring system was used in pathological evaluation.
Results: Upgrade in Gleason score was found in 51/112 of the cases. Only 2/51 cases were PI-RADS score 1. Upgrade rate of Gleason score were 15,6% for PI-RADS score <4; and 84,3% for score ≥4. The most frequent upgrade was from ISUP 1 to ISUP 2. There was no significant difference in PSA, PSAd tumor size, k-trans and ADC in comparing between two groups. Upgrade was significantly higher in cases with PI-RADS score ≥4 and the transitional zone involvement on MRI (p<0.05).
Conclusion: mpMRI is an effective method of predicting upgrade in Gleason score after radical prostatectomy. PI-RADS score ≥4 or transitional zone involvement has an independent predictive value.

Anahtar Kelimeler

Multiparametric MRI, prostate cancer, prostate biopsy, Gleason, PI-RADS

IS UPGRADE IN GLEASON SCORE AFTER RADICAL PROSTATECTOMY PREDICTABLE WITH PREOPERATIVE MULTIPARAMETRIC PROSTATE MRI?: COMPARISON OF ADC, K-TRANS, TUMOR SIZE AND PI-RADS SCORE

Öz

Giriş ve Amaç: Bu çalışmada, MRG parametreleri ile radikal prostatektomi sonrası Gleason skor artışı arasındaki ilişki araştırılmıştır.
Yöntem: Kasım 2017–Temmuz 2020 tarihleri arasında prostat kanseri şüphesi ile multiparametrik MRG yapılan olgulardan, TRUS eşliğinde sistematik ve kognitif füzyon biyopsi ve sonrasında radikal prostatektomi yapılan 112 çalışma kapsamına alındı. Hastalar, cerrahi sonrası Gleason skor artış olanlar ve olmayanlar şeklinde iki grupta incelendi. Bu iki grup; ADC, k-trans, tümör boyutu ve PI-RADS skoru açısından karşılaştırıldı. Radyolojik değerlendirme, klinik bilgiden yoksun iki radyolog tarafından PI-RADS versiyon 2.1 kullanılarak konsensüs ile yapıldı. ADC ve k-trans değerleri MR iş istasyonunda ölçülüp kaydedildi. Patolojik değerlendirmede ISUP skorlama sistemi kullanıldı.
Bulgular: Çalışmayı oluşturan 112 olgunun 51’inde RP sonrası Gleason skor artışı saptandı. Bu olguların yalnızca 2’si PI-RADS1 idi. Gleason skor artış oranı PI-RADS skor < 4 için %15,6; skor ≥4 için ise %84,3 olarak bulundu. En sık skor artışı ISUP 1’den, ISUP 2’ye görüldü. Skor artışı görülen ve görülmeyen grubun karşılaştırılmasında, PSA, PSAd tümör boyutu, k-trans ve ADC değerleri açısından anlamlı fark görülmedi. PI-RADS skoru ≥4 olan olgularda veya mpMRG’de transizyonel zon tutulumunda Gleason skor artışı anlamlı derecede yüksekti (p<0,05).
Sonuç: mpMRG, radikal prostatektomi sonrası Gleason skor artışını öngörmede etkin bir yöntemdir. Bu amaçla PI-RADS skoru ≥ 4 veya transizyonel zon tutulumu bağımsız bir öngörü değerine sahiptir.

Anahtar Kelimeler

Multiparametrik MRG, PI-RADS, Gleason, prostat kanseri, prostat biyopsi

Kaynakça

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