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Updated: Aug 17, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Regional Histopathology and Prostate MRI Positivity: A Secondary Analysis of the PROMIS Trial
Vasilis Stavrinides1, Joseph M Norris1, Solon Karapanagiotis1
1From the Division of Surgery and Interventional Science (V.S., J.M.N., F.G., A.G., L.M.C.E., S.P., H.C.W., M.E.), Medical Research Council Clinical Trials Unit (L.C.B., R.S.K.), and Centre for Medical Imaging (S.P.), University College London, Charles Bell House, 43-45 Foley St, London W1W 7TS, UK; The Alan Turing Institute, London, UK (V.S., S.K.); Departments of Urology (V.S., J.M.N., A.G., M.E.), Radiology (F.G., A.K., S.P.), and Pathology (A.F., A. Haider., L.M.C.E.), University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK (S.K.); Computational Pathology Group, Institute of Cancer Research, Sutton, London, UK (N.T.); Department of Urology, Frimley Health NHS Foundation Trust, London, UK (S.R.J.B.); Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK (N.B.C.); Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK (T.J.D.); Department of Radiology, Royal Free London NHS Foundation Trust, London, UK (A.E.S.B.); Department of Urology, Whittington Health NHS Trust, London, UK (M.G.); Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK (A. Henderson); Department of Urology, Hampshire Hospitals NHS Foundation Trust, UK (R.G.H.); Public and patient representative, Nottingham, UK (R.O.); Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK (C.P.); Department of Urology, North Bristol NHS Trust, Bristol, UK (R.P.); Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (D.J.R.); Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK (I.S.S.); Department of Urology, Imperial College Healthcare NHS Trust, London, UK (M.W., H.U.A.); and Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK (M.W., H.U.A.).
Abstract:
Background The effects of regional histopathologic changes on prostate MRI scans have not been accurately quantified in men with an elevated prostate-specific antigen (PSA) level and no previous biopsy. Purpose To assess how Gleason grade, maximum cancer core length (MCCL), inflammation, prostatic intraepithelial neoplasia (PIN), or atypical small acinar proliferation within a Barzell zone affects the odds of MRI visibility. Materials and Methods In this secondary analysis of the Prostate MRI Imaging Study (PROMIS; May 2012 to November 2015), consecutive participants who underwent multiparametric MRI followed by a combined biopsy, including 5-mm transperineal mapping (TPM), were evaluated. TPM pathologic findings were reported at the whole-prostate level and for each of 20 Barzell zones per prostate. An expert panel blinded to the pathologic findings reviewed MRI scans and declared which Barzell areas spanned Likert score 3-5 lesions. The relationship of Gleason grade and MCCL to zonal MRI outcome (visible vs nonvisible) was assessed using generalized linear mixed-effects models with random intercepts for individual participants. Inflammation, PIN, and atypical small acinar proliferation were similarly assessed in men who had negative TPM results. Results Overall, 161 men (median age, 62 years [IQR, 11 years]) were evaluated and 3179 Barzell zones were assigned MRI status. Compared with benign areas, the odds of MRI visibility were higher when a zone contained cancer with a Gleason score of 3+4 (odds ratio [OR], 3.1; 95% CI: 1.9, 4.9; P < .001) or Gleason score greater than or equal to 4+3 (OR, 8.7; 95% CI: 4.5, 17.0; P < .001). MCCL also determined visibility (OR, 1.24 per millimeter increase; 95% CI: 1.15, 1.33; P < .001), but odds were lower with each prostate volume doubling (OR, 0.7; 95% CI: 0.5, 0.9). In men who were TPM-negative, the presence of PIN increased the odds of zonal visibility (OR, 3.7; 95% CI: 1.5, 9.1; P = .004). Conclusion An incremental relationship between cancer burden and prostate MRI visibility was observed. Prostatic intraepithelial neoplasia contributed to false-positive MRI findings. ClinicalTrials.gov registration no. NCT01292291 © RSNA, 2022 Supplemental material is available for this article. See also the editorial by Harmath in this issue.
