Investig Clin Urol.  2017 Jan;58(1):12-19. 10.4111/icu.2017.58.1.12.

Predicting biochemical recurrence in patients with high-risk prostate cancer using the apparent diffusion coefficient of magnetic resonance imaging

• Yoon MY
• Park J
• Cho JY
• Jeong CW
• Ku JH
• Kim HH
• Kwak C

• KMID: 2365091
• DOI: http://doi.org/10.4111/icu.2017.58.1.12

Abstract

PURPOSE
We aimed to investigate whether the apparent diffusion coefficient (ADC) value in diffusion-weighted magnetic resonance imaging predicts the prognoses of patients with high-risk prostate cancer.
MATERIALS AND METHODS
A total of 157 patients with high-risk prostate cancer (based on D'Amico's criteria) were included in the analysis. Patients underwent preoperative 3.0 Tesla magnetic resonance imaging within 2 months before radical prostatectomy. Those who received neoadjuvant hormone therapy (33 persons) or radiation therapy (18 persons) were excluded. The ADC of the tumor calculated from 2 b-values (0 and 1,000 s/mm²) was measured. Areas under receiver operating characteristics curves were calculated to maximize the accuracy of the ADC value. Based on the obtained cutoff value, the patients were stratified into 2 groups: Group A consisted of patients with ADC values <746×10⁻⁶ mm²/s and group B comprised those with ADC values ≥746×10⁻⁶ mm²/s.
RESULTS
Group A showed higher rate of lymph positive and biochemical recurrence (BCR) rates than group B. Kaplan-Meier analysis showed that the BCR-free survival rate of group A was much lower than that of group B (p<0.001). On Cox proportional regression analyses, ADC group A (hazard ratio [HR], 3.238, p=0.002) and pathologic lymph node positive (HR, 2.242; p=0.009) were independent predictors of BCR.
CONCLUSIONS
In patients with high-risk prostate cancer, ADC value is significantly associated with BCR-free survival. Therefore, the ADC value is a useful tool for predicting the prognoses of these high-risk patients.

Keyword

Magnetic resonance imaging; Prognosis; Prostate neoplasms; Recurrence

MeSH Terms

Diffusion*
Humans
Kaplan-Meier Estimate
Lymph Nodes
Magnetic Resonance Imaging*
Prognosis
Prostate*
Prostatectomy
Prostatic Neoplasms*
Recurrence*
ROC Curve
Survival Rate

Figure

• 

  Fig. 1 Acquisition of the mean apparent diffusion coefficient (ADC) values using a 3.0 Tesla diffusion-weighted magnetic resonance imaging (DW-MRI) scanner.

• 

  Fig. 2 Receiver operating characteristic (ROC) curve analysis for determining the most appropriate apparent diffusion coefficient (ADC) cutoff value. The cutoff value of 746×10−6 mm2/s was chosen to maximize the discriminatory ability related to sensitivity and specificity. The area under the receiver operating characteristics curve was 0.691 (95% confidential interval [CI]. 0.612–0.762), the sensitivity was 89.86 (95% CI, 80.2–95.8), and the specificity was 43.18 (95% CI, 32.7–54.2).

• 

  Fig. 3 Kaplan-Meier analyses of biochemical recurrence (BCR)-free survival rates according to ADCmean values among the total subjects (A) and among the 4 different subgroups: pathologic Gleason score ≤7 (B), pathologic Gleason score ≥8 (C), pathologic stage ≤ T2 (D), and pathologic stage ≥ T3 (E). Group A, patients with ADC values <746×10−6 mm2/s; group B, patients with ADC values ≥746×10−6 mm2/s.; ADC, apparent diffusion coefficient.

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