Urological Oncology Can Diffusion-Weighted Magnetic Resonance Imaging Predict a High Gleason Score of Prostate Cancer?

Purpose: To determine the relationship between cancer-positive findings on dif-fusion-weighted imaging (DWI) magnetic resonance imaging (MRI) and the Gleason score (GS) of radical prostatectomy specimens in prostate cancer (PC). Materials and Methods: We performed a retrospective study of 105 consecutive patients with PC who underwent radical prostatectomy between January 2009 and October 2011 with DWI MRI and full data available for analyses. Prostatectomy specimen path-ology included GS, margin status, and capsule invasion, and the clinical factors inves-tigated included age and serum prostate-specific antigen. We investigated the relation-ship between positive DWI MRI results and these pathological and clinical factors. Results: PC was diagnosed in 62 of 105 patients on DWI MRI. The prostatectomy speci-mens revealed that the number of cases with GS ＞4+3 was significantly greater in pa-tients with PC-positive DWI MRI results (34/62, 54.80%) than in those with PC-neg-ative results (2/43, 2.33%; p＜0.0001). Positive surgical margins occurred significantly more often in cases with PC-positive DWI MRI results (31/62, 50.0%, compared with 9/43, 21.4%; p=0.0253), and patients with a single tumor lesion in DWI MRI had sig-nificantly higher GSs than did those with multiple tumor lesions (p=0.0301). Our stat-istical results with multiple regression analysis showed that PC-positive DWI MRI re-sults are significantly associated with high GSs. Conclusions: DWI MRI may help to predict high GSs in prostatectomy specimens. Further studies assessing a greater number of patients will be necessary for a definitive evaluation of DWI MRI as a diagnostic tool for determining PC malignancy