Prostate cancer foci detected on multiparametric magnetic resonance imaging are histologically distinct from those not detected

Purpose: We identified histological differences between prostate cancer foci that are detected and missed using multiparametric magnetic resonance imaging. Materials and Methods: A total of 49 patients who underwent multiparametric magnetic resonance imaging, including T2-weighted imaging, including diffusion weighted imaging and dynamic contrast enhanced imaging, before prostatectomy were enrolled in the study. One radiologist identified areas highly suspicious for tumor. One pathologist identified and categorized tumors in terms of size, Gleason score, solid tumor growth, intermixed benign glands, loose stroma, desmoplastic stroma and a high malignant epithelium-to-stroma ratio. Differences between detected and missed tumors were assessed using logistic regression analyses based on generalized estimating equations for correlated data. Results: All histological features showed significant differences between detected and missed tumors on multiparametric magnetic resonance imaging (p <0.0001). Independent predictors of detection on multivariate analysis were size (OR 5.38, p = 0.0077), Gleason score (OR 5.12, p = 0.0094) and solid growth (OR 17.83, p <0.0001). Size, Gleason score and loose stroma were significant predictors of identification with diffusion weighted imaging on univariate analysis (p ≤0.0245), while Gleason score (OR 17.05, p = 0.0212) and solid growth (OR 34.90, p = 0.0103) were independent predictors of identification with diffusion weighted imaging on multivariate analysis. Identification with T2-weighted imaging was associated with size and Gleason score (p ≤0.01876). Identification with dynamic contrast enhanced imaging was associated with intermixed benign epithelium, loose stroma and a high malignant epithelium-to-stroma ratio (p ≤0.0499). No combination of features served as independent predictors on multivariate analysis for T2-weighted imaging or dynamic contrast enhanced imaging. Conclusions: There are fundamental histological differences between detected and missed prostate tumors using magnetic resonance imaging. Insights into these differences may facilitate the prospective role of magnetic resonance imaging in counseling and treatment selection for patients with prostate cancer.