Associations of PTEN and ERG with Magnetic Resonance Imaging Visibility and Assessment of Non–organ-confined Pathology and Biochemical Recurrence After Radical Prostatectomy

Juho T. Eineluoto, Kevin Sandeman, Joona Pohjonen, Konrad Sopyllo, Stig Nordling, Carolin Stürenberg, Adrian Malén, Tuomas P. Kilpeläinen, Henrikki Santti, Anssi Petas, Mika Matikainen, Teijo Pellinen, Petrus Järvinen, Anu Kenttämies, Antti Rannikko, Tuomas Mirtti

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background: Diagnosing clinically significant prostate cancer (PCa) is challenging, but may be facilitated by biomarkers and multiparametric magnetic resonance imaging (MRI).

Objective: To determine the association between biomarkers phosphatase and tensin homolog (PTEN) and ETS-related gene (ERG) with visible and invisible PCa lesions in MRI, and to predict biochemical recurrence (BCR) and non-organ-confined (non-OC) PCa by integrating clinical, MRI, and biomarker-related data.

Design, setting, and participants: A retrospective analysis of a population-based cohort of men with PCa, who underwent preoperative MRI followed by radical prostatectomy (RP) during 2014-2015 in Helsinki University Hospital (n = 346), was conducted. A tissue microarray corresponding to the MRI-visible and MRI-invisible lesions in RP specimens was constructed and stained for PTEN and ERG.

Outcome measurements and statistical analysis: Associations of PTEN and ERG with MRI-visible and MRI-invisible lesions were examined (Pearson's chi 2 test), and predictions of non-OC disease together with clinical and MRI parameters were determined (area under the receiver operating characteristic curve and logistic regression analyses). BCR prediction was analyzed by Kaplan-Meier and Cox proportional hazard analyses.

Results and limitations: Patients with MRI-invisible lesions (n = 35) had less PTEN loss and ERG-positive expression compared with patients (n = 90) with MRI-visible lesions (17.2% vs 43.3% [p = 0.006]; 8.6% vs 20.0% [p = 0.125]). Patients with invisible lesions had better, but not statistically significantly improved, BCR-free survival probability in Kaplan-Meier analyses (p = 0.055). Rates of BCR (5.7% vs 21.1%; p = 0.039), extraprostatic extension (11.4% vs 44.6%; p < 0.001), seminal vesicle invasion (0% vs 21.1%; p = 0.003), and lymph node metastasis (0% vs 12.2%; p = 0.033) differed between the groups in favor of patients with MRI-invisible lesions. Biomarkers had no independent role in predicting non-OC disease or BCR. The short follow-up period was a limitation.

Conclusions: PTEN loss, BCR, and non-OC RP findings were more often encountered with MRI-visible lesions.

Patient summary: Magnetic resonance imaging (MRI) of the prostate misses some cancer lesions. MRI-invisible lesions seem to be less aggressive than MRI-visible lesions. (C) 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Original languageEnglish
JournalEuropean Urology Focus
Volume7
Issue number6
Pages (from-to)1316-1323
Number of pages8
ISSN2405-4569
DOIs
Publication statusPublished - Nov 2021
MoE publication typeA1 Journal article-refereed

Fields of Science

  • 3126 Surgery, anesthesiology, intensive care, radiology
  • Biomarkers
  • ERG
  • Multiparametric magnetic resonance imaging
  • Prostate Imaging Reporting and
  • Data System
  • Prostate cancer
  • PTEN
  • Radical prostatectomy
  • CANCER
  • EXPRESSION
  • GUIDELINES

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