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Genetic correlates of prostate cancer visibility (and invisibility) on mpMRI: It's time to take stock

Norris, Joseph M., Simpson, Benjamin S., Parry, Marina A., Kasivisvanathan, Veeru, Allen, Clare, Ball, Rhys, Freeman, Alex, Kelly, Daniel, Kirkham, Alex, Whitaker, Hayley C. and Emberton, Mark 2020. Genetic correlates of prostate cancer visibility (and invisibility) on mpMRI: It's time to take stock. BJU International 125 (3) , pp. 340-342. 10.1111/bju.14919

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Multiparametric magnetic resonance imaging (mpMRI) has enhanced risk stratification for men at risk of prostate cancer, through accurate pre‐biopsy detection of high‐risk disease [1]. However, it has become apparent that not all clinically significant prostate cancer is detected by mpMRI. Approximately 10‐20% of significant disease is invisible to mpMRI, depending on the threshold set for significance, and on the quality of mpMRI acquisition and interpretation. The threshold for significance has recently been challenged by the 29‐year follow‐up of the SPCG‐4 study, in which men with overall Gleason score 3 + 4 did not suffer prostate‐cancer‐related death [2], whilst those with overall Gleason score 4 + 3 did suffer prostate‐cancer related death (adjusted relative risk 5.73; 95% CI 1.59–20.67) potentially suggesting a new threshold for clinically significant disease. This finding is important, given that in PROMIS, no men with overall Gleason score 4 + 3 had negative pre‐biopsy mpMRI [1], indicating that actually mpMRI may identify all truly significant cancer (if SPCG‐4 is used to guide our threshold). Nonetheless, over the past two years, there has been increasing drive to better understand the nature of mpMRI‐inconspicuous disease, particularly at the molecular level.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Healthcare Sciences
Publisher: Wiley
ISSN: 1464-4096
Funders: MRC
Date of Acceptance: 10 October 2019
Last Modified: 25 Mar 2020 12:12

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