The Evaluation of the Relationship Between ADC Values and Gleason Score in the Prostate Cancer

INTRODUCTION: The purpose of this study was to evaluate the apparent diffusion coefficient (ADC) values of different grades of prostate cancer (PC) and determine whether the use of ADC values could predict the tumor aggressiveness in PC.
METHODS: 47 patients (Gleason score (GS) ≥ 6) who underwent prostate multi-parametric MRI (1.5 Tesla) between January 2017 and December 2020 for the evaluation of suspicious findings on clinical or laboratory evaluation were enrolled in this study. The specimens which were obtained from systematic 12-core trans-rectal ultrasound (TRUS)-guided biopsy were used for histopathologic diagnoses. The average ADC values within the tumors were calculated. Independent sample t-test, one-way analysis of variance (ANOVA, Tukey’s post-hoc or Tamhane) and receiver operating characteristics (ROC) curve analysis were used.
RESULTS: The mean ADC value of high-risk patients which was 585.4±138.7×10-6 mm2 /s, was significantly lower than other subgroups (p=0.036). The mean ADC value in low-risk group (798.1±236.5 ×10-6 mm2/s) was significantly higher (p = 0.012) than others. No significant difference in ADC values was found between low-risk vs intermediate-risk groups (p = 0.149) and intermediaterisk vs high-risk groups (p = 0.419). No statistically significant difference in ADC values between GS 3+4 and GS 4+3 (p, 0.552) was found. ROC analysis revealed an optimal ADC cut-off of 595×10-6 mm2/s for differentiating high-risk group from the other subgroups (sensitivity, 71%; specificity 67.6%, p, 0.038). For the determination of low-risk group, an ADC cut-off of 665×10-6 mm2/s (sensitivity, 80%; specificity, 65.6%, p, 0.017) was found.
DISCUSSION AND CONCLUSION: While ADC values may differentiate the high-risk and low-risk tumors, the strength of ADC in the prediction of intermediate-risk tumors was low. The ADC cut-off value of 665×10-6 mm2/s showed the high sensitivity and moderate specificity for the detection of low-risk tumors.

Prostat Kanserinde ADC Deðerleri ile Gleason Skoru Arasýndaki Ýliþkinin Deðerlendirilmesi

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, farklý derecelerdeki prostat kanserinin (PK) görünür difüzyon katsayýsý (ADC) deðerlerini deðerlendirmek ve ADC deðeri kullanýmýnýn PK'deki tümör agresifliðini tahmin edip edemeyeceðini deðerlendirmekti.
YÖNTEM ve GEREÇLER: Ocak 2017 ile Aralýk 2020 arasýnda klinik veya laboratuvar bulgularýna göre þüpheli olgularýn deðerlendirilmesi için multi-paramterik prostat MRG (1.5 Tesla) çekimi yapýlan 47 hasta (Gleason skoru (GS) ≥ 6) çalýþmaya dahil edildi. Histopatolojik taný için trans-rektal ultrason (TRUS) kýlavuzluðunda 12 kor sistematik biyopsiden elde edilen örnekler kullanýldý. Tümör içindeki ortalama ADC deðerleri hesaplandý. Baðýmsýz örneklem t testi, tek yönlü varyans analizi (ANOVA, Tukey's post-hoc veya Tamhane) ve “receiver operating characteristics” (ROC) eðrisi analizi kullanýldý.
BULGULAR: Yuksek riskli hastalarin ortalama ADC’si 585.4±138.7(×10-6 mm2/s) olculmus olup diger risk alt gruplarina gore anlamli olarak daha dusuktu (p = 0.036). Dusuk risk grubundaki hastalarda ortalama ADC degeri (798,1±236.5×10-6 mm2/s) diger gruplara gore anlamli olarak daha yuksekti (p = 0,012). Dusuk riskli ile orta riskli gruplar (p = 0.149) ve orta riskli ile yuksek riskli gruplar (p = 0.419) arasinda ADC degerlerinde anlamli bir fark bulunmadi. GS 3+4 ve GS 4+3 arasinda ADC degerlerinde istatistiksel olarak anlamli bir fark bulunmadi (p, 0,552). ROC analiziyle, yuksek risk grubunu diger alt gruplardan ayirt etmek icin optimal ADC esik degeri 595×10-6 mm2/s olarak hesaplandi (duyarlilik, %71; ozgulluk %67,6, p, 0,038). Dusuk risk grubunun belirlenmesi icin ADC esik degeri 665×10-6 mm2/s (duyarlilik, %80; ozgulluk, %65,6, p, 0,017) olarak bulundu.
TARTIÞMA ve SONUÇ: ADC degerleri yuksek riskli ve dusuk riskli tumorleri ayirt edebiliyorken, ADC'nin orta riskli tumorleri tahmin etme gucu dusuktu. ADC esik degeri olan 665×10-6 mm2/s, dusuk riskli tumorlerin tespiti icin yuksek duyarlilik ve orta duzeyde ozgulluk gostermektedir.