Correlation between CT Perfusion and Clinico-Pathological Features in Prostate Cancer: A Prospective Study
Elżbieta Łuczyńska, Sylwia Heinze-Paluchowska, Paweł Blecharz, Barbara Jereczek-Fossa, Giuseppe Petralia, Massimo Bellomi, Andrzej Stelmach
Department of Radiology, Center of Oncology, M. Skłodowska-Curie Memorial Institute, Cracow, Poland
Med Sci Monit 2015; 21:153-162
The aim of the study was to assess the correlation between computed tomography perfusion (PCT) parameters and PSA levels, Gleason score, and pTNM stage in patients with prostate cancer (PCa).
Material and Methods: One hundred twenty-five patients with localized PCa were prospectively enrolled in the study. All patients were diagnosed due to suspicious prostate findings and elevated PSA serum levels and underwent PCT followed by core biopsy and radical prostatectomy. Blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability-surface (PS) area product were computed in the suspected PCa area and normal prostatic tissue. Core biopsy followed by prostatectomy was performed 2–4 weeks after PCT. Correlation between PCT findings and PSA levels, Gleason score, and pTNM stage were analyzed.
Results: The mean age of patients was 64 years. All patients had elevated PSA levels (mean value 6.2 ng/ml). Nineteen patients (15.9%) were at low risk of recurrence, 91 (76.5%) were at moderate risk, and 9 (7.6%) were at high risk according to National Comprehensive Cancer Network criteria. PCa was visible on PCT as focal peripheral CT enhancement in 119 out of 125 patients (sensitivity 95.2%). Significant correlations between BV, BF, and PS values and PSA level were found (p<0.05), as well as a trend for difference between BV, BF, and PS in poorly and moderately differentiated tumors (according to Gleason score) in comparison with highly differentiated PCa (p<0.08). The analysis also revealed a correlation between mean perfusion values and BV, MTT, PS, and pTNM cancer stage (p<0.04).
Conclusions: Our study suggests that in low- and intermediate- risk patients, PCT parameters correlate with PSA values, Gleason score, and pTNM stage and can be useful for initial tumor staging.
Keywords: Diagnostic Imaging - methods, Biopsy, Neoplasm Grading, Neoplasm Recurrence, Local - pathology, Neoplasm Staging - methods, Perfusion, Permeability, Prospective Studies, Prostate-Specific Antigen - blood, Prostatectomy, Prostatic Neoplasms - radiography, Severity of Illness Index, Tomography, X-Ray Computed - methods