OBJECTIVES

We sought to evaluate the correlation between MRI phenotypes of prostate cancer as defined by PI-RADS v2 and the Decipher Genomic Classifier (used to estimate the risk of early metastases).

METHODS

This single-center, retrospective study included 72 nonconsecutive men with prostate cancer who underwent MRI before radical prostatectomy performed between April 2014 and August 2017 and whose MRI registered lesions were microdissected from radical prostatectomy specimens and then profiled using Decipher (89 lesions; 23 MRI invisible [PI-RADS v2 scores ≤ 2] and 66 MRI visible [PI-RADS v2 scores ≥ 3]). Linear regression analysis was used to assess clinicopathologic and MRI predictors of Decipher results; correlation coefficients (r) were used to quantify these associations. AUC was used to determine whether PI-RADS v2 could accurately distinguish between low-risk (Decipher score < 0.45) and intermediate-/high-risk (Decipher score ≥ 0.45) lesions.

RESULTS

MRI-visible lesions had higher Decipher scores than MRI-invisible lesions (mean difference 0.22; 95% CI 0.13, 0.32; p < 0.0001); most MRI-invisible lesions (82.6%) were low risk. PI-RADS v2 had moderate correlation with Decipher (r = 0.54) and had higher accuracy (AUC 0.863) than prostate cancer grade groups (AUC 0.780) in peripheral zone lesions (95% CI for difference 0.01, 0.15; p = 0.018).

CONCLUSIONS

MRI phenotypes of prostate cancer are positively correlated with Decipher risk groups. Although PI-RADS v2 can accurately distinguish between lesions classified by Decipher as low or intermediate/high risk, some lesions classified as intermediate/high risk by Decipher are invisible on MRI.

KEY POINTS

• MRI phenotypes of prostate cancer as defined by PI-RADS v2 positively correlated with a genomic classifier that estimates the risk of early metastases. • Most but not all MRI-invisible lesions had a low risk for early metastases according to the genomic classifier. • MRI could be used in conjunction with genomic assays to identify lesions that may carry biological potential for early metastases.