{"entity":{"id":"paper-johnson-mpmri-individual-foci-eur-urol-2019","kind":"paper","name":"Detection of individual prostate cancer foci via multiparametric magnetic resonance imaging","aka":["Johnson 2019","per-lesion MRI sensitivity prostate","mpMRI whole-mount correlation"],"tldr":"Prostate MRI is good at answering whether a man has a serious cancer somewhere. This study matched scans against the whole removed prostate and found it is much worse at finding every tumour: it missed at least one significant tumour in a third of men.","summary":"Dave Johnson, Steven Raman and colleagues at the University of California, Los Angeles co-registered multiparametric magnetic resonance imaging with whole-mount pathology from 588 consecutive men who had radical prostatectomy after a 3 Tesla scan, giving 1,213 pathologically confirmed tumour foci, and measured per-lesion rather than per-patient sensitivity.\n\nThe distinction is not academic. A pathway that only has to decide whether to biopsy needs per-patient sensitivity, and PROMIS showed that is 93 percent for clinically significant disease. A pathway that decides where to treat, which is what focal therapy and magnetic resonance imaging-only surveillance do, needs per-lesion sensitivity, and this study puts that at 45 percent for all foci and 65 percent for clinically significant ones. The gap between the two numbers is where focal therapy planning and imaging-only follow-up carry unmeasured risk.","asOf":"2026-09-25","links":[{"label":"Eur Urol 2019","url":"https://doi.org/10.1016/j.eururo.2018.11.031"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/30509763/"},{"label":"Europe PMC","url":"https://europepmc.org/article/MED/30509763"}],"tags":["prostate-evidence"],"related":["paper-ahmed-promis-multiparametric-mri-lancet-2017","paper-precision-mri-targeted-biopsy-nejm-2018","prostate-roadmap"],"cancers":["prostate","prostate-low-risk","prostate-intermediate-risk","prostate-high-risk"],"sections":["imaging","diagnostics","surgery"],"technologies":["mri"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["gleason-grade-group","prostatectomy","psa","whole-mount-pathology","pi-rads","template-mapping-biopsy"],"trials":[],"people":[],"bottlenecks":["b-biomarker-validation","b-early-detection","b-surgery-radiation-innovation"],"keyPapers":[],"journals":["european-urology"],"dependsOn":[],"notes":[],"journal":"European Urology","year":2019,"doi":"10.1016/j.eururo.2018.11.031","pmid":"30509763","authors":"Johnson DC, Raman SS, Mirak SA, et al.","paperType":"observational","findings":["Multiparametric magnetic resonance imaging detected 45 percent of all 1,213 tumour foci (95 percent confidence interval 42 to 47 percent).","It detected 65 percent of clinically significant lesions (61 to 69 percent) and nearly 80 percent of high-grade tumours.","At least one clinically significant focus was missed in 34 percent of patients overall, and in 45 percent of men with multifocal lesions.","74 percent of missed solitary tumours and 31 percent of missed multifocal tumours were clinically significant.","61.1 percent of missed lesions were 1 cm or smaller, 28.3 percent were between 1 and 2 cm and 10.4 percent were larger than 2 cm; smaller, low-grade, multifocal, non-index tumours with lower prostate-specific antigen density were more likely to be missed."],"whatItMeans":"The limit of what a prostate scan can be asked to do. It is a good triage test for whether to biopsy and a poor map of where every tumour is, which matters for anyone being offered treatment to part of the gland or follow-up by imaging alone.","caveats":["A prostatectomy cohort, so it is enriched for intermediate and high-risk disease (75 percent and 12 percent respectively) and cannot report specificity.","Co-registration of imaging with whole-mount pathology is imperfect, which biases detection downwards to an unknown degree.","The clinical significance of the undetected small foci is uncertain: some of what the scan misses is what the field would rather not find."],"changedPractice":false,"participants":588},"route":"/key-papers/paper-johnson-mpmri-individual-foci-eur-urol-2019/","neighbours":{"paper":[{"id":"paper-precision-mri-targeted-biopsy-nejm-2018","kind":"paper","name":"PRECISION: MRI-targeted or standard biopsy for prostate cancer diagnosis","route":"/key-papers/paper-precision-mri-targeted-biopsy-nejm-2018/"},{"id":"paper-ahmed-promis-multiparametric-mri-lancet-2017","kind":"paper","name":"PROMIS: diagnostic accuracy of multiparametric MRI and TRUS biopsy in prostate cancer","route":"/key-papers/paper-ahmed-promis-multiparametric-mri-lancet-2017/"}],"roadmap":[{"id":"prostate-roadmap","kind":"roadmap","name":"Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch","route":"/roadmaps/prostate-roadmap/"}],"cancer":[{"id":"prostate-high-risk","kind":"cancer","name":"Localised prostate cancer, high and very high risk","route":"/cancers/prostate-high-risk/"},{"id":"prostate-intermediate-risk","kind":"cancer","name":"Localised prostate cancer, intermediate risk","route":"/cancers/prostate-intermediate-risk/"},{"id":"prostate-low-risk","kind":"cancer","name":"Localised prostate cancer, very low and low risk","route":"/cancers/prostate-low-risk/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"diagnostics","kind":"section","name":"Diagnostics & Biomarkers","route":"/fronts/diagnostics/"},{"id":"imaging","kind":"section","name":"Imaging","route":"/fronts/imaging/"},{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"technology":[{"id":"mri","kind":"technology","name":"MRI","route":"/technologies/mri/"}],"term":[{"id":"gleason-grade-group","kind":"term","name":"Gleason score / Grade Group","route":"/terms/gleason-grade-group/"},{"id":"pi-rads","kind":"term","name":"PI-RADS (Prostate Imaging Reporting and Data System)","route":"/terms/pi-rads/"},{"id":"psa","kind":"term","name":"PSA (prostate-specific antigen)","route":"/terms/psa/"},{"id":"prostatectomy","kind":"term","name":"Radical prostatectomy","route":"/terms/prostatectomy/"},{"id":"template-mapping-biopsy","kind":"term","name":"Template mapping biopsy (transperineal template prostate mapping)","route":"/terms/template-mapping-biopsy/"},{"id":"whole-mount-pathology","kind":"term","name":"Whole-mount pathology","route":"/terms/whole-mount-pathology/"}],"bottleneck":[{"id":"b-biomarker-validation","kind":"bottleneck","name":"Biomarkers are not validated or standardised","route":"/bottlenecks/b-biomarker-validation/"},{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"journal":[{"id":"european-urology","kind":"journal","name":"European Urology","route":"/journals/european-urology/"}],"idea":[{"id":"idea-prostate-per-lesion-mri-audit-before-focal-treatment","kind":"idea","name":"Publish a per-lesion miss rate for every prostate MRI service before it is allowed to guide focal treatment","route":"/ideas/idea-prostate-per-lesion-mri-audit-before-focal-treatment/"}]}}