Transcriptome Wide Analysis of Magnetic Resonance Imaging-targeted Biopsy and Matching Surgical Specimens from High-risk Prostate Cancer Patients Treated with Radical Prostatectomy: The Target Must Be Hit

Background The most suspicious lesions on multiparametric magnetic resonance imaging (MRI) may be representative of final pathology. Objective We connect imaging with high-precision spatial annotation of biopsies and genomic cancer signatures to compare the genomic signals of the index lesion and biopsy cores of adjacent and far away locations. Design, setting, and participants Eleven patients diagnosed with high-risk prostate cancer on MRI/transrectal ultrasound-fusion biopsy (Bx) and treated with radical prostatectomy (RP). Five tissue specimens were collected from each patient. Outcome measurements and statistical analysis Whole transcriptome RNA-expression was profiled for each sample. Genomic signatures were used to compare signals in MRI invisible versus visible foci using Pearson's correlation and to assess intratumoral heterogeneity using hierarchical clustering. Results and limitations Ten RP and 27 Bx-samples passed quality control. Gene expression between RP and index Bx, but not adjacent benign samples, was highly correlated. Genomic Gleason grade classifier features measured across the different samples showed concordant expression across Bx and RP tumor samples, while an inverse expression pattern was observed between tumor and benign samples indicating the lack of a strong field-effect. The distribution of low and high Prostate Imaging Reporting and Data System (PI-RADS) samples was 10 and 11, respectively. Genomics of all low PI-RADS samples resembled benign tissue and most high PI-RADS samples resembled cancer tissue. A strong association was observed between PI-RADS version 2 and Decipher as well as the genomic Gleason grade classifier score. Clustering analysis showed that most samples cluster tightly by patient. One patient showed unique tumor biology in index versus secondary lesion suggesting the presence of intrapatient heterogeneity and the utility in profiling multiple foci identified by MRI. Conclusions MRI-targeted Bx-genomics show excellent correlation with RP-genomics and confirm the information captured by PI-RADS. Sampling of the target lesion must be precise as correlation between index and benign lesions was not seen. Patient summary In this report, we tested if targeted prostate sampling using magnetic resonance imaging-fusion biopsy allows to genetically describe index tumors of prostate cancer. We found that imaging genomics correlated well with final prostatectomy provided that the target is hit precisely.