(UroToday.com) The 2025 Western Section AUA annual meeting featured a prostate cancer session and a presentation by Dr. Wayne Brisbane discussing comprehensive analysis of the correlation between molecular subtype and multimodal imaging features of prostate cancer. Over the last several years, both molecular subtyping and multimodal imaging features have helped with risk-stratifying prostate cancer patients.
As such, the objective of this study, presented at the 2025 Western Section AUA annual meeting, was to investigate the correlations between molecular alterations and imaging phenotypes in patients with prostate cancer, and to integrate micro ultrasound, mpMRI, and PSMA PET/CT findings with transcriptomic profiling from biopsy specimens.
There were 80 patients with prostate cancer undergoing micro ultrasound-guided biopsy, followed by a genome-wide RNA expression profiling of biopsy samples using microarray analysis included in the study. Imaging data from mpMRI (n = 76) and PSMA PET/CT (n = 43) were analyzed. Quantitative and qualitative imaging features included lesion size, location, PRIMUS, echogenicity, PI-RADS, ADC, and SUVmax. Molecular markers included TP53, CHD1, PTEN, SPOP, Decipher genomic classifier score, ERG, PAM50, and PSC.
PSMA PET/CT SUVmax was significantly elevated in patients with high androgen receptor activity (p < 0.001). Decipher risk group showed multiple associations: prostate volume on MRI (p = 0.018), micro ultrasound (p = 0.011), increased T stage (p = 0.047), and peripheral zone involvement (p = 0.039) on MRI. PAM50 molecular subtype was associated with lesion size features, including lesion volume on mpMRI (p = 0.011), PI-RADS > 4 (p = 0.023), and lesion length on micro ultrasound (p = 0.016). ERG status was associated with lesion localization features, including anterior/posterior (p = 0.004), zonal distribution (p = 0.001), and peripheral zone involvement (p = 0.047) on mpMRI.
Decipher molecular subtype was significantly associated with prostate volume (MRI p = 0.04, micro ultrasound p = 0.015), and linked to lesion volume (p = 0.022), T stage (p = 0.047), and PRIMUS, echogenicit,y and size features on micro ultrasound (all p < 0.05). PTEN loss was associated with larger prostate volume (mpMRI p < 0.001, micro ultrasound p < 0.001), and also associated with echogenicity score (p = 0.037) and size length (p = 0.032) on micro ultrasound. SPOP mutation was correlated with larger lesion volume (p = 0.007) and peripheral zone involvement (p = 0.049) on MRI. The following table and figure highlight the correlation between molecular subtype and multimodal imaging features:
Dr. Brisbane concluded his presentation discussing a comprehensive analysis of the correlation between molecular subtype and multimodal imaging features of prostate cancer with the following take-home points:
- Specific molecular alterations in prostate cancer are significantly associated with imaging features across modalities
- Multimodal imaging may help predict molecular subtypes, offering a non-invasive tool for early risk assessment and personalized care when genomic testing is not readily available
Presented by: Wayne Brisbane, MD, Assistant Professor of Urology, UCLA Department of Urology, University of California, Los Angeles (UCLA), Los Angeles, CA
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2025 Western Section American Urological Association (AUA) Annual Meeting, Napa Valley, CA, Sun, Nov 2 – Thurs, Nov 6, 2025.