(UroToday.com) The first prostate cancer session at the 2020 Society of Urologic Oncology (SUO) Annual Virtual Meeting highlighted a talk on radiogenomics by Dr. Robert Reiter from the University of California Los Angeles Geffen School of Medicine. Dr. Reiter started his presentation by presenting a case of a 63-year-old African American man with a prostate-specific antigen (PSA) of 8 ng/mL and an MRI showing a 65-gram gland with a single PI-RADs score 4/5 lesion in the left posterior region of the prostate (1.1 cm). He subsequently underwent a targeted biopsy that showed Gleason 4+3=7 in 3/3 cores, and a systematic biopsy that showed Gleason 3+4/4+3 in 4/6 cores on the left and Gleason 4+3 in 1/6 cores at the right lateral base (1 mm). After radical prostatectomy, final pathology showed pT3bN1, with a 2.4 cm Gleason 4+3 tumor on the left with extensive cribriform and intraductal pathology. On the right, he had two tumors, the first a 1.5 cm Gleason 4+5 apical to the base lesion with right seminal vesicle invasion and the second tumor an 8 mm Gleason 3+4 anterior tumor. The single lymph node was positive in the left external iliac chain. It remains to be elucidated why some high-grade tumors are essentially missed on mpMRI, while some are very clear and confirmed on histology. Dr. Reiter notes that MRI “sees” most, but not all significant cancers. In unpublished data from his institution, significant predictors of detection include (i) larger size, (ii) higher Gleason score, (iii) index lesions status, (iv) and solitary tumor. Among 440 patients, 16% of Gleason 3+4 cancers were associated with a PI-RADs 5 lesion on mpMRI, whereas 39.5% of Gleason 3+4 cancers were not associated with a lesion on mpMRI.