PD57-02 WHEN IS MP-MRI RELIABLE IN PREDICTING EXTRA-PROSTATIC EXTENSION IN PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY? RESULTS FROM A LARGE, MULTI-INSTITUTIONAL SERIES (2020)

You have accessJournal of UrologyProstate Cancer: Staging II (PD57)1 Apr 2020PD57-02 WHEN IS MP-MRI RELIABLE IN PREDICTING EXTRA-PROSTATIC EXTENSION IN PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY? RESULTS FROM A LARGE, MULTI-INSTITUTIONAL SERIES Giorgio Gandaglia*, Guillaume Ploussard, Massimo Valerio, Agostino Mattei, Giancarlo Marra, Jean-Baptiste Beauval, Bernard Malavaud, Mathieu Roumiguié, Alessandro Marquis, Luca Afferi, Marco Moschini, Arnas Rakauskas, Roderick Van den Bergh, Nicola Fossati, Carlo Bravi, Vito Cucchiara, Armando Stabile, Marco Bandini, Francesco De Cobelli, Cristian Fiori, Francesco Porpiglia, Paolo Gontero, Francesco Montorsi, and Alberto Briganti Giorgio Gandaglia*Giorgio Gandaglia* More articles by this author , Guillaume PloussardGuillaume Ploussard More articles by this author , Massimo ValerioMassimo Valerio More articles by this author , Agostino MatteiAgostino Mattei More articles by this author , Giancarlo MarraGiancarlo Marra More articles by this author , Jean-Baptiste BeauvalJean-Baptiste Beauval More articles by this author , Bernard MalavaudBernard Malavaud More articles by this author , Mathieu RoumiguiéMathieu Roumiguié More articles by this author , Alessandro MarquisAlessandro Marquis More articles by this author , Luca AfferiLuca Afferi More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Arnas RakauskasArnas Rakauskas More articles by this author , Roderick Van den BerghRoderick Van den Bergh More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Carlo BraviCarlo Bravi More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Armando StabileArmando Stabile More articles by this author , Marco BandiniMarco Bandini More articles by this author , Francesco De CobelliFrancesco De Cobelli More articles by this author , Cristian FioriCristian Fiori More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Paolo GonteroPaolo Gontero More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000967.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although multi-parametric MRI (mpMRI) has been proposed for local staging in localized prostate cancer (PCa), it is characterized by suboptimal characteristics. However, whether this applies to all men with PCa is still unknown. We hypothesized that the performance of mpMRI in the identification of extra-prostatic extension varies accordig to baseline disease characteristics. METHODS: A total of 845 patients who underwent MRI-targeted biopsy and radical prostatectomy (RP) between 2015 and 2019 at six European centers were identified. All patients had a positive MRI-targeted biopsy and received concomitant systematic biopsy. All patients had available details on biopsy grade group and mpMRI data such as suspicious extra-capsular extension (ECE) and seminal vesicle invasion (SVI), PIRADS score and the maximum diameter of the index lesion. The rate of misclassified local stage by mpMRI defined as a discordance between imaging and pathological stage was assessed. mpMRI was reviewed by high-volume dedicated uro-radiologists and surgical specimens were reviewed by dedicated uro-pathologists. Logistic regression analyses assessed predictors of misclassified stage at mpMRI. We then assessed the performance characteristics of mpMRI in predicting ECE according to baseline characteristics. RESULTS: Overall, 162 (19.2%) patients had ECE and or SVI at mpMRI. A total of 310 (36.7%) and 134 (15.8%) patients had pT3a and pT3b disease. The sensitivity and specificity of mpMRI in predicting ECE were 31% and 94%. The rate of misclassified stage by mpMRI at final pathology was 40%. At multivariable regression analyses, a PIRADS score of 5 (OR: 0.61) and clinically significant PCa outside the index lesion (OR: 1.49; all P≤0.03) were predictors of misclassified stage after adjusting for grade group at MRI-targeted biopsy, PSA and the diameter of the index lesion. When considering men with a PIRADS 5 and a negative concomitant systematic biopsy, the sensitivity and specificity of mpMRI in predicting ECE were 52% and 91%. Conversely, in the remaining cohort the sensitivity of MRI in predicting ECE was 21% (specificity: 97%). CONCLUSIONS: mpMRI is characterized by suboptimal accuracy in the identification of pathological ECE and/or SVI. Although the sensitivity of imaging in the assessment of extra-prostatic extension improved in men high PIRADS and negative concomitant systematic biopsy, it reached only 50%. Therefore, mpMRI remains inaccurate for staging even in these selected patients. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1193-e1194 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giorgio Gandaglia* More articles by this author Guillaume Ploussard More articles by this author Massimo Valerio More articles by this author Agostino Mattei More articles by this author Giancarlo Marra More articles by this author Jean-Baptiste Beauval More articles by this author Bernard Malavaud More articles by this author Mathieu Roumiguié More articles by this author Alessandro Marquis More articles by this author Luca Afferi More articles by this author Marco Moschini More articles by this author Arnas Rakauskas More articles by this author Roderick Van den Bergh More articles by this author Nicola Fossati More articles by this author Carlo Bravi More articles by this author Vito Cucchiara More articles by this author Armando Stabile More articles by this author Marco Bandini More articles by this author Francesco De Cobelli More articles by this author Cristian Fiori More articles by this author Francesco Porpiglia More articles by this author Paolo Gontero More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...