728 A Comparison of mpMRI and Template Biopsy in the Prediction of Clinically Significant Prostate Cancer at Final Radical Prostatectomy Pathology

Abstract

Abstract Aim Diagnosis and precise risk stratification of prostate cancer (PCa) is essential for individualized treatment decisions. Method This single-centred retrospective study included consecutive patients undergoing elective RP due to PCa with prior mpMRI and TPMBs biopsy between 2017-2022. We evaluated the value of PI-RAD v2 score, Gleason score (GS) and TPMB cores against RP specimens to determine its efficacy in identifying csPCa i.e Gleason score ≥3+4, or any cancer >6mm in size. Results A total of 49 patients were included. Mean age was 70 years (IQR 67-75) and PSA 11.7 ng/ml (IQR 6.4-13.6). For PI-RAD ≥ 3, 86% (42/49) vs 96% (47/49) had csPCa on TPMB and RP respectively. No statistically significant association was found between PI-RAD v2 score and GS of TPMB or RP (p = 0.9). When comparing the cumulative GS of TPMB versus RP (p<0.001), 49% (n = 24) had identical scores, 29% (n = 14) were downgraded, 22% (n = 11) were upgraded. For upgrading, 6/11 (55%) were PI-RAD 5 lesions. Only 2/11 (18%) and 3/11 (27%) constituted of PI-RAD 3 & 4 respectively. Conclusions There is no correlation between the PI-RAD v2 scoring system and final histopathology of RP specimens, and a low proportion of PI-RAD 3 or 4 lesions are upgraded at final pathology.