MP11-02 USE OF THE PI-RADS v2 DEFINED RELATIONSHIP OF AN INDEX LESION AND PROSTATIC CAPSULE IMPROVES THE STAGING ACCURACY OF MRI

Abstract

You have accessJournal of UrologyProstate Cancer: Staging (MP11)1 Sep 2021MP11-02 USE OF THE PI-RADS v2 DEFINED RELATIONSHIP OF AN INDEX LESION AND PROSTATIC CAPSULE IMPROVES THE STAGING ACCURACY OF MRI Zachary Feuer, Ezequiel Becher, Angela Tong, Richard Huang, James S. Wysock, Fang-Ming Deng, William C. Huang, and Samir S. Taneja Zachary FeuerZachary Feuer More articles by this author , Ezequiel BecherEzequiel Becher More articles by this author , Angela TongAngela Tong More articles by this author , Richard HuangRichard Huang More articles by this author , James S. WysockJames S. Wysock More articles by this author , Fang-Ming DengFang-Ming Deng More articles by this author , William C. HuangWilliam C. Huang More articles by this author , and Samir S. TanejaSamir S. Taneja More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001984.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite the increased utilization of pre-biopsy multiparametric magnetic resonance imaging (mpMRI), the use of MRI as a staging tool remains limited. This is because mpMRI lacks sensitivity in detecting extracapsular extension (ECE). We aim to improve staging by assessing a novel MRI lesion/prostatic capsular relationship parameter, based on the standardized PI-RADS v2 report template, to predict the presence of locally advanced prostate cancer in men undergoing RP. METHODS: We identified men who underwent RP after 3-tesla multiparametric MRI (mpMRI) and subsequent concurrent systematic and MRI-targeted prostate biopsy between 2/2015-9/2019. Outcome of interest was ≥pT3a disease. The MRI lesion/prostatic capsular relationship was categorized using a standardized reporting format described in PI-RADS v2. A nomogram was developed including biopsy Gleason grade group (GGG), PSA density, PI-RADS score, and the MRI lesion/prostatic capsular relationship. Receiver operating characteristic curves (ROC) were calculated. RESULTS: 476 men were included in the study. Median age was 65 (IQR 60-70), median PSA was 6.09 (IQR 4.58-9.00). In univariate analysis, men were >5x more likely to harbor ≥pT3a disease if MRI demonstrated PI-RADS 5 lesion, if biopsy detected GGG 4/5, or if the capsular relationship demonstrated irregularity, or ECE (Table 1). Each remained significant predictors in the multivariate regression model. Use of the capsular relationship parameter improved the concordance index for the ROC curve from 0.7201 to 0.7859 (95%CI 0.737-0.822) (Figure 1). CONCLUSIONS: We demonstrate that the MRI lesion/prostatic capsular relationship is a useful parameter in the prediction of locally advanced prostate cancer. Further, the incorporation of this parameter into a clinical nomogram improves the staging accuracy of mpMRI. The predictive model demonstrates more accurate staging as compared to widely used nomograms not inclusive of MRI parameters. Source of Funding: Joseph and Diane Steinberg Charitable Trust © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e177-e178 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary Feuer More articles by this author Ezequiel Becher More articles by this author Angela Tong More articles by this author Richard Huang More articles by this author James S. Wysock More articles by this author Fang-Ming Deng More articles by this author William C. Huang More articles by this author Samir S. Taneja More articles by this author Expand All Advertisement Loading ...