MP16-15 T-STAGE MIGRATION WITH ROUTINE MRI STAGING MAY IMPACT ON RISK ASSESSMENT WITH CURRENT RISK CALCULATORS

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III1 Apr 2018MP16-15 T-STAGE MIGRATION WITH ROUTINE MRI STAGING MAY IMPACT ON RISK ASSESSMENT WITH CURRENT RISK CALCULATORS Taimur T Shah, Max Peters, Enrique Gomez-Gomez, Hashim U. Ahmed, and Mathias Winkler Taimur T ShahTaimur T Shah More articles by this author , Max PetersMax Peters More articles by this author , Enrique Gomez-GomezEnrique Gomez-Gomez More articles by this author , Hashim U. AhmedHashim U. Ahmed More articles by this author , and Mathias WinklerMathias Winkler More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.549AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In the UK with the acceptance of routine pre-biopsy prostate MRI, there have been observations on stage migration of patients diagnosed with prostate cancer. Patients previously being diagnosed with clinical T1 disease are being upstaged after review of their MRI. T-stage migration was assessed in our prospective laparoscopic radical prostatectomy (LRP) database. METHODS All consecutive patients undergoing LRP at a single institution between 2007 - 2017 had complete pre-operative staging data collected. Clinical stage was recorded by the operating surgeon whilst MRI and pathological stage were recorded after institutional multidisciplinary cancer team review (MDT). First, we assessed concordance between clinical and MRI stage with final pathological stage using cross tabulation, Pearson's Chi2 and Cramer's V statistical tests. Second, we assessed the degree of upstaging seen between DRE and MRI stage. RESULTS 571 men underwent LRP with 20% being D'Amico low risk, 43% medium and 37% high risk. DRE stage was available in 571/571 men and was found to have significant concordance with the final pathological stage with a Pearson's Chi2 of p<0.0001, (Cramer V value:0.17 indicating weak concordance). All MRI staging data was re-reviewed for T-stage and due to the historical nature of the cohort a definitive diagnosis (T1-T3b) was available in 218/571 patients. Cramer V values were 0.31 for T2 disease and 0.37 for T3 disease indicating a moderate level of concordance with the final pathological stage (Pearson's Chi2, p<0.0001). For T2 disease MRI had a sensitivity of 51%, specificity of 79%, PPV of 64% and NPV of 69% whilst for T3 disease the sensitivity was 76%, specificity 60%, PPV 70%, and NPV 67%. From this cohort of 218 patients with both an MRI and DRE stage documented we found that 36/91 (40%) patients diagnosed with T1 disease on DRE stage were upstaged to T2 on MRI and 44/91 (48%) to T3 on MRI. Similarly, 28/65 (43%) found to have T2 disease on DRE stage were upstaged to T3 on MRI. Overall 108/156 (69%) patients with T1 or T2 disease on DRE were upstaged based on their MRI. CONCLUSIONS Our results show significantly better concordance to final pathology with MRI staging compared to DRE clinical stage. Of concern is that currently utilised risk calculators (D'Amico, NCCN) are all based on historical data incorporating DRE clinical stage and the use of MRI staging could lead to a significant stage migration and thus impact on choice of treatment options. There is an urgent need for the development of MRI optimized risk calculators in order to better select treatment options for patients. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e202-e203 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Taimur T Shah More articles by this author Max Peters More articles by this author Enrique Gomez-Gomez More articles by this author Hashim U. Ahmed More articles by this author Mathias Winkler More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...