MP42-15 WHICH IS THE VALUE OF A NEGATIVE MPMRI IN RULING OUT ADVERSE PATHOLOGICAL OUTCOMES AT RADICAL PROSTATECTOMY? A RETROSPECTIVE ANALYSIS ON 212 PROSTATIC LOBES

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You have accessJournal of UrologyImaging/Radiology: Uroradiology II (MP42)1 Apr 2020MP42-15 WHICH IS THE VALUE OF A NEGATIVE MPMRI IN RULING OUT ADVERSE PATHOLOGICAL OUTCOMES AT RADICAL PROSTATECTOMY? A RETROSPECTIVE ANALYSIS ON 212 PROSTATIC LOBES Andrea Iseppi*, Raffaele Inzillo, Chiara Del Prete, Luca Sarchi, Beatrice Filippi, Stefano Toso, Guarino Giulio, Ahmed Eissa, Maria Chiara Sighinolfi, Stefano Puliatti, Giampaolo Bianchi, Salvatore Micali, and Bernardo Rocco Andrea Iseppi*Andrea Iseppi* More articles by this author , Raffaele InzilloRaffaele Inzillo More articles by this author , Chiara Del PreteChiara Del Prete More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Beatrice FilippiBeatrice Filippi More articles by this author , Stefano TosoStefano Toso More articles by this author , Guarino GiulioGuarino Giulio More articles by this author , Ahmed EissaAhmed Eissa More articles by this author , Maria Chiara SighinolfiMaria Chiara Sighinolfi More articles by this author , Stefano PuliattiStefano Puliatti More articles by this author , Giampaolo BianchiGiampaolo Bianchi More articles by this author , Salvatore MicaliSalvatore Micali More articles by this author , and Bernardo RoccoBernardo Rocco More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000891.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiparametric Magnetic resonance imaging (mpMRI) has gained increasingly acceptance for the detection of clinically significant prostate cancer (PCa). Targeting approaches using mpMRI directed biopsies are currently under investigation. The aim of the current study is to evaluate the diagnostic accuracy to detect csPCa of mpMRI targeted plus saturation sampling compared to saturation sampling alone; furthermore, we aim to assess the value of a negative mpMRI to rule out adverse pathological outcomes at radical prostatectomy (RP). To that purpose, we performed a side specific analysis of prostatic lobes from RP specimens METHODS: From our prospectively collected data base of > 500 mpMRI-targeted plus saturation prostate biopsy, 106 men with a PCa diagnosis who underwent radical prostatectomy were considered. mpMRI were performed at 3 different radiological centres; in case of a PIRADS >=3 lesion a targeted sampling was carried out, whereas systematic saturation sampling was performed for each lobe in all cases. 212 prostatic lobes were definitely available for analysis with respect to mpMRI findings. The primary outcome was the detection rate of csPCa at RP (ISUP >=2) for targeted plus saturation sampling compared to saturation sampling alone. As secondary endpoints, the positive predictive value and negative predictive value of mpMRI were calculated with regards to csPCa detection RESULTS: A total of 111 lobes had a csPCa, whereas 101 lobes had an ISUP 1. 163 lobes were pT2, 49 had extracapsular extension of PCa. 63,6% (135/212) prostatic lobes had a positive mpMRI and underwent targeted + saturation sampling, whereas the remaining 77 lobes (36,4%) were negative and had only saturation biopsy. The detection rate of csPCA was 55% (75/135) for mpMRI positive lobes and 46,7% (36/77) for mpMRI negative lobes (p=0,217). A pT3 was evident in 5 lobes with a negative mpMRI (6,4%). Positive predictive value of mpMRI was 55,5%; negative predictive value to rule out csPCa was 53,2%. Targeted biopsy of a single mpMRI-positive lobe would have missed 36/111 (32,4%) lobes with csPCa CONCLUSIONS: In our subgroups of patients with PCa managed with RP, the detection rate of csPCa did not differ significantly between targeted plus saturation and saturation sampling alone. If only a targeted approach is performed, the low predictive value of a negative mpMRI may account for an underestimation of tumor burden and extension. Since surgical tailoring is based on pre-operative assessment of local staging and the dissection relies on the knowledge of the side specific amount of PCa, mpMRI with targeted sampling alone can adversely affect surgical success and oncologic outcome Source of Funding: No © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e609-e609 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrea Iseppi* More articles by this author Raffaele Inzillo More articles by this author Chiara Del Prete More articles by this author Luca Sarchi More articles by this author Beatrice Filippi More articles by this author Stefano Toso More articles by this author Guarino Giulio More articles by this author Ahmed Eissa More articles by this author Maria Chiara Sighinolfi More articles by this author Stefano Puliatti More articles by this author Giampaolo Bianchi More articles by this author Salvatore Micali More articles by this author Bernardo Rocco More articles by this author Expand All Advertisement PDF downloadLoading ...