MP81-12 MRI COMPARED TO DRE STAGING FOR PROSTATE CANCER: A WILL ROGERS PHENOMENON

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening VIII (MP81)1 Apr 2020MP81-12 MRI COMPARED TO DRE STAGING FOR PROSTATE CANCER: A WILL ROGERS PHENOMENON Arnas Rakauskas*, Taimur Shah, Max Peters, Hashim Udin Ahmed, and Mathias Winkler Arnas Rakauskas*Arnas Rakauskas* More articles by this author , Taimur ShahTaimur Shah More articles by this author , Max PetersMax Peters More articles by this author , Hashim Udin AhmedHashim Udin Ahmed More articles by this author , and Mathias WinklerMathias Winkler More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000973.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Risk stratification groups were developed and validated using staging based on DRE. It may be inappropriate to apply MRI staging to these risk stratification systems because non-palpable disease, MRI visible lesions may be reclassified from a group with classically favorable outcomes to a less favorable group. We aimed to test whether this re-classification and apparent improvement in outcomes of both groups might lead to the so-called Wil-Rogers phenomenon in men following radical prostatectomy. METHODS: A retrospective study of 572 consecutive patients undergoing laparoscopic radical prostatectomy at a single institution (2007–2017). Clinical stage was recorded by the operating surgeon whilst MRI and pathological stage were recorded after tumour board review. Progression-free survival was defined as an absence of biochemical recurrence, no adjuvant/salvage treatment, and no metastases or mortality. PFS was compared between D’Amico risk groups using either clinical or radiological stage. RESULTS: Median age was 63 years (IQR 58.5–67) and median PSA was 8.9 ng/ml (6.5–13.2). 20% were D’Amico low risk, while 43% were medium and 37% high risk using DRE as the staging method. The median follow-up time was 23 months (range 0 – 117). DRE stage was available for all patients, while MRI staging for 60% (n=342). PFS was seen in 61% (348/572). The median time to failure by PFS composite outcome was 9 months (range 0–84). When comparing same stage groups, those classified using MRI showed improved PFS on Kaplan-Meier curves compared to the same stage classified by DRE. The difference was significant in the T1 and T3 groups. Univariable analysis showed that patients with DRE T1 disease (HR 0.10 95%, CI 0.01-0.73, p=0.02) or DRE T3 (HR 0.70, CI 0.51-0.97, p=0.03) were at higher risk for failure. Multivariable analysis was performed in a subgroup fashion, comparing corresponding DRE and MRI stages corrected for age, grade group and PSA. Only DRE T1 remained a significant predictor for worst outcome (HR 0.08, CI 0.01-0.59, p=0.01). CONCLUSIONS: Our results suggest that stage classified by MRI rather than DRE leads to a possible Will Rogers phenomenon. Current risk groups were developed and validated on clinical stage and should be used with caution when counselling patients in whom local stage is often based on MRI. Source of Funding: no disclosures © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1240-e1241 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arnas Rakauskas* More articles by this author Taimur Shah More articles by this author Max Peters More articles by this author Hashim Udin Ahmed More articles by this author Mathias Winkler More articles by this author Expand All Advertisement PDF downloadLoading ...