MRI Characteristics Accurately Predict Biochemical Recurrence after Radical Prostatectomy.

Cécile Manceau,Jean-Baptiste Beauval,Christophe Tollon,Ambroise Salin,Christophe Almeras,Guillaume Loison,Michel Soulié,Bernard Malavaud,Mathieu Roumiguié,Marine Lesourd,Guillaume Ploussard,Jean-Romain Gautier,Richard Aziza

doi:10.3390/jcm9123841

Abstract

Background: After radical prostatectomy (RP), biochemical recurrence (BCR) is associated with an increased risk of developing distant metastasis and prostate cancer specific and overall mortality. Methods: The two-centre study included 521 consecutive patients undergoing RP for positive pre-biopsy magnetic resonance imaging (MRI) and pathologically proven prostate cancer (PCa), after which a combination scheme of fusion-targeted biopsy (TB) and systematic biopsy was performed. We assessed correlations between MRI characteristics, International Society of Urological Pathology (ISUP) grade group in TB, and outcomes after RP. We developed an imaging-based risk classification for improving BCR prediction. Results: Higher Prostate Imaging and Reporting and Data System (PI-RADS) score (p = 0.013), higher ISUP grade group in TB, and extracapsular extension (ECE) on the MRI were significantly associated with more advanced disease (pTstage), higher ISUP grade group (p = 0.001), regional lymph nodes metastasis in RP specimens (p < 0.001), and an increased risk of recurrence after surgery. A positive margin status was significantly associated with ECE-MRI (p < 0.001). Our imaging-based classification included ECE on MRI, ISUP grade group on TB, and PI-RADS accurately predicted BCR (AUC = 0.714, p < 0.001). This classification had more improved area under the curve (AUC) than the standard d’Amico classification in our population. Validation was performed in a two-centre cohort. Conclusions: In this cohort, PI-RADS score, MRI stage, and ISUP grade group in MRI-TB were significantly predictive for disease features and recurrence after RP. Imaging-based risk classification integrating these three factors competed with d’Amico classification for predicting BCR.

Highlights

Prostate cancer (PCa) is the second most common cancer worldwide and the fifth leading cause of death from cancer among men [1].Radical prostatectomy (RP) is a treatment for patients with localized disease and with at least a ten years of life expectancy [2]
Recent multivariate analysis [3] suggested a new classification for patients experiencing biochemical recurrence (BCR) that differentiates patients with low or high risk of clinical progression based on prostatic specific antigen (PSA)-doubling time, interval to biochemical failure, and prostatectomy gleason score
Prediction of BCR is still based on risk classification including PSA, grade group, and clinical stage without incorporating magnetic resonance imaging (MRI) criteria [2]

Summary

Introduction

Prostate cancer (PCa) is the second most common cancer worldwide and the fifth leading cause of death from cancer among men [1].Radical prostatectomy (RP) is a treatment for patients with localized disease and with at least a ten years of life expectancy [2]. Prediction of BCR is still based on risk classification including PSA, grade group, and clinical stage without incorporating magnetic resonance imaging (MRI) criteria [2]. After radical prostatectomy (RP), biochemical recurrence (BCR) is associated with an increased risk of developing distant metastasis and prostate cancer specific and overall mortality. Our imaging-based classification included ECE on MRI, ISUP grade group on TB, and PI-RADS accurately predicted BCR (AUC = 0.714, p < 0.001). This classification had more improved area under the curve (AUC) than the standard d’Amico classification in our population. Imaging-based risk classification integrating these three factors competed with d’Amico classification for predicting BCR

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Conclusion