PD13-12 DUCTAL AND INTRADUCTAL CARCINOMA OF THE PROSTATE AT RADICAL PROSTATECTOMY: DIAGNOSTIC ACCURACY OF BIOPSY, MRI-VISIBILITY, AND OUTCOMES

Abstract

You have accessJournal of UrologyCME1 May 2022PD13-12 DUCTAL AND INTRADUCTAL CARCINOMA OF THE PROSTATE AT RADICAL PROSTATECTOMY: DIAGNOSTIC ACCURACY OF BIOPSY, MRI-VISIBILITY, AND OUTCOMES Gaurav Pahouja, Shalin Desai, Hiten D. Patel, Goran Rac, Teresa Cheng, Yudai Okabe, Alexander Gorbonos, Marcus L. Quek, Robert C. Flanigan, Maria M. Picken, and Gopal N. Gupta Gaurav PahoujaGaurav Pahouja More articles by this author , Shalin DesaiShalin Desai More articles by this author , Hiten D. PatelHiten D. Patel More articles by this author , Goran RacGoran Rac More articles by this author , Teresa ChengTeresa Cheng More articles by this author , Yudai OkabeYudai Okabe More articles by this author , Alexander GorbonosAlexander Gorbonos More articles by this author , Marcus L. QuekMarcus L. Quek More articles by this author , Robert C. FlaniganRobert C. Flanigan More articles by this author , Maria M. PickenMaria M. Picken More articles by this author , and Gopal N. GuptaGopal N. Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002545.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ductal adenocarcinoma (DA) and intraductal carcinoma (IDC) of the prostate are associated with higher stage disease at radical prostatectomy (RP), but diagnostic performance of biopsy or visibility of these lesions on multiparametric magnetic resonance imaging (MRI) is not well established. We evaluated diagnostic accuracy of biopsy, MRI-visibility, and outcomes for patients undergoing RP with DA/IDC histology compared to pure acinar adenocarcinoma (AA) of the prostate. METHODS: A retrospective cohort study of men receiving RP between 2014-2021 revealing any degree of AA, DA, or IDC on final pathology were included. Clinical variables, prostate biopsy, surgical data, final pathologic data, and biochemical recurrence (BCR) were analyzed. Student’s t-tests, Wilcoxson rank sum tests, and chi-squared tests were used as appropriate. Multivariable Cox proportional hazards regression evaluated BCR while multivariable logistic regression evaluated predictors of DA/IDC pathology. RESULTS: A total of 609 patients were included with 103 (16.9%) found to have DA (N=66) and/or IDC (N=72) histology, while 506 (83.1%) had pure AA. Compared to the patients with pure AA, patients with DA/IDC were older (p=0.001), had higher PSA (7.9 vs 6.4, p=0.01), and had higher grade group (GG) (p <0.001) and cancer volume on biopsy. DA was noted on biopsy in 15 (2.5%) and IDC in 38 (6.2%) patients. The sensitivity and specificity of biopsy compared to RP for diagnosis of DA/IDC was 29.1% (16.7 DA, 27.8% IDC) and 96.6% (99.3% DA, 96.6% IDC), respectively. Positive and negative predictive values were 63.8% and 87.0%. DA/IDC patients had higher GG (p <0.001), extraprostatic extension (72.8% vs 49.4%, p <0.001), lymphovascular invasion (p <0.001), perineural invasion (p=0.03), and pathologic N stage (pN1 16.5% vs 4.9%, p <0.001) compared to pure AA patients. DA/IDC was associated with worse BCR (HR=1.77, (95% CI 1.08-2.90), p=0.02) after adjustment for age, PSA, RP GG, pT stage and positive surgical margins. Higher age (p=0.04), RP GG (p <0.01), and pT3a (p=0.02) were associated with DA/IDC on RP. In a subset of 281 men receiving MRI, PI-RADS distribution was similar for patients with DA/IDC vs pure AA (90.7% vs 80.7% with PI-RADS 4-5 lesions, p=0.23). CONCLUSIONS: Patients with DA/IDC histology had unfavorable pathologic features at RP with worse BCR independent of standard prognostic factors. Sensitivity of prostate biopsy was low for detection of DA/IDC histology at RP. Of the DA/IDC patients on RP that had MRI lesions, 90.7% were categorized as PI-RADS 4-5. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e255 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gaurav Pahouja More articles by this author Shalin Desai More articles by this author Hiten D. Patel More articles by this author Goran Rac More articles by this author Teresa Cheng More articles by this author Yudai Okabe More articles by this author Alexander Gorbonos More articles by this author Marcus L. Quek More articles by this author Robert C. Flanigan More articles by this author Maria M. Picken More articles by this author Gopal N. Gupta More articles by this author Expand All Advertisement PDF DownloadLoading ...