PD43-05 ABSENCE OF EVIDENCE IS NOT EVIDENCE OF ABSENCE: NORMAL AREAS ON MRI COULD HARBOUR SIGNIFICANT TUMOUR

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening VI1 Apr 2017PD43-05 ABSENCE OF EVIDENCE IS NOT EVIDENCE OF ABSENCE: NORMAL AREAS ON MRI COULD HARBOUR SIGNIFICANT TUMOUR Ashwin Sridhar, Ben Lamb, Gerald Busuttil, Mohammed Zahran, Keren Zaccai, Maria Davari, Imran Ahmad, Anna Mohammed, Greg Shaw, Prabhakar Rajan, Senthil Nathan, Timothy Briggs, Navin Ramachandran, Clare Allen, and John Kelly Ashwin SridharAshwin Sridhar More articles by this author , Ben LambBen Lamb More articles by this author , Gerald BusuttilGerald Busuttil More articles by this author , Mohammed ZahranMohammed Zahran More articles by this author , Keren ZaccaiKeren Zaccai More articles by this author , Maria DavariMaria Davari More articles by this author , Imran AhmadImran Ahmad More articles by this author , Anna MohammedAnna Mohammed More articles by this author , Greg ShawGreg Shaw More articles by this author , Prabhakar RajanPrabhakar Rajan More articles by this author , Senthil NathanSenthil Nathan More articles by this author , Timothy BriggsTimothy Briggs More articles by this author , Navin RamachandranNavin Ramachandran More articles by this author , Clare AllenClare Allen More articles by this author , and John KellyJohn Kelly More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1910AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Accurate prostate cancer risk stratification is essential to guide decision making on active surveillance and interventional therapy. The aim of this study was to determine if a targeted biopsy strategy to sample only MRI detected lesions could replace standard practice of systematic prostate biopsies. METHODS Prostate MRI scans of all patients undergoing RARP for prostate cancer between 2013 and 2016 were prospectively analysed with a uro-radiologist as part of an established quality assurance program. MRI scans were graded as optimal or suboptimal by the radiologist. Localisation of MRI detected prostate cancer (represented in a diagram) was compared to histopathological mapping of cancer following RALP. Significant out of MRI field cancer was defined as Gleason ≥3+4. Location was analysed according to 5 different zones: Anterior, left posterolateral, right posterolateral, apex and base. RESULTS The median Age, PSA and Gleason score were 62.9 (4576), 10.67 (156) and 7 (610) respectively. 778 (89.7%) of patients had = pT2c. Significant prostate cancer was found in 2418/4335 zones (55.8%) on final postoperative pathology. MRI was able to pick up 1797/2418 (74.3%) of the significant lesions and missed 25.7%. Of these significant lesions, 34.7% were ≥4+3. Optimal MRI scans picked up more significant lesions than suboptimal scans (79.6% vs 71.4%). The overall sensitivity of MRI to detect significant prostate cancer was 71.2%, specificity 84.9%, PPV 85.6% and NPV 63.4%. Cohen's Kappa coefficient varied from 0.12 (poor) to 0.44 (moderate); Area under the ROC curve ranged from 0.572 to 0.722 with apical and anterior lesions having lower values. Individual zonal accuracy data is as per table 1. CONCLUSIONS Our results show that in a population of men with significant prostate cancer, MRI can reliably detect significant prostate cancer in in 85.6% of the time. A targeted strategy using MRI will have a 36.6% chance of non detection of significant invisible cancer. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e819 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Ashwin Sridhar More articles by this author Ben Lamb More articles by this author Gerald Busuttil More articles by this author Mohammed Zahran More articles by this author Keren Zaccai More articles by this author Maria Davari More articles by this author Imran Ahmad More articles by this author Anna Mohammed More articles by this author Greg Shaw More articles by this author Prabhakar Rajan More articles by this author Senthil Nathan More articles by this author Timothy Briggs More articles by this author Navin Ramachandran More articles by this author Clare Allen More articles by this author John Kelly More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...