PD46-10 STANDARDIZED MAGNETIC RESONANCE IMAGING READING FOR PREDICTION OF EXTRAPROSTATIC EXTENSION AND PROSTATECTOMY OUTCOME IN PATIENTS WITH LOW-, INTERMEDIATE- AND HIGH-RISK PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Detection and Screening V1 Apr 2015PD46-10 STANDARDIZED MAGNETIC RESONANCE IMAGING READING FOR PREDICTION OF EXTRAPROSTATIC EXTENSION AND PROSTATECTOMY OUTCOME IN PATIENTS WITH LOW-, INTERMEDIATE- AND HIGH-RISK PROSTATE CANCER Jan Philipp Radtke, Maya Müller-Wolf, Martin Freitag, Constantin Schwab, Gencay Hatiboglu, Wilfried Roth, Matthias Roethke, Heinz-Peter Schlemmer, Markus Hohenfellner, Boris Hadaschik, and Dogu Teber Jan Philipp RadtkeJan Philipp Radtke More articles by this author , Maya Müller-WolfMaya Müller-Wolf More articles by this author , Martin FreitagMartin Freitag More articles by this author , Constantin SchwabConstantin Schwab More articles by this author , Gencay HatibogluGencay Hatiboglu More articles by this author , Wilfried RothWilfried Roth More articles by this author , Matthias RoethkeMatthias Roethke More articles by this author , Heinz-Peter SchlemmerHeinz-Peter Schlemmer More articles by this author , Markus HohenfellnerMarkus Hohenfellner More articles by this author , Boris HadaschikBoris Hadaschik More articles by this author , and Dogu TeberDogu Teber More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2741AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To investigate the value of multiparametric magnetic resonance imaging (mpMRI) to predict extracapsular extension (ECE) and a negative surgical margin status (SM) at radical prostatectomy (RP) for different prostate cancer (PC) risk groups. METHODS 1070 men underwent 3 Tesla mpMRI including T2-weighted, diffusion weighted imaging and dynamic contrast enhanced sequences without an endorectal coil before MRI/TRUS-fusion guided prostate biopsy. MRI were analyzed using PIRADS. We also investigated an ESUR score for extraprostatic disease. 132 men subsequently underwent RP at our department. Median number of cores taken per patient was 26 (24 systematic and 2 MRI-targeted biopsies). Biopsies were assessed according to START. Pathological stage and SM status at RP was used as reference for ECE. The cohort was classified into low-, intermediate- and high-risk groups according to NCCN criteria. Two different definitions of significant PC were investigated. Statistical analyses included regression analyses, Receiver operating characteristics (ROC) and Youden's index to assess an ESUR score-cutoff. RESULTS Preoperatively, 20 patients had low-, 78 intermediate- and 34 high-risk PC. Final pathology showed pT3 in 58 and pT4 in one patient. Area under curve (AUC) in ROC curve analysis was 0.86 for ESUR-ECE-score to detect pT3a disease. Youden-selected threshold was 4. At ECE-score≥4, the probability of positive SM were significantly increased (p=0.03). Positive/negative predictive value (PPV/NPV) of ECE-score≥4 for harboring pT3 was 82.5%/71.4%, 25.0%/93.3%, 89.5%/76.3% and 88.2%/35.3% for the overall-cohort, low-, intermediate- and high-risk cohort). Logistic regression analyses detected a significant Odd Ratio for pT3 disease for ECE-score, Tumor volume≥0.7 ml, significant PC according to Epstein criteria and high-risk according to NCCN criteria. Interestingly, in the high-risk subgroup 6/34(17.6%) patients were correct assessed as not harboring pT3 by imaging, thus allowing nerve-sparing surgery. The SM-status was determined by ESUR-ECE-score, tumor diameter and PIRADS, but not by surgical approach (robotic versus retropubic RP)(p=0.523). CONCLUSIONS Prediction of pT3 disease is crucial to plan nerve-sparing surgery and to achieve negative SM in RP. MpMRI has promising potential to estimate pT3. The standardized ECE Scoring system is an independent predictor of pT3 and may help to plan nerve-sparing RP with oncologic security, even in high-risk patients. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e960 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jan Philipp Radtke More articles by this author Maya Müller-Wolf More articles by this author Martin Freitag More articles by this author Constantin Schwab More articles by this author Gencay Hatiboglu More articles by this author Wilfried Roth More articles by this author Matthias Roethke More articles by this author Heinz-Peter Schlemmer More articles by this author Markus Hohenfellner More articles by this author Boris Hadaschik More articles by this author Dogu Teber More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...