PD47-11 THE ROLE OF MRI-TARGETED BIOPSY IN PREDICTION OF ADVERSE PATHOLOGICAL AND ONCOLOGICAL OUTCOME AFTER RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Staging II1 Apr 2018PD47-11 THE ROLE OF MRI-TARGETED BIOPSY IN PREDICTION OF ADVERSE PATHOLOGICAL AND ONCOLOGICAL OUTCOME AFTER RADICAL PROSTATECTOMY Yoh Matsuoka, Hiroshi Tanaka, Tomo Kimura, Yuma Waseda, Sho Uehara, Yosuke Yasuda, Toshiki Kijima, Soichiro Yoshida, Minato Yokoyama, Junichiro Ishioka, Kazutaka Saito, Kazunori Kihara, and Yasuhisa Fujii Yoh MatsuokaYoh Matsuoka More articles by this author , Hiroshi TanakaHiroshi Tanaka More articles by this author , Tomo KimuraTomo Kimura More articles by this author , Yuma WasedaYuma Waseda More articles by this author , Sho UeharaSho Uehara More articles by this author , Yosuke YasudaYosuke Yasuda More articles by this author , Toshiki KijimaToshiki Kijima More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Junichiro IshiokaJunichiro Ishioka More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Kazunori KiharaKazunori Kihara More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2171AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multiparametric MRI and MRI-targeted biopsy (MTB) facilitate prostate cancer (PC) detection. We have reported that the Prostate Imaging Reporting and Data System (PI-RADS) version 2 promotes overstaging (AJR 2017) and that risk-group migration occurs when MTB data is applied in systematic biopsy (SB)-based risk models (AUA 2016). We aimed to clarify roles of MTB in the prediction of extraprostatic extension (EPE) and biochemical recurrence (BCR) after radical prostatectomy (RP). METHODS Subjects were 174 clinically localized PC patients who had undergone multiparametric MRI, 12-core SB, and RP without prior treatment. MTB was performed for index lesions with PI-RADS scores ≥3. BCR was defined as PSA >0.2 ng/ml. Preoperative factors were examined for associations with EPE and BCR by logistic and Cox regression analyses, respectively. The performance of models was evaluated. RESULTS SB showed no PC in 19 men (11%) and PC of grade groups (GG) 1/2/3/≥4 in 42/65/24/24 men (24/37/14/14%). MTB (median core number, 4) was performed in 153 men (88%) and showed no PC in 11 men (6%) and PC of GG 1/2/3/≥4 in 25/63/28/26 men (14/36/16/15%). EPE was identified in 35 men (20%). After a median follow-up of 43 months, 28 men (16%) had BCR. In multivariate analyses, T-stage ≥3 on MRI (p <0.001) and MTB-GG ≥4 (p = 0.004) were independent predictors of EPE. Among 92 men at T-stage ≥3 on MRI, EPE was found in 67% (10/15) of men with MTB-GG ≥4 and 30% (23/77) of men without MTB-GG ≥4 (p = 0.007). Regarding BCR, PSA ≥10 ng/ml (hazard ratio [HR] 4.1, p = 0.001), SB-GG ≥3 (HR 2.8, p = 0.02), MTB-GG ≥3 (HR 11.6, p <0.001), and maximal cancer length (MCL) ≥6 mm in MTB (HR 6.4, p <0.001) were independent predictors. A scoring model was developed in which the score was calculated as 1 (if PSA ≥10 ng/ml) + 1 (if SB-GG ≥3) + 2 (if MTB-GG ≥3) + 2 (if MCL ≥6 mm in MTB) or 0 (otherwise). Postoperative courses were stratified with three-year BCR-free rates of 100/78/34% for men with scores 0-2/3-4/5-6 (n = 113/35/26) (p <0.001). The concordance index was 0.82 for this model and 0.58 and 0.63 for the NCCN risk model using SB alone and both SB and MTB, respectively. CONCLUSIONS MTB has predictive values for pathological and oncological outcomes after RP. PC grades on MTB may complement MRI staging, and grades and size on MTB could be useful in risk stratification for BCR. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e902 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Yoh Matsuoka More articles by this author Hiroshi Tanaka More articles by this author Tomo Kimura More articles by this author Yuma Waseda More articles by this author Sho Uehara More articles by this author Yosuke Yasuda More articles by this author Toshiki Kijima More articles by this author Soichiro Yoshida More articles by this author Minato Yokoyama More articles by this author Junichiro Ishioka More articles by this author Kazutaka Saito More articles by this author Kazunori Kihara More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...