PD57-03 NOMOGRAM INCLUDING MAXIMUM CORE LENGTH AT BIOPSY AND INDEX LESION SIZE AT MPMRI BEST PREDICTS THE EXTRACAPSULAR EXTENSION OF PROSTATE CANCER AT WHOLE-MOUNT SECTIONS OF RADICAL PROSTATECTOMIES

Abstract

You have accessJournal of UrologyProstate Cancer: Staging II (PD57)1 Apr 2020PD57-03 NOMOGRAM INCLUDING MAXIMUM CORE LENGTH AT BIOPSY AND INDEX LESION SIZE AT MPMRI BEST PREDICTS THE EXTRACAPSULAR EXTENSION OF PROSTATE CANCER AT WHOLE-MOUNT SECTIONS OF RADICAL PROSTATECTOMIES Francesco Sanguedolce*, Jose Daniel Subiela Henriquez, Luisa Granados Palacio, Jhonatan Hernandez Mancera, Maria Jose Martinez Barcina, Jose Calderon Cortez, Territo Angelo, Palou Redorta Joan, and Breda Alberto Francesco Sanguedolce*Francesco Sanguedolce* More articles by this author , Jose Daniel Subiela HenriquezJose Daniel Subiela Henriquez More articles by this author , Luisa Granados PalacioLuisa Granados Palacio More articles by this author , Jhonatan Hernandez ManceraJhonatan Hernandez Mancera More articles by this author , Maria Jose Martinez BarcinaMaria Jose Martinez Barcina More articles by this author , Jose Calderon CortezJose Calderon Cortez More articles by this author , Territo AngeloTerrito Angelo More articles by this author , Palou Redorta JoanPalou Redorta Joan More articles by this author , and Breda AlbertoBreda Alberto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000967.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The accuracy of mpMRI in predicting extracapsular extension (ECE) of prostate cancer (PCa) is limited. The PIRADS scoring system includes the 15 mm index lesion (IL) size as a cut-off to distinguish between scores 4 and 5, and it was introduced for its relationship to a higher risk of extracapsular extension (ECE). We have analysed clinical and radiological parameters to select and integrate the most relevant features in a new nomogram for the prediction of ECE. METHODS: From 01/2013 to 12/2017, 128 patients had an mpMRI (T2W, DWI and DCE) before undertaking a radical prostatectomy (RP) at our institution. Clinical parameters included PSA, PSA density (PSAd), clinical stage (cT), ISUP grade group (Gg) and maximum length of cancer (MLC) at TRUS biopsy; variables collected at mpMRI involved index lesion size (IL), length of capsular contact (LCC),PIRADS v2 score, overall prostate LIKERT score, ESUR ECE score and LIKERT ECE score. Reference standard was the histology features at whole-mount specimen sections. Two experienced radiologists retrospectively reviewed the imaging studies blinded to the final histology. Variables resulting associated to ECE at univariate analysis were dichotomised as appropriate by identifying cut-off values at ROC curve (continuous variables) and Kundel test (categorical/nominal variables). Multivariate logistic regression was performed with the step-wise method; the statistically significant variables associated to ECE were included in a nomogram calibrated with the Hosmer-Lomeshow and R2 test. Inter-observer variabilities between the mpMRI readings of the two radiologists were assessed with the Intraclass Correlation Coefficient (ICC). RESULTS: Variables introduced in the multivariate model resulted to be the cT (<T2≥), Gg (<7≥), MLC (<5.5≥ mm), IL (<11≥ mm), PSAd (<0.26≥), PIRADS (≤4>), ESUR (≤2>), LIKERT (≤4>). The variables which finally were entered in the nomogram included the cT, MLC and IL. The probability for ECE with the combination of the three variables was 81.8%, the AUC of the model in a ROC analysis was 0.84 [95%CI(0.75-0.91)], p<0.001, and the calibration analysis resulted in a Hosmer-Lemeshow test p=0.985 and a R2=56.52%. ICC were good for PIRADS, ESUR and overall/ECE LIKERT (0.752, 0.810, 0.834, 0.857, respectively), and substantial for IL size (0.916). CONCLUSIONS: The combination of clinical and mpMRI features best predicts ECE at radical prostatectomy. The 15 mm cut-off distinguishing PIRADS score 4 to 5 should be lowered Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1194-e1194 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesco Sanguedolce* More articles by this author Jose Daniel Subiela Henriquez More articles by this author Luisa Granados Palacio More articles by this author Jhonatan Hernandez Mancera More articles by this author Maria Jose Martinez Barcina More articles by this author Jose Calderon Cortez More articles by this author Territo Angelo More articles by this author Palou Redorta Joan More articles by this author Breda Alberto More articles by this author Expand All Advertisement PDF downloadLoading ...