PD57-04 MRI-BASED PI-RADS SCORE PREDICTS ISUP UPGRADING AND ADVERSE PATHOLOGY AT RADICAL PROSTATECTOMY IN MEN WITH BIOPSY ISUP 1 PROSTATE CANCER

Abstract

You have accessJournal of UrologyCME1 May 2022PD57-04 MRI-BASED PI-RADS SCORE PREDICTS ISUP UPGRADING AND ADVERSE PATHOLOGY AT RADICAL PROSTATECTOMY IN MEN WITH BIOPSY ISUP 1 PROSTATE CANCER Snir Dekalo, Jeremy Cepek, Mario Sofer, Sophie Barnes, Ofer Yossepowitch, and Roy Mano Snir DekaloSnir Dekalo More articles by this author , Jeremy CepekJeremy Cepek More articles by this author , Mario SoferMario Sofer More articles by this author , Sophie BarnesSophie Barnes More articles by this author , Ofer YossepowitchOfer Yossepowitch More articles by this author , and Roy ManoRoy Mano More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002637.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate whether PI-RADS version 2 category 4 or 5 lesions in patients with ISUP 1 cancer on prostate biopsy predict ISUP upgrading and/or adverse pathology at radical prostatectomy. METHODS: We reviewed 127 consecutive patients who underwent 3-Tesla mpMRI and had ISUP 1 on biopsy followed by radical prostatectomy. mpMRI lesions were categorized according to the PI-RADS version 2 system. The study endpoints included ISUP upgrading to a clinically significant cancer (ISUP≥2) and/or adverse pathology on prostatectomy. Associations between baseline characteristics and endpoints were evaluated with logistic regression analyses. RESULTS: PI-RADS 4 or 5 lesions were identified in 89 patients (70%). The rate of ISUP upgrading was higher among patients with PI-RADS 4-5 lesions (84%) compared to patients with equivocal or non-suspicious mpMRI findings (26%, p<0.001). On multivariable logistic regression analysis both PI-RADS 4-5 lesions (OR 24.3, 95% CI 7.3, 80.5, p<0.001) and stage T2 on DRE (OR 5.9, 95% CI 1.2, 29. 4, p=0.03) were independent predictors of upgrading. Men with PI-RADS 4-5 lesions had significantly higher rates of extra-prostatic extension (51% vs. 3%, p<0.001) and positive surgical margins (16% vs. 3%. p=0.03). On multivariable logistic regression analysis PI-RADS 4-5 (OR 21.7, 95% CI 4.8, 99, p<0.001) was the only independent predictor of adverse pathology. CONCLUSIONS: Among patients with a biopsy ISUP 1 who underwent mpMRI, the presence of PI-RADS v2 4 or 5 lesions was a strong independent predictor of upgrading and adverse pathology. Future studies should evaluate whether incorporating mpMRI findings when selecting patients for active surveillance improves treatment outcome. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e961 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Snir Dekalo More articles by this author Jeremy Cepek More articles by this author Mario Sofer More articles by this author Sophie Barnes More articles by this author Ofer Yossepowitch More articles by this author Roy Mano More articles by this author Expand All Advertisement PDF DownloadLoading ...