Predicting Pathological Features at Radical Prostatectomy in Patients with Prostate Cancer Eligible for Active Surveillance by Multiparametric Magnetic Resonance Imaging

Giuseppe Lucarelli,Barbara Jereczek-Fossa,Gilberto Laurino Almeida,Deliu Victor Matei,Antonio Cioffi,Danilo Bottero,Elena Tagliabue,Daniela Terracciano,Giovanni Cordima,Giuseppe Renne,Neil A. Bhowmick,Carlo Buonerba,Ottavio de Cobelli,Giuseppe Di Lorenzo,Matteo Ferro,Sara Raimondi,Giuseppe Petralia

doi:10.1371/journal.pone.0139696

Abstract

PurposeThe aim of this study was to investigate the prognostic performance of multiparametric magnetic resonance imaging (mpMRI) and Prostate Imaging Reporting and Data System (PIRADS) score in predicting pathologic features in a cohort of patients eligible for active surveillance who underwent radical prostatectomy.MethodsA total of 223 patients who fulfilled the criteria for “Prostate Cancer Research International: Active Surveillance”, were included. Mp–1.5 Tesla MRI examination staging with endorectal coil was performed at least 6–8 weeks after TRUS-guided biopsy. In all patients, the likelihood of the presence of cancer was assigned using PIRADS score between 1 and 5. Outcomes of interest were: Gleason score upgrading, extra capsular extension (ECE), unfavorable prognosis (occurrence of both upgrading and ECE), large tumor volume (≥0.5ml), and seminal vesicle invasion (SVI). Receiver Operating Characteristic (ROC) curves and Decision Curve Analyses (DCA) were performed for models with and without inclusion of PIRADS score.ResultsMultivariate analysis demonstrated the association of PIRADS score with upgrading (P<0.0001), ECE (P<0.0001), unfavorable prognosis (P<0.0001), and large tumor volume (P = 0.002). ROC curves and DCA showed that models including PIRADS score resulted in greater net benefit for almost all the outcomes of interest, with the only exception of SVI.ConclusionsmpMRI and PIRADS scoring are feasible tools in clinical setting and could be used as decision-support systems for a more accurate selection of patients eligible for AS.

Highlights

The use of prostate specific antigen (PSA) testing has recently been criticized for prostate cancer (PCa) screening[1,2], it continues to be the best biomarker available for early PCa detection
Multivariate analysis demonstrated the association of Prostate Imaging Reporting and Data System (PIRADS) score with upgrading (P
Receiver Operating Characteristic (ROC) curves and Decision Curve Analyses (DCA) showed that models including PIRADS score resulted in greater net benefit for almost all the outcomes of interest, with the only exception of seminal vesicle invasion (SVI)

Summary

Introduction

The use of prostate specific antigen (PSA) testing has recently been criticized for prostate cancer (PCa) screening[1,2], it continues to be the best biomarker available for early PCa detection. The increasing use of this biomarker in association with several PSA derivatives, such as free to total PSA ratio (%fPSA), PSA density (PSAD), and PSA velocity, has led to frequent detection of small, well differentiated, low-risk PCa without significant decrease in mortality[3] This fact gives rise to the thought that clinically insignificant disease is being treated excessively and active follow up of these patients should be preferred instead of radical treatment. Preoperative neural network software including mpMRI variables, PSA level and GS has been reported to predict insignificant prostate cancer, in the context of clinically nonpalpable tumors, suggesting a prognostic and pathologic predictive role in clinically very low risk PCa[12] In this scenario it has been developed a scoring system called Prostate Imaging Reporting and Data System (PIRADS), with the aim to enable elaboration, interpretation, and reporting of prostate mpMRI findings[13].

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Conclusion