Cancer Patients Undergoing Radical Prostatectomy Research Articles

P024 The added Value of PSMA PET/CT to MRI for local staging in prostate cancer patients undergoing radical prostatectomy

P024 The added Value of PSMA PET/CT to MRI for local staging in prostate cancer patients undergoing radical prostatectomy

MRI-measured periprostatic to subcutaneous adipose tissue thickness ratio as an independent risk factor in prostate cancer patients undergoing radical prostatectomy

The purpose of this study is to evaluate whether the periprostatic adipose tissue thickness (PPATT) is an independent prognostic factor for prostate cancer patients after laparoscopic radical prostatectomy (LRP). This retrospective cohort study included consecutive prostate cancer patients who underwent LRP treatment at Wuhan Union Hospital from June 2, 2016, to September 7, 2023. PPATT was defined as the thickness of periprostatic fat and was obtained by measuring the shortest vertical distance from the pubic symphysis to the prostate on the midsagittal T2-weighted MR images. Subcutaneous adipose tissue thickness (SATT) was obtained by measuring the shortest vertical distance from the pubic symphysis to the skin at the same slice with PPATT. The primary outcome of the study was biochemical recurrence (BCR), and the secondary outcome was overall survival (OS). Multivariable Cox regression analysis was used to identify independent prognostic factors for prostate cancer survival and prognosis. Based on the optimal cutoff value, 162 patients were divided into a low PPATT/SATT group (n = 82) and a high PPATT/SATT group (n = 80). During the entire follow-up period (median 23.5 months), 26 patients in the high PPATT/SATT group experienced BCR (32.5%), compared to 18 in the low PPATT/SATT group (22.0%). Kaplan–Meier curve analysis indicated that the interval to BCR was significantly shorter in the high PPATT/SATT group (P = 0.037). Multivariable Cox regression analysis revealed that an increase in the PPATT/SATT ratio was associated with BCR (hazard ratio: 1.90, 95% CI, 1.03–3.51; P = 0.040). The PPATT/SATT ratio is a significant independent risk factor for BCR after LRP for prostate cancer patients.

Size of lymph-node metastases in prostate cancer patients undergoing radical prostatectomy: implication for imaging and oncologic follow-up of 2705 lymph-node positive patients

BackgroundDespite modern imaging modalities, lymph-node staging before radical prostatectomy (RP) remains challenging in patients with prostate cancer (PCa). The visibility of lymph-node metastases (LNMs) is critically influenced by their size.ObjectiveThis study aims to describe the distribution of maximal tumor diameters (i.e., size) in LNMs of pN1-PCa at RP and its consequences on visibility in preoperative imaging and oncological outcomes.Design, setting, and participantsA total of 2705 consecutive patients with pN1-PCa at RP, harboring a cumulative 7510 LNMs, were analyzed. Descriptive and multivariable analyses addressed the risk of micrometastases (MM)-only disease and the visibility of LNMs. Kaplan–Meier curves and Cox analyses were used for biochemical recurrence-free survival (BCRFS) stratified for MM-only disease.ResultsThe median LNM size was 4.5mm (interquartile range (IQR): 2.0–9.0 mm). Of 7510 LNMs, 1966 (26%) were MM (≤ 2mm). On preoperative imaging, 526 patients (19%) showed suspicious findings (PSMA-PET/CT: 169/344, 49%). In multivariable analysis, prostate-specific antigen (PSA) (OR 0.98), age (OR 1.01), a Gleason score greater than 7 at biopsy (OR 0.73), percentage of positive cores at biopsy (OR 0.36), and neoadjuvant treatment (OR 0.51) emerged as independent predictors for less MM-only disease (p < 0.05). Patients with MM-only disease compared to those harboring larger LNMs had a longer BCRFS (median 60 versus 29 months, p < 0.0001).ConclusionOverall, 26% of LNMs were MM (≤ 2mm). Adverse clinical parameters were inversely associated with MM at RP. Consequently, PSMA-PET/CT did not detect a substantial proportion of LNMs. LNM size and count are relevant for prognosis.

A comparative analysis of perioperative complications and biochemical recurrence between standard and extended pelvic lymph node dissection in prostate cancer patients undergoing radical prostatectomy: a systematic review and meta-analysis.

Pelvic lymph node dissection (PLND) is commonly performed during radical prostatectomy (RP) for prostate cancer staging. This study aimed to comprehensively analyze existing evidence compare perioperative complications associated with standard (sPLND) versus extended PLND templates (ePLND) in RP patients. A meta-analysis of prospective studies on PLND complications was conducted. Systematic searches were performed on Web of Science, Pubmed, Embase, and the Cochrane Library until May 2023. Risk ratios (RRs) were estimated using random-effects models in the meta-analysis. The statistical analysis of the data was carried out using Review Manager software. Nine studies, including three randomized clinical trial and six prospective studies, with a total of 4962 patients were analyzed. The meta-analysis revealed that patients undergoing ePLND had a higher risk of partial perioperative complications, such as lymphedema ( I2 =28%; RR 0.05; 95% CI: 0.01-0.27; P <0.001) and urinary retention ( I2 =0%; RR 0.30; 95% CI: 0.09-0.94; P =0.04) compared to those undergoing sPLND. However, there were no significant difference was observed in pelvic hematoma ( I2 =0%; RR 1.65; 95% CI: 0.44-6.17; P =0.46), thromboembolic ( I2 =57%; RR 0.91; 95% CI: 0.35-2.38; P =0.85), ureteral injury ( I2 =33%; RR 0.28; 95% CI: 0.05-1.52; P =0.14), intraoperative bowel injury ( I2 =0%; RR 0.87; 95% CI: 0.14-5.27; P =0.88), and lymphocele ( I2 =0%; RR 1.58; 95% CI: 0.54-4.60; P =0.40) between sPLND and ePLND. Additionally, no significant difference was observed in overall perioperative complications ( I2 =85%; RR 0.68; 95% CI: 0.40-1.16; P =0.16). Furthermore, ePLND did not significantly reduce biochemical recurrence ( I2 =68%; RR 0.59; 95% CI: 0.28-1.24; P =0.16) of prostate cancer. This analysis found no significant differences in overall perioperative complications or biochemical recurrence between sPLND and ePLND, but ePLND may offer enhanced diagnostic advantages by increasing the detection rate of lymph node metastasis.

Impact of the time elapsed between prostate biopsy and surgery on the accuracy of nomograms predicting lymph node invasion in patients with clinically localized prostate cancer.

We aimed to investigate whether the performance characteristics of available nomograms predicting lymph node invasion (LNI) in prostate cancer patients undergoing radical prostatectomy (RP) change according to the time elapsed between diagnosis and surgery. We identified 816 patients who underwent RP with extended pelvic lymph node dissection (ePLND) after combined prostate biopsy at 6 referral centers. We plotted the accuracy (ROC-derived area under the curve [AUC]) of each Briganti nomogram according to the time elapsed between biopsy ad RP. We then tested whether discrimination of the nomograms improved after accounting for the time elapsed between biopsy ad RP. The median time between biopsy and RP was 3 months. The LNI rate was 13%. The discrimination of each nomogram decreased with increasing time elapsed between biopsy and surgery, where the AUC of the 2019 Briganti nomogram was 88% vs. 70% for men undergoing surgery <2 vs. >6 months from the biopsy. The addition of the time elapsed between biopsy ad RP improved the accuracy of all available nomograms (P < 0.003), with the Briganti 2019 nomogram showing the highest discrimination. Clinicians should be aware that the discrimination of available nomograms decreases according to the time elapsed between diagnosis and surgery. The indication of ePLND should be carefully evaluated in men below the LNI cut-off who had a diagnosis more than 6 months before RP. This has important implications when considering the longer waiting lists related to the impact of COVID-19 on healthcare systems.

Senescence-associated secretory phenotype constructed detrimental and beneficial subtypes and prognostic index for prostate cancer patients undergoing radical prostatectomy

BackgroundCellular senescence is growing in popularity in cancer. A dual function is played by the senescence-associated secretory phenotype (SASP) that senescent cells produce in the development of pro-inflammatory niches, tissue regeneration or destruction, senescence propagation, and malignant transformation. In this study, we conducted thorough bioinformatic analysis and meta-analysis to discover detrimental and beneficial subtypes and prognostic index for prostate cancer (PCa) patients using the experimentally confirmed SASP genes.MethodsWe identified differentially expressed and prognosis-related SASP genes and used them to construct two molecular subtypes and risk score. Another two external cohorts were used to confirm the prognostic effect of the above subtypes and risk score and meta-analysis was further conducted. Additionally, functional analysis, tumor stemness and heterogeneity and tumor microenvironment were also evaluated. We completed analyses using software R 3.6.3 and its suitable packages. Meta-analysis was performed by software Stata 14.0.ResultsThrough multivariate Cox regression analysis and consensus clustering analysis, we used VGF, IGFBP3 and ANG to establish detrimental and beneficial subtypes in the TCGA cohort, which was validated through other two independent cohorts. Meta-analysis showed that detrimental SASP group had significantly higher risk of biochemical recurrence (BCR) than beneficial SASP group (HR: 2.48). Moreover, we also constructed and validated risk score based on these genes to better guide clinical practice. DNA repair, MYC target, oxidative phosphorylation, proteasome and ribosome were highly enriched in detrimental SASP group. Detrimental SASP group had significantly higher levels of B cells, CD8+ T cells, homologous recombination deficiency, loss of heterozygosity, microsatellite instability, purity, tumor mutation burden, mRNAsi, differentially methylated probes and epigenetically regulated RNA expression than beneficial SASP group. The top mutation genes between detrimental and beneficial SASP groups were SPOP, FOXA1, KMT2C, APC, BSN, DNAH17, MYH6, EPPK1, ZNF536 and ZC3H13 with statistical significance.ConclusionsFrom perspective of SASP, we found detrimental and beneficial tumor subtypes which were closely associated with BCR-free survival for PCa patients, which might be important for the furture research in the field of PCa.

Association of quantifiable prostate MRI parameters with any and large cribriform pattern in prostate cancer patients undergoing radical prostatectomy

PurposeCribriform pattern has recently been recognized as an important independent risk factor for prostate cancer (PCa) outcome. This study aimed to identify the association of quantifiable prostate magnetic resonance imaging (MRI) parameters with any and large cribriform pattern at radical prostatectomy (RP) specimens. MethodsPreoperative prostate MRI’s from 188 men undergoing RP between 2010 and 2018 were retrospectively acquired. RP specimens of the patients were revised for Gleason score (GS), and presence of any and large cribriform pattern. MRI parameters such as MRI visibility, PI-RADS score, lowest apparent diffusion coefficient (ADC) value, lesion size, and radiologic extra-prostatic extension (EPE) were reviewed. The association of prostate MRI parameters for presence of any and large cribriform pattern at RP was analysed using logistic regression. Results116/188 (61.7%) PCa patients had any cribriform and 36/188 (19.1%) large cribriform pattern at RP. 171/188 (91.0%) men had MRI-visible lesions; 111/116 (95.7%) tumours with any and 36/36 (100%) with large cribriform pattern were visible at MRI. PCa with any and large cribriform pattern both had lower ADC values than those without (p < 0.001). In adjusted analysis, lowest ADC value was as an independent predictor for any cribriform (Odds Ratio (OR) 0.2, 95% Confidence Interval (CI) 0.1–0.8; p = 0.01) and large cribriform pattern (OR 0.2, 95% CI 0.1–0.7; p = 0.01), while other parameters were not. ConclusionsThe majority of PCa with cribriform pattern at RP were visible at MRI, and lowest ADC value was an independent predictor for both any and large cribriform pattern.

MP20-05 LATROPHILINS AS DOWNSTREAM EFFECTORS OF THE ANDROGEN RECEPTOR INDUCE PROSTATE CANCER PROGRESSION

You have accessJournal of UrologyCME1 Apr 2023MP20-05 LATROPHILINS AS DOWNSTREAM EFFECTORS OF THE ANDROGEN RECEPTOR INDUCE PROSTATE CANCER PROGRESSION Yuki Teramoto, Takuro Goto, Masato Yasui, and Hiroshi Miyamoto Yuki TeramotoYuki Teramoto More articles by this author , Takuro GotoTakuro Goto More articles by this author , Masato YasuiMasato Yasui More articles by this author , and Hiroshi MiyamotoHiroshi Miyamoto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003245.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Latrophilins (LPHNs), including LPHN1, LPHN2, and LPHN3, are a group of the G-protein-coupled receptor where a spider venom latrotoxin (LTX) is known to bind. Alterations in their encoded genes (e.g. ADGRL1, ADGRL2, ADGRL3) have been linked to susceptibility to attention deficit hyperactivity disorder (ADHD). Interestingly, ADHD is diagnosed approximately 3 times more often in boys than in girls, and prenatal exposure to excess androgens has been suggested to increase its risk. However, LPHNs remain largely uncharacterized in neoplastic diseases. The present study aimed to determine the functional role of LPHNs in the progression of prostate cancer. METHODS: In human prostate cancer lines, we assessed the effects of androgen receptor (AR) ligands and LPHN ligands (e.g. LTX, FLRT3) or silencing of each LPHN via shRNA virus infection on the expression of LPHNs and the cell growth/expression of related proteins, respectively. In 150 radical prostatectomy cases, we immunohistochemically stained for LPHN1/LPHN2/LPHN3. RESULTS: In AR-positive LNCaP/C4-2/CWR22Rv1 cells, dihydrotestosterone treatment considerably increased the expression levels of LPHN1, LPHN2, and LPHN3, which was at least partially restored by AR inhibitors, bicalutamide and enzalutamide. Chromatin immunoprecipitation assay further revealed the binding of endogenous ARs, including ARv7, to the promoter region of each LPHN in prostate cancer cells. Treatment with LTX or FLRT3 resulted in induction in the cell viability and migration of AR-positive lines, as well as the expression of prostate-specific antigen, and reduction in apoptosis. LTX/FLRT3 also enhanced the expression of phosphorylated forms of JAK2 and STAT3, as well as Bcl-2. Meanwhile, knockdown of LPHN1, LPHN2, or LPHN3 showed opposite effects on all of those described above for LTX/FLRT3 treatment. In addition, similar stimulation by LTX/FLRT3 treatment or inhibition by knockdown of each LPHN was seen in AR-negative PC-3 and DU145 cells. In immunohistochemistry, high LPHN1 (H-score >200; HR=3.706, p=0.006)/LPHN2 (>100; HR=6.023, p=0.002)/LPHN3 (>200; HR=4.265, p=0.004) was associated with a significantly higher risk of biochemical recurrence after prostatectomy even in a multivariate setting. CONCLUSIONS: These findings indicate that LPHNs, as downstream effectors of the ARs, promote the growth of prostate cancer. LPHNs could thus be independent prognosticators in prostate cancer patients undergoing radical prostatectomy, as well as therapeutic targets for both androgen-sensitive and castration-resistant tumors. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e276 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yuki Teramoto More articles by this author Takuro Goto More articles by this author Masato Yasui More articles by this author Hiroshi Miyamoto More articles by this author Expand All Advertisement PDF downloadLoading ...

Correlation between ADC, ADC ratio, and Gleason Grade group in prostate cancer patients undergoing radical prostatectomy: Retrospective multicenter study with different MRI scanners.

MRI is an important tool in the prostate cancer work-up, with special emphasis on the ADC sequence. This study aimed to investigate the correlation between ADC and ADC ratio compared to tumor aggressiveness determined by a histopathological examination after radical prostatectomy. Ninety-eight patients with prostate cancer underwent MRI at five different hospitals prior to radical prostatectomy. Images were retrospectively analyzed individually by two radiologists. The ADC of the index lesion and reference tissues (contralateral normal prostatic, normal peripheral zone, and urine) was recorded. Absolute ADC and different ADC ratios were compared to tumor aggressivity according to the ISUP Gleason Grade Groups extracted from the pathology report using Spearman's rank correlation coefficient (ρ). ROC curves were used to evaluate the ability to discriminate between ISUP 1-2 and ISUP 3-5 and intra class correlation and Bland-Altman plots for interrater reliability. All patients had prostate cancer classified as ISUP grade ≥ 2. No correlation was found between ADC and ISUP grade. We found no benefit of using the ADC ratio over absolute ADC. The AUC for all metrics was close to 0.5, and no threshold could be extracted for prediction of tumor aggressivity. The interrater reliability was substantial to almost perfect for all variables analyzed. ADC and ADC ratio did not correlate with tumor aggressiveness defined by ISUP grade in this multicenter MRI study. The result of this study is opposite to previous research in the field.

Is There an Impact of Transperineal Versus Transrectal Magnetic Resonance Imaging–targeted Biopsy on the Risk of Upgrading in Final Pathology in Prostate Cancer Patients Undergoing Radical Prostatectomy? An European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-institutional Study

BackgroundThe concordance rates of transperineal (TP) versus transrectal (TR) prostate biopsies with radical prostatectomy (RP) specimen have been assessed poorly in men diagnosed with magnetic resonance imaging (MRI)-targeted biopsy (TBx). ObjectiveTo evaluate International Society of Urological Pathology (ISUP) concordance rates between the final pathology at RP and MRI-TBx or MRI-TBx + random biopsy (RB) according to the biopsy approach. Design, setting, and participantsA multi-institutional database included patients diagnosed with TP or TR treated with RP. InterventionTP-TBx or TR-TBx of the prostate. Outcome measurements and statistical analysisThe ISUP grade at biopsy was compared with the final pathology. A multivariable logistic regression analysis (MVA) was performed to assess the association between the biopsy approach (TP-TBx vs TR-TBx) and ISUP upgrading, downgrading, concordance, and clinically relevant increase (CRI). Results and limitationsOverall, 752 (59%) versus 530 (41%) patients underwent TR versus TP. At the MVA, TP-TBx was an independent predictor of upgrading (odds ratio [OR] 0.6, 95% confidence interval [CI] 0.4–0.9, p < 0.01) and improved concordance relative to the final pathology (OR 1.7, 95% CI 1.2–2.5, p < 0.01) after adjusting for age, cT stage, Prostate Imaging Reporting and Data System, number of targeted cores, prostate-specific antigen, and prostate volume. Moreover, TP-TBx was associated with a lower risk of CRI than TR-TBx (OR 0.7, p < 0.01). This held true when considering patients who underwent MRI-TBx + RB (OR 0.6, p < 0.01). The inclusion of men who had RP represents a potential selection bias. ConclusionsThe adoption of TP-TBx compared with TR-TBx may reduce the risk of upgrading and improve the concordance of biopsy grade with the final pathology. The TP approach decreases the odds of CRI with improved patient selection for the correct active treatment. Patient summaryIn this report, we evaluated whether transperineal (TP) targeted biopsy (TBx) may improve the concordance of clinically significant prostate cancer with the final pathology in comparison with transrectal (TR) TBx in a large worldwide population. We found that TP-TBx might increase concordance compared with TR-TBx. Adding random biopsies to target one increases accuracy; however, concordance with the final pathology is overall suboptimal even with the TP approach.

Is there an impact of transperineal vs. transrectal MRI-targeted biopsy on the risk of upgrading and concordance with final pathology in prostate cancer patients undergoing radical prostatectomy? An EAU-YAU study

Is there an impact of transperineal vs. transrectal MRI-targeted biopsy on the risk of upgrading and concordance with final pathology in prostate cancer patients undergoing radical prostatectomy? An EAU-YAU study

A novel model Integrating clinical, mp-MRI, and epigenomic features to predict lymph node invasion in prostate cancer patients undergoing radical prostatectomy and pelvic lymph node dissection

A novel model Integrating clinical, mp-MRI, and epigenomic features to predict lymph node invasion in prostate cancer patients undergoing radical prostatectomy and pelvic lymph node dissection

3 - First in-men evaluation of OTL78, a near-infrared fluorescent prostate-specific membrane antigen-targeting probe, in prostate cancer patients undergoing radical prostatectomy

3 - First in-men evaluation of OTL78, a near-infrared fluorescent prostate-specific membrane antigen-targeting probe, in prostate cancer patients undergoing radical prostatectomy

Revisiting current National Comprehensive Cancer Network (NCCN) high-risk prostate cancer stratification: a National Cancer Database analysis.

High-risk prostate cancer includes heterogenous populations with variable outcomes. This study aimed to compare the prognostic ability of individual high-risk factors, as defined by National Comprehensive Cancer Network (NCCN) risk stratification, in prostate cancer patients undergoing radical prostatectomy. We queried the National Cancer Database from 2004 to 2018 for patients with non-metastatic high-risk prostate cancer who underwent radical prostatectomy and stratified them as Group H1: Prostate specific antigen (PSA) > 20 ng/ml alone, Group H2: cT3a stage alone and Group H3: Gleason Grade (GG) group 4/5 as per NCCN guidelines. The histopathological characteristics and rate of adjuvant therapy were compared between different groups. Inverse probability weighting (IPW)-adjusted Kaplan-Meier curves were utilized to compare overall survival (OS) in group H1 and H2 with H3. Overall, 61,491 high-risk prostate cancer patients were identified, and they were classified into Group H1 (n = 14,139), Group H2 (n = 2855) and Group H3 (n = 44,497). Compared to group H1 or H2, pathological GG group > 3 (p < 0.001), pathological stage pT3b or higher (p < 0.001), lymph nodal positive disease (pN1) (p < 0.001) and rate of adjuvant therapy (p < 0.001) were significantly in Group H3. IPW-adjusted Kaplan-Meier curves showed significantly better 5-year OS in group H1 compared to group H3 [95.1% vs 93.3%, p < 0.001] and group H2 compared to group H3 [94.4% vs 92.9%, p < 0.001]. PSA > 20 ng/ml or cT3a stage in isolation have better oncologic and survival outcomes compared to GG > 3 disease and sub-stratification of 'High-risk' category might lead to better patient prognostication.

SC207 - A more extended pelvic lymph node dissection decreases recurrence rates in selected prostate cancer patients undergoing radical prostatectomy

SC207 - A more extended pelvic lymph node dissection decreases recurrence rates in selected prostate cancer patients undergoing radical prostatectomy

SC267 - 99M-technetium-psma radio-guided surgery to detect nodal metastases in prostate cancer patients undergoing radical prostatectomy and extended pelvic lymph node dissection: a phase 2 prospective, single-institution study

SC267 - 99M-technetium-psma radio-guided surgery to detect nodal metastases in prostate cancer patients undergoing radical prostatectomy and extended pelvic lymph node dissection: a phase 2 prospective, single-institution study

One step nucleic acid amplification (OSNA) for detection of lymph node metastasis during robotic radical prostatectomy for prostate cancer: A pilot study

The OSNA technique is based on reverse transcription loop-mediated DNA amplification for the detection of cytokeratin 19 (CK19) messen-ger RNA (mRNA). The purpose of our paper, which represents the first study in the literature, is to test the accuracy of this method in the detection of lymph node metastases in patients undergoing robotic radical prostatectomy with lymph node dis-section. Our cohort consisted of patients that have undergone robotic radical prostatectomy with extended lymph node dissec-tion. Lymph nodes were evaluated with imprint technique and then with frozen section examination. The remaining tissue was evaluated by OSNA method. Lymph nodes were defined as 'neg-ative' or 'positive' according to mRNA copy number. 7 patients and 25 lymph nodes were included in our cohort. Two patients were found negative with all pathology methods. In one patient the standard stains revealed a suspi-cious outcome but it was positive for micrometastasis with OSNA. In another patient the outcome was positive for standard stains and negative for OSNA. Finally, 2 patients were found positive for OSNA and negative for imprint methods. One Step Nucleic Acid Amplification (OSNA) method using CK19 seems to fail in detection of lymph node metastases in prostate cancer patients undergoing radical prostatectomy and lymph node dissection.

External Validation of Models for Prediction of Side-specific Extracapsular Extension in Prostate Cancer Patients Undergoing Radical Prostatectomy

BackgroundPredicting the risk of side-specific extracapsular extension (ECE) is essential for planning nerve-sparing radical prostatectomy (RP) in patients with prostate cancer (PCa). ObjectiveTo externally validate available models for prediction of ECE. Design, setting, and participantsSixteen models were assessed in a cohort of 737 consecutive PCa patients diagnosed via multiparametric magnetic resonance imaging (MRI)-targeted and systematic biopsies and treated with RP between January 2016 and November 2021 at eight referral centers. Outcome measurements and statistical analysisModel performance was evaluated in terms of discrimination using area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA). Results and limitationsOverall, ECE was identified in 308/1474 (21%) prostatic lobes. Prostatic lobes with ECE had higher side-specific clinical stage on digital rectal examination and MRI, number of positive biopsy cores, and International Society of Urological Pathology grade group in comparison to those without ECE (all p < 0.0001). Less optimistic performance was observed in comparison to previous published studies, although the models described by Pak, Patel, Martini, and Soeterik achieved the highest accuracy (AUC ranging from 0.73 to 0.77), adequate calibration for a probability threshold <40%, and the highest net benefit for a probability threshold >8% on DCA. Inclusion of MRI-targeted biopsy data and MRI information in models improved patient selection and clinical usefulness. Using model-derived cutoffs suggested by their authors, approximately 15% of positive surgical margins could have been avoided. Some available models were not included because of missing data, which constitutes a limitation of the study. ConclusionsWe report an external validation of models predicting ECE and identified the four with the best performance. These models should be applied for preoperative planning and patient counseling. Patient summaryWe validated several tools for predicting extension of prostate cancer outside the prostate gland. These tools can improve patient selection for surgery that spares nerves affecting recovery of sexual potency after removal of the prostate. They could potentially reduce the risk of finding cancer cells at the edge of specimens taken for pathology, a finding that suggests that not all of the cancer has been removed.

MP51-15 THE ROLE OF 68 GA-PSMA- AND 68 GA-DOTA-RM2 PET/MRI IN THE PRIMARY STAGING OF HIGH-RISK PROSTATE CANCER PATIENTS UNDERGOING RADICAL PROSTATECTOMY. PRELIMINARY RESULTS OF A PROSPECTIVE, SINGLE CENTER STUDY

MP51-15 THE ROLE OF ⁶⁸ GA-PSMA- AND ⁶⁸ GA-DOTA-RM2 PET/MRI IN THE PRIMARY STAGING OF HIGH-RISK PROSTATE CANCER PATIENTS UNDERGOING RADICAL PROSTATECTOMY. PRELIMINARY RESULTS OF A PROSPECTIVE, SINGLE CENTER STUDY

The Impact of the Ongoing COVID-19 Epidemic on the Increasing Risk of Adverse Pathology in Prostate Cancer Patients Undergoing Radical Prostatectomy.

We aimed to assess whether the ongoing course of the COVID-19 epidemic has been associated with an increased risk of adverse pathology (AP) findings in prostate cancer (PC) patients treated with radical prostatectomy (RP). We performed a retrospective data analysis which included 408 consecutive, non-metastatic, previously untreated PC patients who underwent RP in our institution between March 2020 and September 2021. Patients were divided into two equally numbered groups in regard to the median surgery date (Early Epidemic [EE] and Late Epidemic [LE]) and compared. Adverse pathology was defined as either grade group (GG) ≥ 4, pT ≥ 3a or pN+ at RP. Patients in the LE group demonstrated significantly higher rates of AP than in the EE group (61 vs. 43% overall and 50 vs. 27% in preoperative non-high-risk subgroup, both p < 0.001), mainly due to higher rates of upgrading. On multivariable analysis, consecutive epidemic week (odds ratio: 1.02, 95% confidence interval: 1.00–1.03, p = 0.009) as well as biopsy GG ≥ 2 and a larger prostate volume (mL) were associated with AP in non-high-risk patients. The study serves as a warning call for increased awareness of risk underassessment in contemporarily treated PC patients.