Pelvic lymph node metastasis (PLNM) at the time of radical prostatectomy (RP) portends an unfavorable prognosis in prostate cancer patients. Conventional and advanced imaging remains limited in its ability to detect PLNM.
We sought to evaluate the combination of a genomic classifier Decipher with Prostate Imaging Reporting and Data System (PI-RADS) scores in improving the detection of PLNM.
A retrospective review was performed of patients whom underwent RP, Decipher analysis, and preoperative prostate MRI. Categorical variables were compared using Pearson chi-square tests. Quantitative variables were assessed with Wilcoxon rank-sum tests. Multivariable logistic regression was used to identify predictors of PLNM on final pathology.
In total, 202 patients were included in the analysis, 23 of whom (11%) had PLNM. Patients with PLNM had higher median Decipher scores (0.73) than those without PLNM (0.61; p = 0.003). Patients with PLNM were more likely to demonstrate PI-RADS scores ≥ 4 (96%) than those without PLNM (74%; p = 0.012). Logistic regression demonstrated an interaction between Decipher score with PI-RADS score ≥4 (OR = 20.41; 95% CI, 2.10-198.74; p = 0.009) The combination demonstrated an area under the curve (AUC) of 0.73 (95% CI, 0.63-0.82; p < 0.001) for predicting PLNM.
The combination of elevated Decipher genomic score (≥ 0.6) and clinically significant PI-RADS score (≥ 4) is associated with PLNM at the time of RP in a modern high-risk cohort of patients with PCa.
Prostate MRI and genomic testing may help identify patients with adverse pathology.
The British journal of radiology. 2023 Feb 06 [Epub ahead of print]
Tarik Benidir, Zaeem Lone, Jane K Nguyen, Ryan Ward, Martin Hofmann, Eric A Klein, Omar Y Mian, Christopher J Weight, Andrei S Purysko
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA., Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA.