Background: Currently most clinical models for predicting biochemical recurrence (BCR) after radical prostatectomy (RP) incorporate staging information from RP specimens, creating a gap in pre-operative risk assessment. Objective: To compare utility of pre-surgical staging information from MRI and post-surgical staging information from RP pathology in predicting BCR in patients with PCa. Methods: This retrospective study included 604 patients (median age, 60 years) with PCa who underwent prostate MRI before RP from June 2007 to December 2018. A single genitourinary radiologist assessed MRI examinations for extraprostatic extension (EPE) and seminal vesicle invasion (SVI) during clinical interpretations. Utility of EPE and SVI on MRI and RP pathology for BCR prediction was assessed through Kaplan-Meier and Cox proportional hazard analyses. Established clinical BCR prediction models, including University of California San Francisco (UCSF)-Cancer of the Prostate Risk Assessment (CAPRA) model and CAPRA-S model, were evaluated in a subset of 374 patients with available Gleason grade groups from biopsy and RP pathology; two CAPRA-MRI models (modifying CAPRA-S to replace RP staging features with MRI staging features) were also assessed. Results: Univariable predictors of BCR included EPE on MRI (HR=3.6), SVI on MRI (HR=4.4), EPE on RP pathology (HR=5.0), and SVI on RP pathology (HR=4.6) (all P<.001). Three-year BCR-free survival (RFS) rates for patients without versus with EPE were 84% versus 59% for MRI and 89% versus 58% for RP pathology, and for patients without versus with SVI were 82% versus 50% for MRI and 83% versus 54% for RP histology (all P<.001). For patients with T3 disease on RP pathology, 3-year RFS rates were 67% and 41% for patients without and with T3 disease on MRI. AUCs of CAPRA models, including CAPRA-MRI models, ranged from 0.743 to 0.778. AUCs were not significantly different between CAPRA-S and CAPRA-MRI models (P>.05). RFS rates were significantly different between lowand intermediate-risk groups for only CAPRA-MRI models (80% vs 51% and 74% vs 44%: both P<.001). Conclusion: Pre-surgical MRI-based staging features perform comparably to post-surgical pathologic staging features for predicting BCR. Clinical impact: MRI staging can pre-operatively identify patients at high BCR risk, helping to inform early clinical decision making.
AJR. American journal of roentgenology. 2023 Jul 05 [Epub ahead of print]
Katie M Merriman, Stephanie A Harmon, Mason J Belue, Enis C Yilmaz, Zoë Blake, Nathan S Lay, Tim E Phelps, Maria J Merino, Howard L Parnes, Yan Mee Law, Sandeep Gurram, Bradford J Wood, Peter L Choyke, Peter A Pinto, Baris Turkbey
Molecular Imaging Branch, NCI, NHI, Bethesda, MD, USA., Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA., Laboratory of Pathology, NCI, NIH, Bethesda, MD, USA., Division of Cancer Prevention, NCI, NIH, Bethesda, MD, USA., Department of Radiology, Singapore General Hospital, Singapore., Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA.