PURPOSE: To identify risk factors that predicted unfavorable pathological outcomes after radical prostatectomy (RP) in patients with low-risk prostate cancer, and to evaluate the role of MRI.
MATERIALS AND METHODS: The medical records of 1,262 patients who underwent twelve-core biopsy, preoperative MRI, and RP in a single center between September, 2007 and June, 2012 were reviewed retrospectively. In total, 382 patients with low-risk prostate cancer (D'Amico criteria) were included in the analysis. Multivariate logistic regression analysis was performed to identify predictive factors for unfavorable pathological outcomes.
RESULTS: The median age and preoperative PSA level were 65 years and 4.6ng/ml, respectively, and 212 (55.5%) patients had Gleason sum upgrading. In 249 patients (65.1%), the prostate cancer lesion was identifiable on 3-teslar MRI (T2-weighted and diffusion-weighted without dynamic contrast image): it was located in the anterior and posterior of the prostate in 42.9% and 57.0% of patients, respectively. Unfavorable pathology was found in 29.6% of patients after RP. Multivariate analysis revealed that older age (OR=1.072, p< 0.001), number of positive cores (OR=1.373, p< 0.001), and an anterior location of the index tumor on MRI (OR=2.121, p=0.017) were significant predictors of unfavorable final pathology (pT3 or more or upgrading of the tumor to Gleason 3+4 plus a tumor volume of ≥15% or upgrading to Gleason 4+3 or more).
CONCLUSIONS: An anterior location of cancer on MRI was useful for predicting a Gleason sum upgrade or an unfavorable pathological outcome after RP in patients with low-risk prostate cancer.
Written by:
Song SH, Pak S, Park S, Song C, Jeong IG, Choi HJ, Kim JK, Cho KS, Kim CS, Ahn H. Are you the author?
1Department of Urology, University of Ulsan College of Medicine, Asan Medical Center; Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center.
Reference: J Urol. 2014 Mar 11. pii: S0022-5347(14)02912-7.
doi: 10.1016/j.juro.2014.02.2568
PubMed Abstract
PMID: 24631106
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