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. 2020 Nov 26;9(12):3841.
doi: 10.3390/jcm9123841.

MRI Characteristics Accurately Predict Biochemical Recurrence after Radical Prostatectomy

Cécile Manceau  1 , Jean-Baptiste Beauval  2 , Marine Lesourd  1 , Christophe Almeras  2 , Richard Aziza  3 , Jean-Romain Gautier  2 , Guillaume Loison  2 , Ambroise Salin  2 , Christophe Tollon  2 , Michel Soulié  1 , Bernard Malavaud  1 , Mathieu Roumiguié  1 , Guillaume Ploussard  2
Affiliations

MRI Characteristics Accurately Predict Biochemical Recurrence after Radical Prostatectomy

Cécile Manceau et al. J Clin Med. .

Abstract

Background: After radical prostatectomy (RP), biochemical recurrence (BCR) is associated with an increased risk of developing distant metastasis and prostate cancer specific and overall mortality.

Methods: The two-centre study included 521 consecutive patients undergoing RP for positive pre-biopsy magnetic resonance imaging (MRI) and pathologically proven prostate cancer (PCa), after which a combination scheme of fusion-targeted biopsy (TB) and systematic biopsy was performed. We assessed correlations between MRI characteristics, International Society of Urological Pathology (ISUP) grade group in TB, and outcomes after RP. We developed an imaging-based risk classification for improving BCR prediction.

Results: Higher Prostate Imaging and Reporting and Data System (PI-RADS) score (p = 0.013), higher ISUP grade group in TB, and extracapsular extension (ECE) on the MRI were significantly associated with more advanced disease (pTstage), higher ISUP grade group (p = 0.001), regional lymph nodes metastasis in RP specimens (p < 0.001), and an increased risk of recurrence after surgery. A positive margin status was significantly associated with ECE-MRI (p < 0.001). Our imaging-based classification included ECE on MRI, ISUP grade group on TB, and PI-RADS accurately predicted BCR (AUC = 0.714, p < 0.001). This classification had more improved area under the curve (AUC) than the standard d'Amico classification in our population. Validation was performed in a two-centre cohort.

Conclusions: In this cohort, PI-RADS score, MRI stage, and ISUP grade group in MRI-TB were significantly predictive for disease features and recurrence after RP. Imaging-based risk classification integrating these three factors competed with d'Amico classification for predicting BCR.

Keywords: biochemical recurrence; imaging-based risk classification; magnetic resonance imaging (MRI); prostate cancer; prostate cancer prognosis; radical prostatectomy; systematic biopsies; targeted biopsies.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Biochemical recurrence free curves stratified by MRI characteristics. (a) Biochemical recurrence free curves stratified by PI-RADS. Log rank test p = 0.006. (b) Biochemical recurrence free curves stratified by IRM extracapsular extension. Log-rank test p = 0.004. (c) Biochemical recurrence free curves stratified by number of MRI lesions. Log-rank test p = 0.912. (d) Biochemical recurrence free curves stratified by MRI lesion diameter. Log-rank test p = 0.009. (e) Biochemical recurrence free curves stratified by grade group on targeted biopsy. Log-rank test p = 0.001. bRFS = biochemical recurrence free survival; iECE = extracapsular extension on MRI; MRI: magnetic resonance imaging; Nb MRI lesions = number of MRI lesions; GG on TB = grade group on targeted biopsies; PI-RADS: prostate imaging and reporting and data system.
Figure 2
Figure 2
Imaging-based risk classification; bRFS: biochemical recurrence free survival.
See this image and copyright information in PMC

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