Pathological and 3 Tesla Volumetric Magnetic Resonance Imaging Predictors of Biochemical Recurrence after Robotic Assisted Radical Prostatectomy: Correlation with Whole Mount Histopathology

No AccessJournal of UrologyAdult Urology1 May 2018Pathological and 3 Tesla Volumetric Magnetic Resonance Imaging Predictors of Biochemical Recurrence after Robotic Assisted Radical Prostatectomy: Correlation with Whole Mount Histopathology Nelly Tan, Luyao Shen, Pooria Khoshnoodi, Héctor E. Alcalá, Weixia Yu, William Hsu, Robert E. Reiter, David Y. Lu, and Steven S. Raman Nelly TanNelly Tan School of Medicine University of California-Riverside, Riverside, California Department of Radiology, Loma Linda University, Loma Linda, California , Luyao ShenLuyao Shen Department of Radiological Sciences, University of California-Los Angeles, Los Angeles, California , Pooria KhoshnoodiPooria Khoshnoodi Department of Radiological Sciences, University of California-Los Angeles, Los Angeles, California , Héctor E. AlcaláHéctor E. Alcalá Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, New York , Weixia YuWeixia Yu Computing Technology Research Laboratory, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California , William HsuWilliam Hsu Department of Radiology, Loma Linda University, Loma Linda, California , Robert E. ReiterRobert E. Reiter Department of Urology, University of California-Los Angeles, Los Angeles, California , David Y. LuDavid Y. Lu Department of Pathology, University of California-Los Angeles, Los Angeles, California , and Steven S. RamanSteven S. Raman Department of Radiology, Loma Linda University, Loma Linda, California View All Author Informationhttps://doi.org/10.1016/j.juro.2017.10.042AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We sought to identify the clinical and magnetic resonance imaging variables predictive of biochemical recurrence after robotic assisted radical prostatectomy in patients who underwent multiparametric 3 Tesla prostate magnetic resonance imaging. Materials and Methods: We performed an institutional review board approved, HIPAA (Health Insurance Portability and Accountability Act) compliant, single arm observational study of 3 Tesla multiparametric magnetic resonance imaging prior to robotic assisted radical prostatectomy from December 2009 to March 2016. Clinical, magnetic resonance imaging and pathological information, and clinical outcomes were compiled. Biochemical recurrence was defined as prostate specific antigen 0.2 ng/cc or greater. Univariate and multivariate regression analysis was performed. Results: Biochemical recurrence had developed in 62 of the 255 men (24.3%) included in the study at a median followup of 23.5 months. Compared to the subcohort without biochemical recurrence the subcohort with biochemical recurrence had a greater proportion of patients with a high grade biopsy Gleason score, higher preoperative prostate specific antigen (7.4 vs 5.6 ng/ml), intermediate and high D'Amico classifications, larger tumor volume on magnetic resonance imaging (0.66 vs 0.30 ml), higher PI-RADS® (Prostate Imaging-Reporting and Data System) version 2 category lesions, a greater proportion of intermediate and high grade radical prostatectomy Gleason score lesions, higher pathological T3 stage (all p <0.01) and a higher positive surgical margin rate (19.3% vs 7.8%, p = 0.016). On multivariable analysis only tumor volume on magnetic resonance imaging (adjusted OR 1.57, p = 0.016), pathological T stage (adjusted OR 2.26, p = 0.02), positive surgical margin (adjusted OR 5.0, p = 0.004) and radical prostatectomy Gleason score (adjusted OR 2.29, p = 0.004) predicted biochemical recurrence. Conclusions: In this cohort tumor volume on magnetic resonance imaging and pathological variables, including Gleason score, staging and positive surgical margins, significantly predicted biochemical recurrence. This suggests an important new imaging biomarker. References 1 : United States Cancer Statistics: 1999–2014 Incidence and Mortality Web-based Report. Atlanta: United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute2017. Google Scholar 2 : Natural history of progression after PSA elevation following radical prostatectomy. JAMA1999; 281: 1591. Crossref, Medline, Google Scholar 3 : Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol2003; 169: 517. Link, Google Scholar 4 : International validation of a preoperative nomogram for prostate cancer recurrence after radical prostatectomy. J Clin Oncol2002; 20: 3206. Google Scholar 5 : Preoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Natl Cancer Inst2006; 98: 715. Google Scholar 6 : Magnetic resonance imaging for predicting prostate biopsy findings in patients considered for active surveillance of clinically low risk prostate cancer. J Urol2012; 188: 1732. Link, Google Scholar 7 : Multiparametric magnetic resonance imaging guided diagnostic biopsy detects significant prostate cancer and could reduce unnecessary biopsies and over detection: a prospective study. J Urol2014; 192: 67. Link, Google Scholar 8 : In-bore 3-T MR-guided transrectal targeted prostate biopsy: Prostate Imaging Reporting and Data System Version 2-based diagnostic performance for detection of prostate cancer. Radiology2017; 283: 130. Google Scholar 9 : Comparison of prostate volume measured by endorectal coil MRI to prostate specimen volume and mass after radical prostatectomy. Acad Radiol2015; 22: 556. Google Scholar 10 : Prostate cancer: role of pretreatment multiparametric 3-T MRI in predicting biochemical recurrence after radical prostatectomy. AJR Am J Roentgenol2014; 202: W459. Google Scholar 11 : Tumor contact with prostate capsule on magnetic resonance imaging: a potential biomarker for staging and prognosis. Urol Oncol2017; 35: 30.e1. Google Scholar 12 : Magnetic resonance imaging in the prediction of biochemical recurrence of prostate cancer after radical prostatectomy. BJU Int2009; 104: 315. Google Scholar 13 : Updated prostate imaging reporting and data system (PIRADS v2) recommendations for the detection of clinically significant prostate cancer using multiparametric MRI: critical evaluation using whole-mount pathology as standard of reference. Eur Radiol2016; 26: 1606. Google Scholar 14 : Nomogram predicting the probability of early recurrence after radical prostatectomy for prostate cancer. J Urol2009; 181: 601. Link, Google Scholar 15 : Endorectal magnetic resonance imaging as a predictor of biochemical outcome after radical prostatectomy in men with clinically localized prostate cancer. J Urol2000; 164: 759. Link, Google Scholar 16 : Prediction of biochemical recurrence following radical prostatectomy in men with prostate cancer by diffusion-weighted magnetic resonance imaging: initial results. Eur Radiol2011; 21: 1111. Google Scholar 17 : Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA1998; 280: 969. Google Scholar 18 : Prostate cancer: utility of whole-lesion apparent diffusion coefficient metrics for prediction of biochemical recurrence after radical prostatectomy. AJR Am J Roentgenol2015; 205: 1208. Google Scholar 19 : Fully automated prostate segmentation on MRI: comparison with manual segmentation methods and specimen volumes. AJR Am J Roentgenol2013; 201: W720. Google Scholar 20 : Impact of Gleason subtype on prostate cancer detection using multiparametric magnetic resonance imaging: correlation with final histopathology. J Urol2018; 198: 316. Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byRajwa P, Mori K, Huebner N, Martin D, Sprenkle P, Weinreb J, Ploussard G, Pradere B, Shariat S and Leapman M (2021) The Prognostic Association of Prostate MRI PI-RADS™ v2 Assessment Category and Risk of Biochemical Recurrence after Definitive Local Therapy for Prostate Cancer: A Systematic Review and Meta-AnalysisJournal of Urology, VOL. 206, NO. 3, (507-516), Online publication date: 1-Sep-2021.Faiena I, Salmasi A, Mendhiratta N, Markovic D, Ahuja P, Hsu W, Elashoff D, Raman S and Reiter R (2018) PI-RADS Version 2 Category on 3 Tesla Multiparametric Prostate Magnetic Resonance Imaging Predicts Oncologic Outcomes in Gleason 3 + 4 Prostate Cancer on BiopsyJournal of Urology, VOL. 201, NO. 1, (91-97), Online publication date: 1-Jan-2019. Volume 199Issue 5May 2018Page: 1218-1223 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.Keywordsbiomarkerstumorprostate specific antigenlocalprostatic neoplasmsmagnetic resonance imagingneoplasm recurrenceMetricsAuthor Information Nelly Tan School of Medicine University of California-Riverside, Riverside, California Department of Radiology, Loma Linda University, Loma Linda, California Equal study contribution. More articles by this author Luyao Shen Department of Radiological Sciences, University of California-Los Angeles, Los Angeles, California Equal study contribution. More articles by this author Pooria Khoshnoodi Department of Radiological Sciences, University of California-Los Angeles, Los Angeles, California More articles by this author Héctor E. Alcalá Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, New York More articles by this author Weixia Yu Computing Technology Research Laboratory, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California More articles by this author William Hsu Department of Radiology, Loma Linda University, Loma Linda, California More articles by this author Robert E. Reiter Department of Urology, University of California-Los Angeles, Los Angeles, California More articles by this author David Y. Lu Department of Pathology, University of California-Los Angeles, Los Angeles, California More articles by this author Steven S. Raman Department of Radiology, Loma Linda University, Loma Linda, California More articles by this author Expand All Advertisement PDF downloadLoading ...