Added Value of Multiparametric Magnetic Resonance Imaging to Clinical Nomograms for Predicting Adverse Pathology in Prostate Cancer

No AccessJournal of UrologyAdult Urology1 Nov 2018Added Value of Multiparametric Magnetic Resonance Imaging to Clinical Nomograms for Predicting Adverse Pathology in Prostate Cancer Kareem N. Rayn, Jonathan B. Bloom, Samuel A. Gold, Graham R. Hale, Joseph A. Baiocco, Sherif Mehralivand, Marcin Czarniecki, Vikram K. Sabarwal, Vladimir Valera, Bradford J. Wood, Maria J. Merino, Peter Choyke, Baris Turkbey, and Peter A. Pinto Kareem N. RaynKareem N. Rayn Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Jonathan B. BloomJonathan B. Bloom Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Samuel A. GoldSamuel A. Gold Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Graham R. HaleGraham R. Hale Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Joseph A. BaioccoJoseph A. Baiocco Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Sherif MehralivandSherif Mehralivand Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Department of Urology and Pediatric Urology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany , Marcin CzarnieckiMarcin Czarniecki Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Vikram K. SabarwalVikram K. Sabarwal Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Vladimir ValeraVladimir Valera Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Bradford J. WoodBradford J. Wood Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Maria J. MerinoMaria J. Merino Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Peter ChoykePeter Choyke Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Baris TurkbeyBaris Turkbey Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , and Peter A. PintoPeter A. Pinto Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland View All Author Informationhttps://doi.org/10.1016/j.juro.2018.05.094AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We examined the additional value of preoperative prostate multiparametric magnetic resonance imaging and transrectal ultrasound/multiparametric magnetic resonance imaging fusion guided targeted biopsy when performed in combination with clinical nomograms to predict adverse pathology at radical prostatectomy. Materials and Methods: We identified all patients who underwent 3 Tesla multiparametric magnetic resonance imaging prior to fusion biopsy and radical prostatectomy. The Partin and the MSKCC (Memorial Sloan Kettering Cancer Center) preradical prostatectomy nomograms were applied to estimate the probability of organ confined disease, extraprostatic extension, seminal vesicle invasion and lymph node involvement using transrectal ultrasound guided systematic biopsy and transrectal ultrasound/multiparametric magnetic resonance imaging fusion guided targeted biopsy Gleason scores. With radical prostatectomy pathology as the gold standard we developed multivariable logistic regression models based on these nomograms before and after adding multiparametric magnetic resonance imaging to assess any additional predictive ability. Results: A total of 532 patients were included in study. When multiparametric magnetic resonance imaging findings were added to the systematic biopsy based MSKCC nomogram, the AUC increased by 0.10 for organ confined disease (p <0.001), 0.10 for extraprostatic extension (p = 0.003), 0.09 for seminal vesicle invasion (p = 0.011) and 0.06 for lymph node involvement (p = 0.120). Using Gleason scores derived from targeted biopsy compared to systematic biopsy provided an additional predictive value of organ confined disease (Δ AUC 0.07, p = 0.003) and extraprostatic extension (Δ AUC 0.07, p = 0.048) at radical prostatectomy with the MSKCC nomogram. Similar results were obtained using the Partin nomogram. Conclusions: Magnetic resonance imaging alone or in addition to standard clinical nomograms provides significant additional predictive ability of adverse pathology at the time of radical prostatectomy. 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Volume 200Issue 5November 2018Page: 1041-1047Supplementary Materials Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.Keywordsprostatic neoplasmsimage-guided biopsyprostatectomyrisk assessmentnomogramsMetricsAuthor Information Kareem N. Rayn Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Jonathan B. Bloom Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Samuel A. Gold Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Graham R. Hale Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Joseph A. Baiocco Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Sherif Mehralivand Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Department of Urology and Pediatric Urology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany More articles by this author Marcin Czarniecki Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Vikram K. Sabarwal Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Vladimir Valera Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Bradford J. Wood Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Financial interest and/or other relationship with Philips InVivo and National Institutes of Health Cooperative Research and Development Agreement. More articles by this author Maria J. Merino Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Peter Choyke Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Baris Turkbey Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Peter A. Pinto Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Expand All Advertisement PDF downloadLoading ...