Impact of Magnetic Resonance Imaging on Prostate Cancer Staging and European Association of Urology Risk Classification

Draulans, Cédric; Everaerts, Wouter; Isebaert, Sofie; Gevaert, Thomas; Oyen, Raymond; Joniau, Steven; Lerut, Evelyne; Wever, Liesbeth De; Weynand, Birgit; Vanhoutte, Els K.; Meerleer, Gert De; Haustermans, Karin

doi:10.1016/j.urology.2019.04.023

Cited by 23 publications

(18 citation statements)

References 30 publications

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“…A comparison of or incorporation into commonly used clinical risk stratification tools such as the Partin tables and MSKCC nomogram that rely on clinical parameters and biopsy results was performed in ten studies [19,21,23,27,30,33,45,78,88,89]. All but two reported better performance for imaging techniques (mostly MRI), although external validation is pending [19,21,23,27,30,33,45,78,88,89]. Highest accuracy was achieved when imaging was incorporated into existing models.…”

Section: Comparisons and Clinical Risk Toolsmentioning

confidence: 99%

The Role of Magnetic Resonance Imaging and Positron Emission Tomography/Computed Tomography in the Primary Staging of Newly Diagnosed Prostate Cancer: A Systematic Review of the Literature

Abrams-Pompe

Fanti

Schoots

et al. 2021

European Urology Oncology

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Section: Comparisons and Clinical Risk Toolsmentioning

confidence: 99%

The Role of Magnetic Resonance Imaging and Positron Emission Tomography/Computed Tomography in the Primary Staging of Newly Diagnosed Prostate Cancer: A Systematic Review of the Literature

Abrams-Pompe

Fanti

Schoots

et al. 2021

European Urology Oncology

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“…Draulans et al revealed that the use of MRI images instead of DRE upstaged clinical T stage (33%) and European Association of Urology (EAU) risk grouping (31%). 13 MRI showed a higher sensitivity than did DRE for detection of non-organ-con ned PC (59 vs 41%, p< 0.01) in terms of corresponding pathologic T stage, and furthermore, with incorporation of MRI instead of DRE staging alone, the surgical treatment strategy would be altered in 27% of patients. In other words, DRE or transrectal ultrasonography (TRUS) alone is not accurate enough for local staging (T stage), and MRI is still one of the best imaging tools for assessing ECE in clinical practice.…”

Section: Discussionmentioning

confidence: 98%

Clinical Outcomes in Locally Advanced Prostate Cancer Between Radical Prostatectomy and Radiotherapy With Androgen Deprivation Therapy: A Propensity Score-matched Analysis

Huang

Cheng

et al. 2021

Preprint

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To compare clinical outcomes between the use of robotic-assisted laparoscopic radical prostatectomy (RP) and radiotherapy (RT) with long-term androgen deprivation therapy (ADT) in locally advanced prostate cancer (PC), we enrolled 315 patients with locally advanced PC (clinical T-stage 3/4). Propensity score-matching at a 1:1 ratio was performed. The median follow-up period was 59.2 months (IQR: 39.8-87.4). There were 117 (37.1%) patients in the RP group and 198 (62.9%) patients in the RT group. RT patients were older and had higher PSA at diagnosis, higher Gleason score grade group and more advanced T-stage (all p<0.001). After propensity score-matching, there were 68 patients in each group. Among locally advanced PC patients, treatment with RP had a higher risk of biochemical recurrence compared to the RT group. In multivariate Cox regression analysis, treatment with RT plus ADT significantly decreased the risk of biochemical failure (HR: 0.162, p<0.001), but there was no significant difference in local recurrence, distant metastasis and overall survival (p=0.470, p=0.268 and p=0.509, respectively). This information may provide insight for clinicians and patients for decision-making regarding their preference for either treatment strategy.

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“…Previous studies have often compared stage only i.e. between digital rectal examination with MRI and also confined their work in men undergoing radical prostatectomy [ 41 , 42 ]. This we believe introduces a cohort selection bias in that these men often have lower disease burdens and are less likely to have clinically palpable tumours.…”

Section: Discussionmentioning

confidence: 99%

Assessing the impact of MRI based diagnostics on pre-treatment disease classification and prognostic model performance in men diagnosed with new prostate cancer from an unscreened population

et al. 2022

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Introduction Pre-treatment risk and prognostic groups are the cornerstone for deciding management in non-metastatic prostate cancer. All however, were developed in the pre-MRI era. Here we compared categorisation of cancers using either only clinical parameters or with MRI enhanced information in men referred for suspected prostate cancer from an unscreened population. Patient and methods Data from men referred from primary care to our diagnostic service and with both clinical (digital rectal examination [DRE] and systematic biopsies) and MRI enhanced attributes (MRI stage and combined systematic/targeted biopsies) were used for this study. Clinical vs MRI data were contrasted for clinico-pathological and risk group re-distribution using the European Association of Urology (EAU), American Urological Association (AUA) and UK National Institute for Health Care Excellence (NICE) Cambridge Prognostic Group (CPG) models. Differences were retrofitted to a population cohort with long-term prostate cancer mortality (PCM) outcomes to simulate impact on model performance. We further contrasted individualised overall survival (OS) predictions using the Predict Prostate algorithm. Results Data from 370 men were included (median age 66y). Pre-biopsy MRI stage reassignments occurred in 7.8% (versus DRE). Image-guided biopsies increased Grade Group 2 and ≥ Grade Group 3 assignments in 2.7% and 2.9% respectively. The main change in risk groups was more high-risk cancers (6.2% increase in the EAU and AUA system, 4.3% increase in CPG4 and 1.9% CPG5). When extrapolated to a historical population-based cohort (n = 10,139) the redistribution resulted in generally lower concordance indices for PCM. The 5-tier NICE-CPG system outperformed the 4-tier AUA and 3-tier EAU models (C Index 0.70 versus 0.65 and 0.64). Using an individualised prognostic model, changes in predicted OS were small (median difference 1% and 2% at 10- and 15-years’ respectively). Similarly, estimated treatment survival benefit changes were minimal (1% at both 10- and 15-years’ time frame). Conclusion MRI guided diagnostics does change pre-treatment risk groups assignments but the overall prognostic impact appears modest in men referred from unscreened populations. Particularly, when using more granular tiers or individualised prognostic models. Existing risk and prognostic models can continue to be used to counsel men about treatment option until long term survival outcomes are available.

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Impact of Magnetic Resonance Imaging on Prostate Cancer Staging and European Association of Urology Risk Classification

Cited by 23 publications

References 30 publications

The Role of Magnetic Resonance Imaging and Positron Emission Tomography/Computed Tomography in the Primary Staging of Newly Diagnosed Prostate Cancer: A Systematic Review of the Literature

The Role of Magnetic Resonance Imaging and Positron Emission Tomography/Computed Tomography in the Primary Staging of Newly Diagnosed Prostate Cancer: A Systematic Review of the Literature

Clinical Outcomes in Locally Advanced Prostate Cancer Between Radical Prostatectomy and Radiotherapy With Androgen Deprivation Therapy: A Propensity Score-matched Analysis

Assessing the impact of MRI based diagnostics on pre-treatment disease classification and prognostic model performance in men diagnosed with new prostate cancer from an unscreened population

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