Multiparametric MRI is not sufficient for prostate cancer staging: A single institutional experience validated by a multi-institutional regional collaborative

Chandrasekar, Thenappan; Denisenko, Andrew; Mico, Vasil; McPartland, Connor; Shah, Yash; Mark, James Ryan; Lallas, Costas D.; Fonshell, Claudette; Danella, John; Jacobs, Bruce L.; Lanchoney, Thomas; Raman, Jay D.; Tomaszewski, Jeffrey J.; Reese, Adam; Singer, Eric A.; Ginzburg, Serge; Smaldone, Marc C.; Uzzo, Robert; Guzzo, Thomas J.; Trabulsi, Edouard J.

doi:10.1016/j.urolonc.2023.05.004

Cited by 5 publications

(4 citation statements)

References 26 publications

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“…Preoperative mpMRI is currently utilized for surgical planning, but studies have lacked reasonable accuracy in predicting organ-confined PCa. [20][21][22][23] de Rooij et al published a meta-analysis of 75 studies and found the EPE 0.57 sensitivity and 0.91 specificity. 6 Jansen et al reported on 430 patients undergoing mpMRI prior to prostatectomy and found a consistently low sensitivity rate (0.45).…”

Section: Discussionmentioning

confidence: 99%

Comparing Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen–Positron Emission Tomography for Prediction of Extraprostatic Extension of Prostate Cancer and Surgical Guidance: A Prospective Nonrandomized Clinical Trial

Bahler,

Tachibana,

Tann

et al. 2024

Journal of Urology

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Study Need and Importance: Advanced prostate imaging with MRI has greatly increased personalized medicine by shifting to a lesion-based approach. This lesion-based approach has enabled targeted biopsy and refinement of surgical plans for both focal therapy and radical prostatectomy. For radical prostatectomy, predicting extraprostatic extension (EPE) is critical to safely select men for nervesparing surgery and continence-sparing approaches such as Retzius sparing. However, enthusiasm for MRI has been tempered with real-world sensitivity for EPE near 60%. Prostate cancer is difficult to image with anatomy-based modalities (ultrasound, CT, MRI, etc). 68 Gaeprostate-specific membrane antigene11 positron emission tomography CT (PSMA-PET) offers the advantage of molecularly targeted tracers with high sensitivity for lesions likely to have EPE (Gleason 4D3). We hypothesized that PSMA-PET, when compared to MRI, would have increased sensitivity for EPE. What We Found: Fifty patients were prospectively enrolled, and the population was weighted toward EPE (44%) and high-risk with Gleason grade 3 D 4 (30%), 4 D 3 (30%), and 4 D 4/4 D 5 (38%). Radiologists knew patients were scheduling for prostatectomy, but they reviewed anonymized images with no clinicopathologic information (blinded). The sensitivity was higher for PSMA-PET when compared to MRI (86% vs 57%, P [ .03), while specificity was similar. The PSMA-PET changed the surgical plan from nonnerve sparing to nerve sparing in 20 (40%) cases and from nerve sparing to nonnerve sparing in 5 cases. The Figure demonstrates the ability of PSMA-PET to locate tumors near the prostate capsule at risk for EPE. The positive margin rate was not increased in patients with treatment change toward nerve-sparing. Limitations: This is a single-institution study with expert radiology interpretations. Imaging accuracy could vary based on the quality of PET scanner and experience of the radiologists. Interpretation for Patient Care: In this prospective trial, PSMA-PET resulted in higher sensitivity for EPE and increased the nerve-sparing rate during radical robotic prostatectomy without increasing positive margins.

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Section: Discussionmentioning

confidence: 99%

Comparing Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen–Positron Emission Tomography for Prediction of Extraprostatic Extension of Prostate Cancer and Surgical Guidance: A Prospective Nonrandomized Clinical Trial

Bahler,

Tachibana,

Tann

et al. 2024

Journal of Urology

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“…Nevertheless, not all upgraded and upstaged patients will experience disease progression ( 1 , 2 ). Accordingly, clinicians need predictors of PCa progression that are not represented by molecular biology, which is still far from daily routine, neither by multiparametric magnetic resonance imaging (mpMRI), which is not reproducible for being operator dependent ( 1 , 2 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

The 2012 Briganti nomogram not only predicts lymph node involvement but also disease progression in surgically treated intermediate-risk prostate cancer patients with PSA <10 ng/mL, ISUP grade group 3, and clinical stage up to cT2b

Porcaro,

Panunzio,

Orlando

et al. 2024

Int. braz j urol.

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“…However, while the former remains distant from routine clinical application, the latter currently faces challenges related to reproducibility. 1,2,[5][6][7] Within the context of the intermediate prognostic risk category, the consideration of potential pelvic lymph node invasion (PLNI) emerges as a notable concern. Tackling this issue involves relying on validated nomograms, with Briganti's 2012 nomogram being one of the most commonly utilized tools.…”

Section: Introductionmentioning

confidence: 99%

“…However, despite its prevalence, the prognostic impact of Briganti's 2012 nomogram has yet to undergo systematic testing. 1,2,5,6 Motivated by these considerations, our study seeks to explore and elucidate the potential prognostic impact of Briganti's 2012 nomogram in EAU intermediate-risk patients presenting with unfavorable tumor grade and undergoing treatment with RARP, potentially in conjunction with ePLND. Through this investigation, we aim to contribute valuable insights that may further refine the understanding of prognosis in this specific subset of prostate cancer patients.…”

Section: Introductionmentioning

confidence: 99%

2012 Briganti nomogram predict prostate cancer progression in EAU intermediate risk with unfavorable tumor grade: A single center experience

Porcaro,

Costantino,

Brancelli

et al. 2024

Urologia

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Background: To investigate the potential prognostic impact of Briganti’s 2012 nomogram in EAU intermediate-risk patients presenting with an unfavorable tumor grade and treated with robot-assisted radical prostatectomy, eventually associated with extended pelvic lymph node dissection. Materials and methods: From January 2013 to December 2021, the study included 179 EAU intermediate-risk patients presenting with an unfavorable tumor grade (ISUP 3), eventually associated with a PSA of 10–20 ng/ml and/or cT-2b. Briganti’s 2012 nomogram was assessed as both a continuous and dichotomous variable, categorized according to the median (risk score ⩾7% vs <7%). Disease progression, defined as biochemical recurrence and/or metastatic progression, was evaluated using Cox proportional hazards in both univariate and multivariate analyses. Results: Disease progression occurred in 43 (24%) patients after a median (95% CI) follow-up of 78 (65.7–88.4) months. The nomogram risk score predicted disease progression, evaluated both as a continuous variable (hazard ratio, HR = 1.064; 95% CI: 1.035–1.093; p < 0.0001) and as a categorical variable (HR = 3.399; 95% CI: 1.740–6.638; p < 0.0001). This association was confirmed in multivariate analysis, where hazard ratios remained consistent even after adjusting for clinical and pathological factors. Conclusions: In EAU intermediate-risk PCa cases presenting with an unfavorable tumor grade and treated surgically, Briganti’s 2012 nomogram was associated with disease progression after surgery. Consequently, as the nomogram risk score increased, patients were more likely to experience PCa progression, facilitating the stratification of the patient population into distinct prognostic subgroups.

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Multiparametric MRI is not sufficient for prostate cancer staging: A single institutional experience validated by a multi-institutional regional collaborative

Cited by 5 publications

References 26 publications

Comparing Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen–Positron Emission Tomography for Prediction of Extraprostatic Extension of Prostate Cancer and Surgical Guidance: A Prospective Nonrandomized Clinical Trial

Comparing Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen–Positron Emission Tomography for Prediction of Extraprostatic Extension of Prostate Cancer and Surgical Guidance: A Prospective Nonrandomized Clinical Trial

The 2012 Briganti nomogram not only predicts lymph node involvement but also disease progression in surgically treated intermediate-risk prostate cancer patients with PSA <10 ng/mL, ISUP grade group 3, and clinical stage up to cT2b

2012 Briganti nomogram predict prostate cancer progression in EAU intermediate risk with unfavorable tumor grade: A single center experience

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