Prostate MRI added to CAPRA, MSKCC and Partin cancer nomograms significantly enhances the prediction of adverse findings and biochemical recurrence after radical prostatectomy

Abstract

Background To determine the added value of preoperative prostate multiparametric MRI (mpMRI) supplementary to clinical variables and their role in predicting post prostatectomy adverse findings and biochemically recurrent cancer (BCR). Methods All consecutive patients treated at HUS Helsinki University Hospital with robot assisted radical prostatectomy (RALP) between 2014 and 2015 were included in the analysis. The mpMRI data, clinical variables, histopathological characteristics, and follow-up information were collected. Study end-points were adverse RALP findings: extraprostatic extension, seminal vesicle invasion, lymph node involvement, and BCR. The Memorial Sloan Kettering Cancer Center (MSKCC) nomogram, Cancer of the Prostate Risk Assessment (CAPRA) score and the Partin score were combined with any adverse findings at mpMRI. Predictive accuracy for adverse RALP findings by the regression models was estimated before and after the addition of MRI results. Logistic regression, area under curve (AUC), decision curve analyses, Kaplan-Meier survival curves and Cox proportional hazard models were used. Results Preoperative mpMRI data from 387 patients were available for analysis. Clinical variables alone, MSKCC nomogram or Partin tables were outperformed by models with mpMRI for

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

“…A number of groups are now also exploring using MRI in screening trials although at this juncture it is unclear if MRI will pass the Wilson and Jungner criteria to reduce mortality or perhaps only in helping reduce the harms of screening [27,28]. At a more immediate level MRI is being proposed as a useful adjunct to risk stratification in decision making albeit with surrogate markers of outcome such as adverse pathology, biochemical relapse free survival or progression rates on Active Surveillance [29][30][31][32]. In contrast there is uncertainty on whether MRI will actually improve long-term survival outcomes [10,13,33].Modelling studies so far have found little evidence for this and MRI may in fact contribute to over-diagnosis and over-treatment [10].…”

Added value of shear-wave elastography in the prediction of extracapsular extension and seminal vesicle invasion before radical prostatectomy

“…Several studies have proven the added value of mp-MRI and MRI-targeted Bx in the prediction of ECE and SVI before RP. 2 , 22 , 26 Sandeman et al . 22 reported that adding mp-MRI parameters to the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram and Partin tables can further improve the prediction efficiency of these models for any adverse finding at RP and increase AUCs from 0.71 to 0.78 and from 0.62 to 0.73, respectively.…”

“… 21 The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were then derived according to the threshold. Based on the parameters used in previous studies, 2 , 22 univariate analysis was performed first to select associated factors with P < 0.05. Then, binary logistic regression (LR) analysis was performed, and independent variables were selected using the forward LR method for the regression model.…”

Integrating magnetic resonance imaging and prostate‐specific membrane antigen positron emission tomography/computed tomography results into prostate cancer treatment decision making

“…The study by Meijer et al [1] adds to a growing body of evidence that local staging of prostate cancer with MRI is clinically important, particularly when seminal vesicle invasion is found [2][3][4]. The current TNM classification is clearly at odds with this evidence as it states that MRI findings should not be used for local (T) staging [5].…”