Mp74-12 Impact of Magnetic Resonance Imaging Scan and Image Acquisition Protocol in Detecting Clinically Significant Prostate Cancer at Biopsy: Results From the Promod Working Group

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You have accessJournal of UrologyProstate Cancer: Detection & Screening VI (MP74), Moderated Poster 741 May 2024MP74-12 IMPACT OF MAGNETIC RESONANCE IMAGING SCAN AND IMAGE ACQUISITION PROTOCOL IN DETECTING CLINICALLY SIGNIFICANT PROSTATE CANCER AT BIOPSY: RESULTS FROM THE PROMOD WORKING GROUP Antonio Fanelli, Marco Finati, Ugo Giovanni Falagario, Anna Lantz, Ivan Jambor, Luca Carmignani, Emanuele Montanari, Pierluigi Bove, Paolo Gontero, Alessandro Sciarra, Carlo Trombetta, Pierfrancesco Bassi, Giuseppe Simone, Vincenzo Mirone, Alessandro Antonelli, Luigi Schips, Gian Maria Busetto, Carlo Bettocchi, Mattero Ferro, Peter Bostrom, Tobias Nordstrom, Ottavio De Cobelli, Luigi Cormio, and Giuseppe Carrieri Antonio FanelliAntonio Fanelli , Marco FinatiMarco Finati , Ugo Giovanni FalagarioUgo Giovanni Falagario , Anna LantzAnna Lantz , Ivan JamborIvan Jambor , Luca CarmignaniLuca Carmignani , Emanuele MontanariEmanuele Montanari , Pierluigi BovePierluigi Bove , Paolo GonteroPaolo Gontero , Alessandro SciarraAlessandro Sciarra , Carlo TrombettaCarlo Trombetta , Pierfrancesco BassiPierfrancesco Bassi , Giuseppe SimoneGiuseppe Simone , Vincenzo MironeVincenzo Mirone , Alessandro AntonelliAlessandro Antonelli , Luigi SchipsLuigi Schips , Gian Maria BusettoGian Maria Busetto , Carlo BettocchiCarlo Bettocchi , Mattero FerroMattero Ferro , Peter BostromPeter Bostrom , Tobias NordstromTobias Nordstrom , Ottavio De CobelliOttavio De Cobelli , Luigi CormioLuigi Cormio , and Giuseppe CarrieriGiuseppe Carrieri View All Author Informationhttps://doi.org/10.1097/01.JU.0001008632.59099.b9.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Prostate Imaging Reporting and Data System (PI-RADS) steering committee does not provide uniform consensus regarding the optimal magnet strength for use in magnetic resonance imaging (MRI) of the prostate, although low-level evidence suggests a higher diagnostic performance of 3-T versus 1.5-T instruments for diagnosis of clinically significant prostate cancer (csPCa). Moreover, while biparametric MRI (bpMRI) results in an elimination of adverse events, shortened examination time and reduced costs, the comparability of its accuracy when compared to multiparametric MRI (mpMRI) is still debated. Our study aimed to assess the impact of magnet strength and protocol acquisition (bpMRI vs. mpMRI) used in prostate MRI in detecting csPCa. METHODS: The PROMOD working group included a retrospective multicentric cohort of patients who underwent prostate MRI and subsequent MRI-targeted systematic prostate biopsy in the case of positive findings at MRI, defined as PI-RADS ≥3 lesion. The endpoint of our analysis was the csPCa detection rate, defined as ISUP grade group ≥2. MRI accuracy for diagnosis of csPCa was compared by sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values, according to the magnet strength (3 T vs. 1.5 T) and acquisition protocol (bpMRI vs. mpMRI). Multivariable logistic regression was performed to evaluate predictors of csPCa. RESULTS: The median age of patients at diagnosis was 75 years (interquartile range=66-81 years); 388 patients were male (87.4%) At first TURBT, patients with T1b disease had larger tumors (>3 cm: 55.4% vs. 36.6%, p=0.003) when compared with those with T1a. At RE-TURBT, residual HG BC was found in 23% of T1a and 14.5% of T1b (p=0.1), while pathological upstaging (≥T2) was shown in 1.3% with T1a vs. 6.6% with T1b (p=0.04). At a median follow-up of 40 months (interquartile range=17-72 months), recurrence-free survival was 39.7% for the T1a group and 38.8% for the T1b group. Progression was observed in 27 (11.2%) and 21 (18.1%) patients with T1a and T1b disease (p=0.07). Cancer-specific survival was 83% and 75%, while cystectomy was performed in 16.5% versus 19%, respectively. Overall, patients with T1b disease had worse survival curves when compared to those with T1a, albeit this reached statistical significance only for PFS (p=0.01). At multivariable analyses, an adequate BCG course was an independent predictor for all outcomes evaluated (all p<0.01), while T1 substaging did not independently predict any endpoints evaluated. CONCLUSIONS: Extensive invasion of the lamina propria in primary T1 NMIBC was associated with poorer overall PFS and higher risk of upstaging to MIBC at RE-TURBT. Even if T1 substaging alone is suboptimal for predicting oncological outcomes of HG T1 NMIBC, its combination with other factors (lymphovascular invasion, multifocality, associated carcinoma in situ, no prior BCG treatment, >3 cm tumor size, and older age) may improve risk stratification and guide overall management disease. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1197 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Antonio Fanelli More articles by this author Marco Finati More articles by this author Ugo Giovanni Falagario More articles by this author Anna Lantz More articles by this author Ivan Jambor More articles by this author Luca Carmignani More articles by this author Emanuele Montanari More articles by this author Pierluigi Bove More articles by this author Paolo Gontero More articles by this author Alessandro Sciarra More articles by this author Carlo Trombetta More articles by this author Pierfrancesco Bassi More articles by this author Giuseppe Simone More articles by this author Vincenzo Mirone More articles by this author Alessandro Antonelli More articles by this author Luigi Schips More articles by this author Gian Maria Busetto More articles by this author Carlo Bettocchi More articles by this author Mattero Ferro More articles by this author Peter Bostrom More articles by this author Tobias Nordstrom More articles by this author Ottavio De Cobelli More articles by this author Luigi Cormio More articles by this author Giuseppe Carrieri More articles by this author Expand All Advertisement PDF downloadLoading ...