MRI-detectability of clinically significant prostate cancer relates to oncologic outcomes after prostatectomy Journal Article

   


Authors: Wibmer, A. G.; Lefkowitz, R. A.; Lakhman, Y.; Chaim, J.; Nikolovski, I.; Sala, E.; Fine, S. W.; Donahue, T. F.; Kattan, M. W.; Hricak, H.; Vargas, H. A.
Article Title: MRI-detectability of clinically significant prostate cancer relates to oncologic outcomes after prostatectomy
Abstract: Introduction/Background: Magnetic resonance imaging (MRI) misses a proportion of “clinically significant” prostate cancers (csPC) as defined by histopathology criteria. The aim of this study was to analyze whether long-term oncologic outcomes differ between MRI-detectable and MRI-occult csPC. Patients and Methods: Retrospective analysis of 1449 patients with pre-prostatectomy MRI and csPC on prostatectomy specimens (ie, Grade group ≥2 or extraprostatic spread) between 2001-2006. T2-weighted MRIs were classified according to the Prostate Imaging Reporting and Data System into MRI-occult (categories 1, 2), MRI-equivocal (category 3), and MRI-detectable (categories 4, 5). Cumulative incidence of biochemical recurrence (BCR), metastatic disease, and cancer-specific mortality, estimated with competing risk models. The median follow-up in survivors was 11.0 years (IQR: 8.9-13.1). Results: In 188 (13%) cases, csPC was MRI-occult, 435 (30%) MRIs were equivocal, and 826 (57%) csPC were MRI-detectable. The 15-year cumulative incidence [95% CI] of BCR was 8.3% [2.2, 19.5] for MRI-occult cases, 17.4% [11.1, 24.8] for MRI-equivocal cases, and 43.3% [38.7, 47.8] for MRI-detectable cases (P < .001). The cumulative incidences of metastases were 0.61% [0.06, 3.1], 3.5% [1.5, 6.9], and 19.6% [15.4, 24.2] for MRI-occult, MRI-equivocal, and MRI-detectable cases, respectively (P < .001). There were no deaths from prostate cancer observed in patients with MRI-occult csPC, compared to an estimated 1.9% [0.54, 4.9], and 7.1 % [4.5, 10.6] for patients with MRI-equivocal and MRI-detectable cancer, respectively (P < .001). Conclusion: Oncologic outcomes after prostatectomy for csPC differ between MRI-occult and MRI-detectable lesions. Judging the clinical significance of a negative prostate MRI based on histopathologic surrogates alone might be misleading. Among 1449 patients with pre-prostatectomy MRI and clinically significant prostate cancer on prostatectomy histopathology, MRI-occult cancers (n = 188, 13%) were less likely to recur biochemically (8% vs. 43%, P < .001), metastasize (0.6% vs. 20%, P < .001), or lead to prostate cancer mortality (0% vs. 7%, P < .001) than MRI-detectable cancers (n = 826, 57%). MRI-occult cancers constitute a prognostically distinct subgroup among higher-grade prostate cancers. © 2022
Keywords: magnetic resonance imaging; prostate cancer; prostatectomy; biochemical recurrence; metastatic disease; prognosis; cancer specific mortality
Journal Title: Clinical Genitourinary Cancer
Volume: 20
Issue: 4
ISSN: 1558-7673
Publisher: Elsevier Inc.  
Date Published: 2022-08-01
Start Page: 319
End Page: 325
Language: English
DOI: 10.1016/j.clgc.2022.04.001
PUBMED: 35618599
PROVIDER: scopus
PMCID: PMC10191247
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85131047554&doi=10.1016%2fj.clgc.2022.04.001&partnerID=40&md5=20a06f21613fcdd0b5f14c6b74d3ff4a
Notes: Article -- Export Date: 1 August 2022 -- Source: Scopus
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MSK Authors
  1. Joshua Chaim
    40 Chaim
  2. Yuliya Lakhman
    95 Lakhman
  3. Evis Sala
    113 Sala
  4. Robert Lefkowitz
    78 Lefkowitz
  5. Hedvig Hricak
    419 Hricak
  6. Hebert Alberto Vargas Alvarez
    267 Vargas Alvarez
  7. Samson W Fine
    462 Fine
  8. Timothy Francis Donahue
    72 Donahue
  9. Andreas Georg Wibmer
    53 Wibmer
  10. Ines Nikolovski
    22 Nikolovski
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