MRI staging before prostatectomy for prostate cancer can predict risk of recurrence
An Original Research on Genitourinary Imaging published in the American Journal of Roentgenology on July 5, 2023, entitled, "Comparison of MRI-Based Staging and Pathologic Staging for Predicting Biochemical Recurrence of Prostate Cancer After Radical Prostatectomy” by Dr Katie and colleagues mentioned that MRI could determine the risk of prostate cancer recurrence before a patient undergoes surgery. This is a clinically valuable insight drawn by researchers from this study, as MRI staging can identify high biochemical recurrence risk and guide patients in early clinical decision-making.
Most clinical models predict biochemical recurrence (BCR) following radical prostatectomy (RP) and incorporate staging information from RP specimens. This creates a gap in risk assessment pre-operatively.
The primary purpose of the present study was to compare the utility of pre-surgical staging information from MRI and post-surgical staging information from RP pathology in predicting BCR in patients with PCa.
The summary pointers are:
- There were 604 patients with a median age of 60 years and a PCa history.
- These underwent prostate MRI before RP (June 2007 - December 2018).
- During clinical interpretations, a single genitourinary radiologist assessed MRI examinations for extraprostatic extension (EPE) and seminal vesicle invasion (SVI).
- Researchers assessed the Utility of extraprostatic extension or EPE and SVI on MRI and RP pathology for BCR prediction.
- The biochemical recurrence prediction models like the University of California San Francisco Cancer of the Prostate Risk Assessment or CAPRA and CAPRA-S were used; these were pre and post-surgical assessment tools.
- Univariable predictors of BCR included EPE on MRI, SVI on MRI, EPE on RP pathology, and SVI on RP pathology, with hazard ratios of 3.6, 4.4, 5.0, and 4.6, respectively.
- Three-year BCR-free survival (RFS) rates for patients without versus with EPE were 84% versus 59% for MRI, and 89% versus 58% for RP pathology, and for patients without versus with SVI were 82% versus 50% for MRI and 83% versus 54% for RP histology.
- For patients with T3 disease on RP pathology, 3-year RFS rates were 67% and 41% for patients without and with T3 disease on MRI. AUCs of CAPRA models, including CAPRA-MRI models, ranged from 0.743 to 0.778. AUCs were not significantly different between CAPRA-S and CAPRA-MRI models (P>.05). RFS rates were significantly different between low and intermediate-risk groups for only CAPRA-MRI models (80% vs 51% and 74% vs 44%: both P<.001).
They said Pre-surgical MRI-based staging features perform comparably to post-surgical pathologic staging features for predicting BCR.
MRI staging identifies patients at high BCR risk pre-operatively, they highlighted. This plays a crucial role in early clinical decision-making.
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