Selecting patients with intermediate-risk prostate cancer for active surveillance: Does MRI have a role?
BAUS ePoster online library. Stonier T. 11/10/20; 304177; P10-1 Disclosure(s): This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748. Support for T. Stonier is provided by the Fulbright Scholarship/The Urology Foundation (TUF). Support for G. Jibara is provided by NIH/NCI T32 CA82088.
Mr. Thomas Stonier
Mr. Thomas Stonier
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Selecting patients with intermediate-risk prostate cancer for active surveillance: Does MRI have a role?

Stonier T1,2, Tin A3, Jibara G2, Vickers A3, Fine S2, Vargas H2, Eastham J2
1Department of Urology, St. George's Hospital, London, United Kingdom, 2Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, USA, 3Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA

Introduction:
Selecting which ISUP GG2 patients can be safely managed with active surveillance (AS) remains controversial. The aims of this study are to evaluate the association of MRI score with adverse pathology at final prostatectomy, which could help identify patients that may be higher risk for AS.

Patients and Methods:
We undertook a retrospective cohort study at our institution, identifying 1117 patients with favourable intermediate risk disease (Gleason 3+4, PSA≤10ng/ml, stage≤T3a, <50% positive cores) who underwent RARP between 2010-2019. We defined a multivariable logistic regression model with adverse pathology (upstaging to T3a/b disease, upgrading ≥GG3 or lymph node invasion) as the outcome, MRI score as the predictor, and included risk of organ confined disease using a nomogram which incorporated preoperative PSA, Gleason grade, clinical stage, number of negative cores, and number of positive cores. Secondary outcomes of biochemical recurrence and upgrading alone were also investigated.

Results:
70% of patients had a positive MRI (equivalent to PIRADS score 4/5). 11% of patients were upgraded and 35% had adverse pathology on final specimen. A positive MRI was associated with higher rates of adverse pathology (OR 2.44, p<0.0001), upgrading (3.89, p<0.0001) and biochemical recurrence after RARP (HR 1.62, p=0.075) at a median follow-up of 2.2yrs (IQR 1.3-4.2yrs), when compared to the reference group of patients with a PIRADS score 3.

Conclusions:
In patients with favourable ISUP GG2 PCa who are potential AS candidates, higher PIRADS score on MRI is associated with an increased risk of aggressive pathological features on prostatectomy specimens.
Selecting patients with intermediate-risk prostate cancer for active surveillance: Does MRI have a role?

Stonier T1,2, Tin A3, Jibara G2, Vickers A3, Fine S2, Vargas H2, Eastham J2
1Department of Urology, St. George's Hospital, London, United Kingdom, 2Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, USA, 3Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA

Introduction:
Selecting which ISUP GG2 patients can be safely managed with active surveillance (AS) remains controversial. The aims of this study are to evaluate the association of MRI score with adverse pathology at final prostatectomy, which could help identify patients that may be higher risk for AS.

Patients and Methods:
We undertook a retrospective cohort study at our institution, identifying 1117 patients with favourable intermediate risk disease (Gleason 3+4, PSA≤10ng/ml, stage≤T3a, <50% positive cores) who underwent RARP between 2010-2019. We defined a multivariable logistic regression model with adverse pathology (upstaging to T3a/b disease, upgrading ≥GG3 or lymph node invasion) as the outcome, MRI score as the predictor, and included risk of organ confined disease using a nomogram which incorporated preoperative PSA, Gleason grade, clinical stage, number of negative cores, and number of positive cores. Secondary outcomes of biochemical recurrence and upgrading alone were also investigated.

Results:
70% of patients had a positive MRI (equivalent to PIRADS score 4/5). 11% of patients were upgraded and 35% had adverse pathology on final specimen. A positive MRI was associated with higher rates of adverse pathology (OR 2.44, p<0.0001), upgrading (3.89, p<0.0001) and biochemical recurrence after RARP (HR 1.62, p=0.075) at a median follow-up of 2.2yrs (IQR 1.3-4.2yrs), when compared to the reference group of patients with a PIRADS score 3.

Conclusions:
In patients with favourable ISUP GG2 PCa who are potential AS candidates, higher PIRADS score on MRI is associated with an increased risk of aggressive pathological features on prostatectomy specimens.
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