Preoperative prediction of extra capsular extension on final specimen utilising mpMRI and PSA density: Results from a series of 1421 robotic sssisted radical prostatectomy specimens
BAUS ePoster online library. Quraishi M. 11/10/20; 304198; P9-12 Disclosure(s): Nil to declare
Mohammed Quraishi
Mohammed Quraishi
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Preoperative prediction of extra capsular extension on final specimen utilising mpMRI and PSA density: Results from a series of 1421 robotic sssisted radical prostatectomy specimens

Quraishi M1, Osman B1, Stanowski M2, Latif E2, Morrison I2, Kommu S2, Streeter E2, Eddy B2
1Eastbourne District General Hospital, United Kingdom, 2Kent & Canterbury Hospital, United Kingdom

Introduction:
Preoperative risk of Extra Capsular Extension (ECE) of prostate cancer is traditionally estimated based on parameters including PSA, core positivity on biopsy and clinical stage. ECE is associated with higher rates of biochemical recurrence and disease progression. Individualised risk assessment is therefore warranted preoperatively for better counselling and surgical planning of optimal oncological outcomes and possible nerve sparing. We aimed to assess the accuracy of mpMRI with PSA Density (PSAD) in predicting ECE on final histology.

Methods:
A retrospective review of 1,421 patients who had undergone a robotic assisted radical prostatectomy (RARP) during 2011-2018 was performed, the patients underwent a preoperative 1.5T or 3T mpMRI. PSA Density was calculated via presenting PSA value and TRUS volume at biopsy.

Results:
Our mpMRI had a Positive Predictive Value (PPV) of 74% and 65% and a Negative Predictive Value of 65% and 75% in diagnosing pT3 and pT2 respectively on final specimen. Specificity of mpMRI for ECE was found to be 85%. MpMRI identified pT3 was downgraded to pT2 and upgraded to pT4 in 24% and 1.4% of cases respectively on final histology specimen. A higher PSAD (PSAD>0.23) is associated with a likely understaged pT3 disease on mpMRI or a higher likelihood of ECE on final histology (p<0.01).

Conclusion:
Our study highlights the crucial role of mpMRI in individualised preoperative surgical planning and patient counselling for non-nerve sparing RARP, by enabling accurate predicting of ECE. PSAD can be utilised in conjunction with mpMRI to create a model to enable more accurate prediction of ECE.
Preoperative prediction of extra capsular extension on final specimen utilising mpMRI and PSA density: Results from a series of 1421 robotic sssisted radical prostatectomy specimens

Quraishi M1, Osman B1, Stanowski M2, Latif E2, Morrison I2, Kommu S2, Streeter E2, Eddy B2
1Eastbourne District General Hospital, United Kingdom, 2Kent & Canterbury Hospital, United Kingdom

Introduction:
Preoperative risk of Extra Capsular Extension (ECE) of prostate cancer is traditionally estimated based on parameters including PSA, core positivity on biopsy and clinical stage. ECE is associated with higher rates of biochemical recurrence and disease progression. Individualised risk assessment is therefore warranted preoperatively for better counselling and surgical planning of optimal oncological outcomes and possible nerve sparing. We aimed to assess the accuracy of mpMRI with PSA Density (PSAD) in predicting ECE on final histology.

Methods:
A retrospective review of 1,421 patients who had undergone a robotic assisted radical prostatectomy (RARP) during 2011-2018 was performed, the patients underwent a preoperative 1.5T or 3T mpMRI. PSA Density was calculated via presenting PSA value and TRUS volume at biopsy.

Results:
Our mpMRI had a Positive Predictive Value (PPV) of 74% and 65% and a Negative Predictive Value of 65% and 75% in diagnosing pT3 and pT2 respectively on final specimen. Specificity of mpMRI for ECE was found to be 85%. MpMRI identified pT3 was downgraded to pT2 and upgraded to pT4 in 24% and 1.4% of cases respectively on final histology specimen. A higher PSAD (PSAD>0.23) is associated with a likely understaged pT3 disease on mpMRI or a higher likelihood of ECE on final histology (p<0.01).

Conclusion:
Our study highlights the crucial role of mpMRI in individualised preoperative surgical planning and patient counselling for non-nerve sparing RARP, by enabling accurate predicting of ECE. PSAD can be utilised in conjunction with mpMRI to create a model to enable more accurate prediction of ECE.
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