MP18-15: The Impact of Magnetic Resonance Imaging-detected Zonal Location on Prostate Cancer Recurrence: Implications for Preoperative Risk Stratification
Friday, May 3, 2024 3:30 PM to 5:30 PM · 2 hr. (US/Central)
302B
Abstract
Information
Full Abstract and Figures
Author Block
Kyle C Schuppe*, Alexander P Kenigsberg, William S Azar, Charles Hesswani, Sahil H Parikh, Christopher Koller, Neil Mendhiratta, Bethesda, MD, Sarah Azari, Washington DC, DC, David G Gelikman, Daniel Nethala, Sandeep Gurram, Baris Turkbey, Peter A Pinto, Bethesda, MD
Introduction
Preoperative prostate cancer risk-stratification is based on digital rectal exam-guided clinical stage, prostate specific antigen (PSA), and biopsy Grade Group (GG). These factors were validated in the pre-magnetic resonance imaging (MRI) era. The role of specific MRI features in predicting recurrence of prostate cancer is an area of active investigation. This study aims to evaluate whether zonal anatomy on preoperative MRI has implications for biochemical recurrence (BCR).
Methods
Patients who underwent radical prostatectomy at a single institution between 2007 and 2023 were included. All patients underwent preoperative MRI, as per protocol. Patients who received neoadjuvant therapy or who had invisible lesions on MRI or lesions extending between zones were excluded. Patients with multiple lesions were categorized as transitional zone (TZ) or peripheral zone (PZ)-predominant based on the location of the lesion with the highest PI-RADS score. Lesion size was used to determine index lesion location if PI-RADS were equivalent. Univariate analyses were utilized to evaluate differences between the PZ and TZ groups.
Results
624 patients underwent RARP, 461 of whom were included for analysis. 351 had PZ-predominant lesions and 110 had TZ lesions, with a median follow up of 50 and 40.5 months, respectively (p=0.026). Baseline characteristics are in Table 1. Those with TZ lesions were older (64 vs 62.5, p=0.03), had higher preop PSA (8.3 vs 6.4 ng/ml, p<0.01), higher PSA density (0.19 vs 0.15, p=0.02), and larger prostate size (45 vs 41cc, p=0.01) (Table 1). Patients with PZ lesions were more likely to have cT2+ disease (p<0.01). At two year follow-up, 46/351 (13.1%) of PZ and 8/110 (7.3%) of TZ groups experienced BCR (p=0.097). At five year follow-up, BCR was seen in 76/351 (21.7%) and 12/110 (10.9%) of PZ and TZ patients, respectively (p=0.012).
Conclusions
Despite having higher age, PSA, and clinical T stage, those with PZ lesions had higher rates of BCR than those with TZ lesions. These findings suggest that MRI zonal anatomy may play a role in preoperative risk stratification and may allow for more precision in managing and counseling prostate cancer patients.
Source Of Funding
None
Author Block
Kyle C Schuppe*, Alexander P Kenigsberg, William S Azar, Charles Hesswani, Sahil H Parikh, Christopher Koller, Neil Mendhiratta, Bethesda, MD, Sarah Azari, Washington DC, DC, David G Gelikman, Daniel Nethala, Sandeep Gurram, Baris Turkbey, Peter A Pinto, Bethesda, MD
Introduction
Preoperative prostate cancer risk-stratification is based on digital rectal exam-guided clinical stage, prostate specific antigen (PSA), and biopsy Grade Group (GG). These factors were validated in the pre-magnetic resonance imaging (MRI) era. The role of specific MRI features in predicting recurrence of prostate cancer is an area of active investigation. This study aims to evaluate whether zonal anatomy on preoperative MRI has implications for biochemical recurrence (BCR).
Methods
Patients who underwent radical prostatectomy at a single institution between 2007 and 2023 were included. All patients underwent preoperative MRI, as per protocol. Patients who received neoadjuvant therapy or who had invisible lesions on MRI or lesions extending between zones were excluded. Patients with multiple lesions were categorized as transitional zone (TZ) or peripheral zone (PZ)-predominant based on the location of the lesion with the highest PI-RADS score. Lesion size was used to determine index lesion location if PI-RADS were equivalent. Univariate analyses were utilized to evaluate differences between the PZ and TZ groups.
Results
624 patients underwent RARP, 461 of whom were included for analysis. 351 had PZ-predominant lesions and 110 had TZ lesions, with a median follow up of 50 and 40.5 months, respectively (p=0.026). Baseline characteristics are in Table 1. Those with TZ lesions were older (64 vs 62.5, p=0.03), had higher preop PSA (8.3 vs 6.4 ng/ml, p<0.01), higher PSA density (0.19 vs 0.15, p=0.02), and larger prostate size (45 vs 41cc, p=0.01) (Table 1). Patients with PZ lesions were more likely to have cT2+ disease (p<0.01). At two year follow-up, 46/351 (13.1%) of PZ and 8/110 (7.3%) of TZ groups experienced BCR (p=0.097). At five year follow-up, BCR was seen in 76/351 (21.7%) and 12/110 (10.9%) of PZ and TZ patients, respectively (p=0.012).
Conclusions
Despite having higher age, PSA, and clinical T stage, those with PZ lesions had higher rates of BCR than those with TZ lesions. These findings suggest that MRI zonal anatomy may play a role in preoperative risk stratification and may allow for more precision in managing and counseling prostate cancer patients.
Source Of Funding
None
Sessions
MP18: Imaging/Uroradiology I
302B