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MRI predicts prostatic urethral involvement in men undergoing radical prostatectomy: implications for cryo-ablation of localized prostate cancer

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World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To determine whether multi-parametric magnetic resonance imaging (mpMRI) can reliably predict proximity of prostate cancer to the prostatic urethra in a contemporary series of men undergoing radical prostatectomy (RP) at two academic centers.

Methods

Clinical characteristics of consecutive men undergoing pre-operative mpMRI prior to RP and whole-mount axial serial step-sectioned pathology examination at two academic centers between Jun 2016 and Oct 2018 were analyzed retrospectively. Every tumor was characterized by its pathologic minimum distance to the prostatic urethral lumen (pMDUL). Only the cancer closest to the urethra represented the prostatic urethral index lesion. The radiologic minimum distance of the index lesion to the prostatic urethral lumen was measured and noted as ≤ 5 mm versus  > 5 mm. The sensitivity, specificity, positive and negative predicting values (PPV and NPV) and area under the receivers operating characteristics curve (AUC) were calculated for performance of mpMRI for predicting pMDUL ≤ 5 mm.

Results

Of the 163 surgical specimens examined, 112 (69%) exhibited a pMDUL ≤ 5 mm. These men had significantly higher grade group (GG) and advanced pathological and clinical stage. The rates of high PI-RADS score and presence of gross extracapsular extension were also significantly greater for the group with pMDUL ≤ 5 mm. The AUC, sensitivity, specificity, PPV, and NPV were 0.641, 51.8, 76.5, 82.9, and 42.4%, respectively, for mpMRI to predict pMDUL < 5 mm.

Conclusions

Nearly 70% of men undergoing RP present with tumor within 5 mm of the prostatic urethra. These tumors present higher risk characteristics, and mpMRI exhibited moderate performance and high PPV in their pre-operative detection. Physicians performing partial gland ablation should take these results into consideration during treatment selection and planning.

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Funding

No funding was required for the development of this study.

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Authors and Affiliations

  1. Department of Urology, NYU Langone Health, 222 E41st St, 12th floor, New York, NY, 10017, USA

    Ezequiel Becher & Herbert Lepor

  2. Department of Urology, Keck School of Medicine, USC Institute of Urology and Catherine and Joseph Aresty, University of Southern California, Los Angeles, CA, USA

    Akash Sali, Andre Abreu, Tsuyoshi Iwata, Atsuko Iwata, Chhavi Gupta & Inderbir Gill

  3. Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Akash Sali, Chhavi Gupta & Manju Aron

  4. Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Andre Abreu & Suzanne Palmer

  5. Department of Radiology, NYU Langone Health, New York, NY, USA

    Angela Tong

  6. Department of Pathology, NYU Langone Health, New York, NY, USA

    Fang-Ming Deng

Authors
  1. Ezequiel Becher
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  2. Akash Sali
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  3. Andre Abreu
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  4. Tsuyoshi Iwata
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  5. Angela Tong
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  6. Fang-Ming Deng
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  7. Atsuko Iwata
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  8. Chhavi Gupta
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  9. Inderbir Gill
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  10. Manju Aron
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  11. Suzanne Palmer
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  12. Herbert Lepor
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Contributions

BE: project development and manuscript writing. SA: data analysis. AA: project development. IT: data analysis. TA: data collection. DFM: data collection. IA: data analysis. GC: data collection. GI: project development. AM: data collection. PS: data collection. LH: project development.

Corresponding author

Correspondence to Ezequiel Becher.

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Conflict of interest

AA: Consultant for Koelis and was proctor in training for Steba Biotech.

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Becher, E., Sali, A., Abreu, A. et al. MRI predicts prostatic urethral involvement in men undergoing radical prostatectomy: implications for cryo-ablation of localized prostate cancer. World J Urol 39, 3309–3314 (2021). https://doi.org/10.1007/s00345-020-03566-5

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  • DOI: https://doi.org/10.1007/s00345-020-03566-5

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