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Prognostic significance of PI-RADS 5 lesions in patients treated by radical prostatectomy

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Abstract

Purpose

To analyse the pathological features and survival of patients with a PI-RADS 5 lesion on pre-biopsy MRI.

Methods

We extracted from a European multicentre prospectively gathered database the data of patients with a PI-RADS 5 lesion on pre-biopsy MRI, diagnosed using both systematic and targeted biopsies and subsequently treated by radical prostatectomy. The Kaplan–Meier model was used to assess the biochemical-free survival of the whole cohort and univariable and multivariable Cox models were set up to study factors associated with survival.

Results

Between 2013 and 2019, 539 consecutive patients with a PI-RADS 5 lesion on pre-biopsy MRI were treated by radical prostatectomy and included in the analysis. Follow-up data were available for 448 patients. Radical prostatectomy and lymph node dissection specimens showed non-organ confined disease in 297/539 (55%), (including 2 patients with a locally staged pT2 lesion and lymph node involvement (LNI)). With a median follow-up of 25 months (12–39), the median biochemical recurrence-free survival was 54% at 2 years (95% CI 45–61) and 28% at 5 years (95% CI 18–39). Among the factors studied, MRI T stage [T3a vs T2 HR 3.57 (95%CI 1.78–7.16); T3b vs T2 HR 6.17 (95% CI 2.99–12.72)] and PSA density (HR 4.47 95% CI 1.55–12.89) were significantly associated with a higher risk of biochemical recurrence in multivariable analysis.

Conclusion

Patients with a PI-RADS 5 lesion on pre-biopsy MRI have a high risk of early biochemical recurrence after radical prostatectomy. MRI T stage and PSA density can be used to improve patient selection and counselling.

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Data availability

De-identified data will be made readily available to reviewers upon request.

Code availability

Statistical software code will be made readily available to reviewers upon request.

References

  1. Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ et al (2016) PI-RADS prostate imaging—reporting and data system: 2015, version 2. Eur Urol 69:16–40. https://doi.org/10.1016/j.eururo.2015.08.052

    Article  PubMed  Google Scholar 

  2. Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH et al (2018) MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 378:1767–1777. https://doi.org/10.1056/NEJMoa1801993

    Article  PubMed  PubMed Central  Google Scholar 

  3. Rouvière O, Puech P, Renard-Penna R, Claudon M, Roy C, Mège-Lechevallier F et al (2019) Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol 20:100–109

    Article  PubMed  Google Scholar 

  4. Manceau C, Beauval J-B, Lesourd M, Almeras C, Aziza R, Gautier J-R et al (2020) MRI characteristics accurately predict biochemical recurrence after radical prostatectomy. J Clin Med 9:E3841. https://doi.org/10.3390/jcm9123841

    Article  Google Scholar 

  5. Rajwa P, Mori K, Huebner NA, Martin DT, Sprenkle PC, Weinreb JC et al (2021) The prognostic association of prostate MRI PI-RADS v2 assessment category and risk of biochemical recurrence after definitive local therapy for prostate cancer: a systematic review and meta-analysis. J Urol. https://doi.org/10.1097/JU.0000000000001821

    Article  PubMed  Google Scholar 

  6. Turkbey B, Rosenkrantz AB, Haider MA, Padhani AR, Villeirs G, Macura KJ et al (2019) Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2. Eur Urol 76:340–51. https://doi.org/10.1016/j.eururo.2019.02.033

    Article  PubMed  Google Scholar 

  7. de Rooij M, Israël B, Tummers M, Ahmed HU, Barrett T, Giganti F et al (2020) ESUR/ESUI consensus statements on multi-parametric MRI for the detection of clinically significant prostate cancer: quality requirements for image acquisition, interpretation and radiologists’ training. Eur Radiol 30:5404–5416. https://doi.org/10.1007/s00330-020-06929-z

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kohestani K, Wallström J, Dehlfors N, Sponga OM, Månsson M, Josefsson A et al (2019) Performance and inter-observer variability of prostate MRI (PI-RADS version 2) outside high-volume centres. Scand J Urol 53:304–311. https://doi.org/10.1080/21681805.2019.1675757

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gandaglia G, Ploussard G, Valerio M, Mattei A, Fiori C, Fossati N et al (2019) A Novel nomogram to identify candidates for extended pelvic lymph node dissection among patients with clinically localized prostate cancer diagnosed with magnetic resonance imaging-targeted and systematic biopsies. Eur Urol 75:506–514. https://doi.org/10.1016/j.eururo.2018.10.012

    Article  PubMed  Google Scholar 

  10. Mazzone E, Gandaglia G, Ploussard G, Marra G, Valerio M, Campi R et al (2022) Risk stratification of patients candidate to radical prostatectomy based on clinical and multiparametric magnetic resonance imaging parameters: development and external validation of novel risk groups. Eur Urol 81:193–203. https://doi.org/10.1016/j.eururo.2021.07.027

    Article  CAS  PubMed  Google Scholar 

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Funding

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Authors and Affiliations

  1. Department of Urology, Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000, Grenoble, France

    G. Fiard & J. L. Descotes

  2. Department of Medical Assessment, Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000, Grenoble, France

    A. Seigneurin

  3. Urology Department, CHU Toulouse, Toulouse, France

    M. Roumiguié

  4. Department of Urology, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium

    S. Albisinni & T. Roumeguère

  5. Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy

    S. Albisinni

  6. Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France

    J. Anract & N. Barry Delongchamps

  7. Department of Urology, Jules Bordet Institute, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium

    G. Assenmacher, A. Peltier, T. Roumeguère & R. Diamand

  8. Department of Urology, Hôpital Européen Georges-Pompidou, APHP, Paris-Paris University-U1151 Inserm-INEM, Necker, Paris, France

    C. Dariane

  9. Department of Urology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200, Brussels, Belgium

    A. Feyaerts, T. Saussez & J. Van Damme

  10. Urology Department, Hôpital Cavale Blanche, CHRU Brest, Brest, France

    A. Fourcade & G. Fournier

  11. Urology Department, Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy

    P. Gontero & M. Oderda

  12. Department of Urology, IRCCS “Regina Elena” National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, RM, Italy

    R. Mastroianni & G. Simone

  13. Department of Urology, La Croix du Sud Hospital, IUCT-O, Quint Fonsegrives, France

    G. Ploussard

Authors
  1. G. Fiard
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  2. A. Seigneurin
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  3. M. Roumiguié
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  4. S. Albisinni
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  5. J. Anract
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  6. G. Assenmacher
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  7. N. Barry Delongchamps
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  8. C. Dariane
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  9. A. Feyaerts
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  10. A. Fourcade
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  11. G. Fournier
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  12. P. Gontero
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  13. R. Mastroianni
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  14. M. Oderda
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  15. A. Peltier
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  16. T. Roumeguère
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  17. T. Saussez
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  18. G. Simone
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  19. J. Van Damme
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  20. J. L. Descotes
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  21. G. Ploussard
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  22. R. Diamand
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Contributions

GF: Protocol/project development, Data collection or management, Manuscript writing/editing. AS: Data analysis. MR: Data collection or management, Manuscript writing/editing. SA: Data collection or management, Manuscript writing/editing. JA: Data collection or management. GA: Data collection or management. NBD: Data collection or management, Manuscript writing/editing. CD: Data collection or management. AF: Data collection or management. AF: Data collection or management. GF: Data collection or management. PG: Data collection or management. RM: Data collection or management. MO: Data collection or management, Manuscript writing/editing. AP: Data collection or management, Manuscript writing/editing. TR: Data collection or management, Manuscript writing/editing. TS: Data collection or management. GS: Data collection or management, Manuscript writing/editing. JVD: Data collection or management. JLD: Data collection or management. GP: Data collection or management, Manuscript writing/editing. RD: Protocol/project development, Data collection or management, Manuscript writing/editing.

Corresponding author

Correspondence to G. Fiard.

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The authors declare that they have no conflict of interest.

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This retrospective study conducted from medical charts used data obtained during routine care. Data protection declaration was performed with the CNIL under number 2216501v0.

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Fiard, G., Seigneurin, A., Roumiguié, M. et al. Prognostic significance of PI-RADS 5 lesions in patients treated by radical prostatectomy. World J Urol 41, 1285–1291 (2023). https://doi.org/10.1007/s00345-023-04371-6

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  • DOI: https://doi.org/10.1007/s00345-023-04371-6

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