Pathological and 3 Tesla Volumetric Magnetic Resonance Imaging Predictors of Biochemical Recurrence after Robotic Assisted Radical Prostatectomy: Correlation with Whole Mount Histopathology

J Urol. 2018 May;199(5):1218-1223. doi: 10.1016/j.juro.2017.10.042. Epub 2017 Nov 8.

Abstract

Purpose: We sought to identify the clinical and magnetic resonance imaging variables predictive of biochemical recurrence after robotic assisted radical prostatectomy in patients who underwent multiparametric 3 Tesla prostate magnetic resonance imaging.

Materials and methods: We performed an institutional review board approved, HIPAA (Health Insurance Portability and Accountability Act) compliant, single arm observational study of 3 Tesla multiparametric magnetic resonance imaging prior to robotic assisted radical prostatectomy from December 2009 to March 2016. Clinical, magnetic resonance imaging and pathological information, and clinical outcomes were compiled. Biochemical recurrence was defined as prostate specific antigen 0.2 ng/cc or greater. Univariate and multivariate regression analysis was performed.

Results: Biochemical recurrence had developed in 62 of the 255 men (24.3%) included in the study at a median followup of 23.5 months. Compared to the subcohort without biochemical recurrence the subcohort with biochemical recurrence had a greater proportion of patients with a high grade biopsy Gleason score, higher preoperative prostate specific antigen (7.4 vs 5.6 ng/ml), intermediate and high D'Amico classifications, larger tumor volume on magnetic resonance imaging (0.66 vs 0.30 ml), higher PI-RADS® (Prostate Imaging-Reporting and Data System) version 2 category lesions, a greater proportion of intermediate and high grade radical prostatectomy Gleason score lesions, higher pathological T3 stage (all p <0.01) and a higher positive surgical margin rate (19.3% vs 7.8%, p = 0.016). On multivariable analysis only tumor volume on magnetic resonance imaging (adjusted OR 1.57, p = 0.016), pathological T stage (adjusted OR 2.26, p = 0.02), positive surgical margin (adjusted OR 5.0, p = 0.004) and radical prostatectomy Gleason score (adjusted OR 2.29, p = 0.004) predicted biochemical recurrence.

Conclusions: In this cohort tumor volume on magnetic resonance imaging and pathological variables, including Gleason score, staging and positive surgical margins, significantly predicted biochemical recurrence. This suggests an important new imaging biomarker.

Keywords: biomarkers; local; magnetic resonance imaging; neoplasm recurrence; prostate specific antigen; prostatic neoplasms; tumor.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Biopsy / methods
  • False Positive Reactions
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Male
  • Margins of Excision
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Recurrence, Local / diagnosis*
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / prevention & control
  • Neoplasm Staging
  • Preoperative Care / methods
  • Prognosis
  • Prostate / diagnostic imaging
  • Prostate / pathology
  • Prostate / surgery
  • Prostate-Specific Antigen / blood
  • Prostatectomy / adverse effects*
  • Prostatectomy / methods
  • Prostatic Neoplasms / diagnostic imaging*
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / surgery
  • Robotic Surgical Procedures / adverse effects*
  • Robotic Surgical Procedures / methods
  • Survival Analysis
  • Treatment Outcome
  • Tumor Burden

Substances

  • Prostate-Specific Antigen