MRI Characteristics Accurately Predict Biochemical Recurrence after Radical Prostatectomy

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Radical prostatectomy (RP) for prostate cancer (PCa) can lead to biochemical recurrence (BCR).
• BCR is linked to increased risk of metastasis and mortality.
• Predicting BCR is crucial for patient management post-RP.

Purpose of the Study:

• To assess the correlation between MRI characteristics, ISUP grade group from targeted biopsy (TB), and outcomes after RP.
• To develop and validate an imaging-based risk classification for improved BCR prediction.

Main Methods:

• A two-center study of 521 patients undergoing RP after positive MRI and PCa diagnosis.
• Combination of fusion-targeted biopsy (TB) and systematic biopsy.
• Assessment of MRI features, ISUP grade group in TB, and post-RP outcomes.

Main Results:

• Higher PI-RADS score, ISUP grade group, and extracapsular extension (ECE) on MRI correlated with advanced disease and increased recurrence risk.
• An imaging-based classification (ECE, ISUP grade group, PI-RADS) accurately predicted BCR (AUC = 0.714).
• This classification demonstrated improved predictive performance over the d'Amico classification.

Conclusions:

• PI-RADS score, MRI stage, and ISUP grade group from MRI-TB are significant predictors of disease features and recurrence post-RP.
• The developed imaging-based risk classification shows competitive performance against the d'Amico classification for BCR prediction.