Risk model based on MRI fusion biopsy characteristics predicts biochemical recurrence after radical prostatectomy

To determine the prostate cancer biochemical recurrence-related fusion biopsy characteristics before radical surgery and to establish the risk prediction model of biochemical recurrence of prostate cancer.

Three hundred and four patients undergoing radical surgery for prostate cancer at Huadong Hospital affiliated to Fudan University between 2009 and 2020 for preoperative magnetic resonance imaging (MRI) before biopsy with suspicious prostate cancer lesions. Each case was followed by a 10 + x needle combination of targeted biopsy (intentional or robotic fusion) with systematic biopsy. Prostate-specific antigen levels were measured at 1, 3, and 6 months postoperatively, followed by reexamination every 6 months. Survival analysis was performed by the Kaplan-Meier method, univariate and multivariate analysis by Cox, and Logistic risk regression models.

Higher Prostate Imaging Reporting And Data System (PI-RADS) scores (p < 0.001), suspicious extracapsular invasion (p < 0.001), and seminal vesicle invasion (p < 0.001) on MRI, the largest lesion diameter on MRI (p = 0.006), higher biopsy International Society of Urological Pathology (ISUP) grade group (p < 0.001) related to higher biochemical recurrence rates, higher pathological staging (p < 0.001), and a greater probability of local lymph node metastasis (p < 0.001). We accurately predicted the biochemical recurrence of prostate cancer after radical surgery based on preoperative features including the long diameter of the largest MRI lesion more than 23 mm, seminal vesicle invasion on MRI, and targeted fusion biopsy ISUP grade >3 Risk stratified classification (AUC = 0.729, p < 0.001). In our cohort, this risk stratification had a larger area under the curve than predictive models based only on magnetic resonance parameters and traditional risk scores.

In this cohort, seminal vesicle invasion on MRI, the long diameter of the largest MRI lesion, and targeted fusion biopsy ISUP grade grope are significantly predictive of pathologic features and biochemical recurrence after prostate surgery. The risk stratification integrating the three parameters could better predict the biochemical recurrence than the traditional model.