Preoperative Multiparametric Prostate Magnetic Resonance Imaging Structured Report Informs Risk for Positive Apical...

Area of Science:

• Urologic oncology and radiology
• Prostate cancer diagnostics
• Surgical pathology

Background:

• The prostatic apex is a common site for positive surgical margins (PSMs) after prostatectomy.
• Prospective data on multiparametric magnetic resonance imaging (mpMRI) for identifying men at risk for apical PSMs (aPSMs) using structured reports are limited.

Purpose of the Study:

• To determine and compare the rate of aPSMs in men with and without prospectively flagged at-risk prostate lesions on mpMRI.
• To utilize whole-mount histopathology as the reference standard for evaluating aPSM rates.

Main Methods:

• Retrospective analysis of prospectively collected data from 428 treatment-naive men with abnormal 3T mpMRI (PI-RADS v2 score ≥3) undergoing surgery.
• Radiologists prospectively flagged lesions near the apical gland or distal urethra using standardized language in structured reports.
• Logistic regression and propensity score adjustment were used to compare aPSM rates between flagged and non-flagged groups, controlling for clinical factors and surgeon experience.

Main Results:

• Men with flagged lesions had a significantly higher rate of aPSMs (56%) compared to non-flagged men (31%) (adjusted odds ratio, 2.5; P < 0.01).
• Factors associated with higher PSM rates included PSA, PSA density, lesion size, apical location, PI-RADS score, grade group, pT stage, and surgeon experience.
• While PSM status was associated with biochemical recurrence, flagged patients did not show a significant difference in recurrence rates compared to non-flagged patients.

Conclusions:

• Standardized language in structured mpMRI reports effectively identifies patients at increased risk for aPSMs.
• mpMRI can preoperatively identify patients at higher risk for aPSMs, aiding urologists in patient counseling and treatment decisions.