Comparison of MRI-Based Staging and Pathologic Staging for Predicting Biochemical Recurrence of Prostate Cancer After...

Area of Science:

• Oncology
• Radiology
• Urology

Background:

• Current prostate cancer (PCa) models predicting biochemical recurrence (BCR) post-radical prostatectomy (RP) rely on postsurgical data, leaving a gap in preoperative risk assessment.
• There is a need for reliable preoperative tools to predict BCR in PCa patients undergoing RP.

Purpose of the Study:

• To compare the predictive utility of presurgical MRI staging versus postsurgical RP pathology for BCR in PCa patients.
• To evaluate the performance of established and modified risk assessment models (CAPRA, CAPRA-S, CAPRA-MRI) in predicting BCR.

Main Methods:

• Retrospective analysis of 604 PCa patients who underwent prostate MRI before RP.
• Assessment of MRI and RP pathology for extraprostatic extension (EPE) and seminal vesicle invasion (SVI).
• Comparison of BCR prediction using Kaplan-Meier, Cox proportional hazards analyses, and AUC for CAPRA, CAPRA-S, and CAPRA-MRI models.

Main Results:

• Both MRI and RP pathology EPE and SVI were significant univariable predictors of BCR (p < .001).
• Three-year BCR-free survival rates showed comparable discrimination between MRI and RP pathology for EPE and SVI.
• CAPRA-MRI models demonstrated significant risk stratification between low- and intermediate-risk groups, outperforming CAPRA-S.

Conclusions:

• Presurgical MRI-based staging features demonstrate comparable performance to postsurgical pathologic staging features in predicting BCR.
• Prostate MRI staging can preoperatively identify high- BCR risk patients, aiding early clinical decision-making.