Risk Biomarkers for Biochemical Recurrence after Radical Prostatectomy for Prostate Cancer Using Clinical and...

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Robotic-assisted radical prostatectomy (RARP) is a standard treatment for prostate cancer.
• Predicting extracapsular extension (ECE) pre-operatively is crucial for surgical planning and prognosis.
• Biochemical recurrence-free survival (BCRFS) is a key outcome measure after prostatectomy.

Purpose of the Study:

• To evaluate the impact of pre-operative MRI-derived covariates for detecting pathological extracapsular extension (pECE+) on BCRFS within 4 years post-RARP.
• To identify predictors of early biochemical recurrence (BCR) in patients undergoing RARP.

Main Methods:

• Retrospective analysis of 177 patients undergoing RARP between 2015-2022.
• Utilized Kaplan-Meier survival analysis and multivariable Cox regression.
• Assessed PSA, age, prostate volume, MRI features, Grade Group (GG), pECE+, and positive surgical margins (PSM).

Main Results:

• The 4-year BCR risk was 21%.
• Adverse MRI features (macroscopic ECE [mECE+], capsular disruption, high tumor capsular contact length [TCCL]), GG ≥ 4, PSM, and pECE+ were significant risk factors for BCR.
• In low/intermediate-risk patients, adverse MRI features increased BCR risk.

Conclusions:

• Pre-surgical MRI features for detecting ECE are vital for predicting early outcomes and guiding clinical decisions.
• mECE+, TCCL, capsular disruption, and GG ≥ 4 are independent prognostic factors for early BCR.
• Identifying adverse MRI features aids in selecting low/intermediate-risk patients for closer monitoring.