Effect of preoperative PI-RADS assessment on pathological outcomes in patients who underwent radical prostatectomy
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Qianyu Peng1, Lili Xu1, Gumuyang Zhang1
1Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
Objective:
To assess the effect of preoperative MRI with standardized Prostate Imaging-Reporting and Data System (PI-RADS) assessment on pathological outcomes in prostate cancer (PCa) patients who underwent radical prostatectomy (RP).
Patients And Methods:
This retrospective cohort study included patients who had undergone prostate MRI and subsequent RP for PCa between January 2017 and December 2022. The patients were divided into the PI-RADS group and the non-PI-RADS group according to evaluation scheme of presurgery MRI. The preoperative characteristics and postoperative outcomes were retrieved and analyzed. The pathological outcomes included pathological T stage (pT2 vs. pT3-4) and positive surgical margins (PSMs). Patients were further stratified according to statistically significant preoperative variables to assess the difference in pathological outcomes. A propensity score matching based on the above preoperative characteristics was additionally performed.
Results:
A total of 380 patients were included in this study, with 201 patients in the PI-RADS group and 179 in the non-PI-RADS group. The two groups had similar preoperative characteristics, except for clinical T stage (cT). As for pathological outcomes, the PI-RADS group showed a significantly lower percentage of pT3-4 (21.4% vs. 48.0%, p < 0.001), a lower percentage of PSMs (31.3% vs. 40.9%, p = 0.055), and a higher concordance between the cT and pT (79.1% vs. 64.8%, p = 0.003). The PI-RADS group also showed a lower proportion of pT3-4 (p < 0.001) in the cT1-2 subgroup and the cohort after propensity score matching. The PSM rate of cT3 patients was reduced by 39.2% in the PI-RADS group but without statistical significance (p = 0.089).
Conclusions:
Preoperative MRI with standardized PI-RADS assessment could benefit the decision-making of patients by reducing the rate of pathologically confirmed non-organ-confined PCa after RP and slightly reducing the PSM rate compared with non-PI-RADS assessment.
Insights
Standardized Prostate Imaging-Reporting and Data System (PI-RADS) assessment using preoperative MRI improved pathological outcomes for prostate cancer (PCa) patients undergoing radical prostatectomy (RP). This approach reduced non-organ-confined disease and positive surgical margins, aiding surgical planning.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Prostate cancer (PCa) management relies on accurate staging for treatment planning.
- Radical prostatectomy (RP) is a primary treatment for localized PCa.
- Preoperative imaging aims to improve surgical precision and patient outcomes.
Purpose of the Study:
- To evaluate the impact of preoperative MRI with Prostate Imaging-Reporting and Data System (PI-RADS) scoring on pathological outcomes in PCa patients.
- To compare outcomes between patients assessed with PI-RADS and those without standardized MRI assessment before RP.
- To determine if PI-RADS assessment influences the rates of non-organ-confined disease and positive surgical margins.
Main Methods:
- Retrospective cohort study of 380 PCa patients undergoing RP (January 2017 - December 2022).
- Patients categorized into PI-RADS (n=201) and non-PI-RADS (n=179) groups based on preoperative MRI assessment.
- Pathological outcomes (pathological T stage, positive surgical margins) analyzed, with propensity score matching performed.
Main Results:
- The PI-RADS group demonstrated significantly lower rates of pT3-4 disease (21.4% vs. 48.0%, p<0.001) and improved clinical-pathological T stage concordance (79.1% vs. 64.8%, p=0.003).
- A trend towards reduced positive surgical margins (PSMs) was observed in the PI-RADS group (31.3% vs. 40.9%, p=0.055).
- These benefits were maintained in subgroups, including cT1-2 patients and after propensity score matching.
Conclusions:
- Preoperative MRI with PI-RADS assessment enhances surgical decision-making for PCa patients.
- This standardized approach leads to a reduction in pathologically confirmed non-organ-confined PCa following RP.
- PI-RADS assessment may also contribute to a slight decrease in positive surgical margin rates.
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