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Published on: April 9, 2019
Factors associated with pathological up-staging in MRI cT3a prostate cancer - a retrospective study from a
Jonathan Ferguson1, Danny Darlington Carbin2, Wissam Abou Chedid1
1Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK.
Introduction:
Multiparametric MRI (mpMRI) parameters of pT3a prostate cancer have not been examined in large cohort studies. Therefore, we aimed to identify factors associated with up-staging of mpMRI cT3a in post-operative histopathological confirmation.
Methods:
Retrospective analysis of a prospectively maintained database of a single UK cancer centre. Only cT3a cases who underwent robotic-assisted radical prostatectomy (RARP) were included (N = 383). MRI and specimen histopathology was reviewed independently by expert uro-radiologists and uro-histopathologists, respectively. Factors included age, BMI, prostate-specific antigen (PSA) level, biopsy international society of urological pathology (ISUP) grade, Prostate Imaging Reporting & Data System (PI-RADS®) score, tumour size, tumour coverage of gland (%), gland weight and surgical margins were analysed as predictors of pT3a prostate cancer.
Results:
N = 383. Mean age 66 years (58-71), mean BMI 27.1 kg/m2 (25.0-30.0). 314 (82.0%) cases down- unchanged or down-staged, and 69 (18.0%) cases upstaged. PSA level (P = 0.002), PI-RADS score (P < 0.001) and ISUP grade (P < 0.001) are positively associated with upstage categories. ISUP grade ≥3 (OR 5.45, CI 1.88, 9.29, P < 0.002), PI-RADS score ≥4 (OR 3.92, CI 1.88-9.29, P < 0.001) and tumour coverage (OR 1.06, CI 1.05-1.08, P < 0.001) significantly positively associated with upstaging disease, with concurrent decreased probability of downstaging (OR 0.55, 0.14, 0.44, respectively, P < 0.05). Tumour coverage was positively correlated with increasing positive surgical margins (P < 0.05). Capsular contact > 15 mm was very unlikely to be upstaged (OR 0.36, CI 0.21-0.62, P < 0.001), aligning with published results past the widely accepted significant level for extracapsular disease on MRI.
Conclusion:
The study has identified PSA level, ISUP, PI-RADS score, tumour volume and percentage coverage are key predictive factors in cT3a upstaging. This study uniquely shows tumour coverage percentage as a predictor of cT3a upstaging on mpMRI. ISUP is the strongest predictor, followed by PI-RADS score and tumour coverage of gland. Multi-institutional studies are needed to confirm our findings.
Insights
Multiparametric MRI (mpMRI) can predict prostate cancer upstaging. International Society of Urological Pathology (ISUP) grade, Prostate Imaging Reporting & Data System (PI-RADS) score, and tumor coverage are key predictors for upstaging cT3a prostate cancer.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Multiparametric MRI (mpMRI) parameters for pT3a prostate cancer lack large cohort studies.
- Identifying predictors for mpMRI cT3a upstaging is crucial for accurate staging.
Purpose of the Study:
- To identify factors associated with up-staging of mpMRI cT3a in post-operative histopathological confirmation.
- To evaluate the predictive value of various clinical and imaging parameters for prostate cancer upstaging.
Main Methods:
- Retrospective analysis of 383 patients with cT3a prostate cancer who underwent robotic-assisted radical prostatectomy (RARP).
- Independent review of MRI and histopathology by expert uro-radiologists and uro-histopathologists.
- Analysis of age, BMI, PSA, ISUP grade, PI-RADS score, tumor size, coverage, gland weight, and surgical margins as predictors of pT3a prostate cancer.
Main Results:
- 18.0% of cases were upstaged post-operatively.
- Prostate-specific antigen (PSA) level, PI-RADS score, and ISUP grade were positively associated with upstaging.
- ISUP grade ≥3, PI-RADS score ≥4, and tumor coverage significantly predicted upstaging.
- Higher tumor coverage correlated with positive surgical margins.
- Capsular contact >15 mm was associated with a lower likelihood of upstaging.
Conclusions:
- PSA level, ISUP grade, PI-RADS score, and tumor coverage percentage are key predictors of cT3a upstaging.
- Tumor coverage percentage is a unique predictor of cT3a upstaging on mpMRI.
- ISUP grade is the strongest predictor, followed by PI-RADS score and tumor coverage.
- Multi-institutional studies are recommended to validate these findings.
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