Effect of the PI-RADS score on adverse surgical outcomes in patients with prostate cancer after radical prostatectomy

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Abstract

Background. Multiparametric magnetic resonance imaging and Prostate Imaging Reporting and Data System (PI-RADS) are widely used to diagnose clinically significant prostate cancer. Meanwhile, PI-RADS diagnostic accuracy varies between 30 % for PI-RADS score 3 to 80 % for PI-RADS score 5. The value of PI-RADS scores in patients already diagnosed with prostate cancer remains unclear.

Aim. To evaluate the impact of PI-RADS score on adverse surgical outcomes: prostate cancer upstaging, increased Gleason score, lymph node metastases, positive surgical margin, and oncological outcomes in patients of the ISUP grade 1 group per the International Society of Urological Pathology (ISUP) scale who underwent radical prostatectomy.

Materials and methods. Forty patients with ISUP grade 1 prostate cancer underwent radical prostatectomy (robotic or laparoscopic). All patients underwent diagnostic multiparametric magnetic resonance imaging with PI-PADS score v2 (v2.1) prior to radical prostatectomy. PI-RADS 3 was determined in 14 (35 %), PI-RADS 4 – in 10 (25 %) and PI-RADS 5 – in 16 (40 %) patients, respectively. The age of patients was 62.7 ± 6.6 years. Stage cT2a was diagnosed in 19 (47.5 %), cT2b – in 5 (12.5 %), cT2c – in 11 (27.5 %), cT3a – in 5 (12.5 %) patients, respectively. Pelvic lymph node dissection was performed in 23 (57.5 %) cases. The median follow-up was 12.6 months.

Results. Upstaging events to pT3a occurred in 2 (15.2 %) patients with PI-RADS 3 lesions, in 5 (31.3 %) patients with PI-RADS 5 lesions; upstaging events to pT3b occurred in 1 (10 %) patient with PI-RADS 4 lesions, and in 1 (6.25 %) patient with PI-RADS 5 lesions. Increased Gleason score (GS) was observed in 22 (55 %) patients: GS increase ≥2 was diagnosed in 8 (57.1 %) patients with PI-RADS 3 lesions, in 3 (30 %) patients with PI-RADS 4 lesions, in 11 (68.7 %) patients with PI-RADS 5 lesions, respectively. Lymph node metastases were observed only in 1 (4.3 %) patient with PI-RADS 5 lesions. Positive surgical margin (>3 mm) was observed in 2 (12.4 %) patients with PI-RADS 5 lesions. Biochemical recurrence occurred in 1 (2.5 %) patient with PI-RADS 3 lesions. One-year biochemical recurrence-free survival was 97.5 %.

Conclusion. Increased PI-RADS score from 3 to 5 is accompanied by increased frequency of prostate cancer upstaging and Gleason score increase in patients with ISUP grade 1 prostate cancer. PI-RADS scores 3–5 can be important in selecting patients for nerve-sparing prostatectomy, pelvic lymph node dissection, and play a part in prediction of biochemical recurrence and lymph node metastasis.

About the authors

A. M. Popov

Central Clinical Hospital with a Polyclinic, Administration of the President of the Russian Federation

Email: palexdoc@yandex.ru
ORCID iD: 0000-0001-7705-9789

15 Marshala Timoshenko St., Moscow 121359

Russian Federation

E. V. Anikanova

Central Clinical Hospital with a Polyclinic, Administration of the President of the Russian Federation

Author for correspondence.
Email: anikanova1801@gmail.com
ORCID iD: 0000-0001-8524-129X

Ekaterina V. Anikanova.

15 Marshala Timoshenko St., Moscow 121359

Russian Federation

O. V. Kryuchkova

Central Clinical Hospital with a Polyclinic, Administration of the President of the Russian Federation

ORCID iD: 0000-0001-6483-2074

15 Marshala Timoshenko St., Moscow 121359

Russian Federation

A. A. Sokolov

Central Clinical Hospital with a Polyclinic, Administration of the President of the Russian Federation

ORCID iD: 0009-0007-0302-0428

15 Marshala Timoshenko St., Moscow 121359

Russian Federation

E. F. Abdryakhimov

Central Clinical Hospital with a Polyclinic, Administration of the President of the Russian Federation

ORCID iD: 0009-0007-3621-2813

15 Marshala Timoshenko St., Moscow 121359

Russian Federation

E. V. Zarya

Central Clinical Hospital with a Polyclinic, Administration of the President of the Russian Federation

ORCID iD: 0009-0001-4444-8881

15 Marshala Timoshenko St., Moscow 121359

Russian Federation

References

  1. Thompson J.E., Moses D., Shnier R. et al. Multiparametric magnetic resonance imaging guided diagnostic biopsy detects significant prostate cancer and could reduce unnecessary biopsies and over detection: a prospective study. J Urol 2014;192:67. doi: 10.1016/j.juro.2014.08.118
  2. Tan N., Lin W.C., Khoshnoodi P. et al. In-bore 3-T MR-guided transrectal targeted prostate biopsy: Prostate Imaging Reporting and Data System Version 2-based diagnostic performance for detection of prostate cancer. Radiology 2017;283:130–9. doi: 10.1148/radiol.2016152827
  3. Turkbey B., Rosenkrantz A.B., Haider M.A. et al. Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2. Eur Urol 2019;76(3):340–51. doi: 10.1016/j.eururo.2019.02.033
  4. Sonn G.A., Fan R.E., Ghanouni P. et al. Prostate magnetic resonance imaging interpretation varies substantially across radiologists. Eur Urol Focus 2019;5:592. doi: 10.1016/j.euf.2017.11.010
  5. Benjamin P., Kristian D.S., Molly P. et al. MRI PI-RADS scores are associated with prostate cancer upstaging on surgical pathology. Prostate 2022;82(3):352–8. doi: 10.1002/pros.24280
  6. Sung K.H., Sang H.S., Hak J.K. et al. Temporal changes of PIRADS scoring by radiologists and correlation to radical prostatectomy pathological outcomes. Prostate Int 2022;10(4):188–93. doi: 10.1016/j.prnil.2022.07.001
  7. Sokolov E.A., Veliev E.I., Veliev R.A. et al. Oncological results of radical prostatectomy depending on the data of multiparametric magnetic resonance imaging and patient selection for nerve-sparing technique. Onkourologiya = Cancer Urology 2020;16(2):74–81. (In Russ.). doi: 10.17650/1726-9776-2020-16-2-74-81
  8. O’Connor L., Wang A., Walker S.M. et al. Use of multiparametric magnetic resonance imaging (mpMRI) in localized prostate cancer. Expert Rev Med Devices 2020;17(5):435–42. doi: 10.1080/17434440.2020.1755257
  9. Somford D.M., Hamoen E.H., Futterer J.J. et al. The predictive value of endorectal 3 Tesla multiparametric magnetic resonance imaging for extraprostatic extension in patients with low, intermediate and high risk prostate cancer. J Urol 2013;190:1728–34. doi: 10.1016/j.juro.2013.05.021
  10. Izak F., Amirali S., Neil M. et al. PI-RADS version 2 category on 3 Tesla multiparametric prostate magnetic resonance imaging predicts oncologic outcomes in Gleason 3+4 prostate cancer on biopsy. J Urol 2019;201(1):91–7. doi: 10.1016/j.juro.2018.08.043
  11. Hassan O., Han M., Zhou A. et al. Incidence of extraprostatic extension at radical prostatectomy with pure Gleason score 3 + 3 = 6 (Grade Group 1) cancer: implications for whether Gleason score 6 prostate cancer should be renamed “not cancer” and for selection criteria for active surveillance. J Urol 2018;199(6):1482–7. doi: 10.1016/j.juro.2017.11.067
  12. Yossepowitch O., Briganti A., Eastham J.A. et al. Positive surgical margins after radical prostatectomy: a systematic review and contemporary update. Eur Urol 2014; 65:303–13. doi: 10.1016/j.eururo.2013.07.039
  13. Preston M.A., Blute M.L. Positive surgical margins after radical prostatectomy: does it matter? Eur Urol 2014;65:314–31. doi: 10.1016/j.eururo.2013.08.037
  14. Abdollah F., Abdo A., Sun M. et al. Pelvic lymph node dissection for prostate cancer: adherence and accuracy of the recent guidelines. Int J Urol 2013;20:405–10. doi: 10.1111/j.1442-2042.2012.03171.x
  15. Huang C., Song G., Wang H. et al. Multiparametric magnetic resonance imaging-based nomogram for predicting prostate cancer and clinically significant prostate cancer in men undergoing repeat prostate biopsy. Biomed Res Int 2018:6368309. doi: 10.1155/2018/6368309
  16. Cookson M.S., Aus G., Burnett A.L. et al. Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel report and recommendations for a standard in the reporting of surgical outcomes. J Urol 2007;177:540–5. doi: 10.1016/j.juro.2006.10.097
  17. Rajwa P., Mori K., Huebner N.A. et al. The prognostic association of prostate MRI PI-RADS v2 assessment category and risk of biochemical recurrence after definitive local therapy for prostate cancer: a systematic review and meta-analysis. J Urol 2021;206(3):507–16. doi: 10.1097/JU.0000000000001821

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