Presentation Authors: Jung Jun Kim*, Yeon Soo Jung, Seok-Soo Byun, Sung Kyu Hong, Seongnam, Korea, Republic of
Introduction: Various recent literature suggests that a negative multiparametric MRI (mpMRI) allows to rule out significant prostate cancer. The objective of our study was to investigate whether a specific portion of D'Amico intermediate risk group could be reclassified as low risk if the mpMRI is negative. We evaluated the histopathological results after radical prostatectomy (RP) in preoperative D'Amico intermediate risk patients that had a negative preoperative mpMRI.
Methods: We retrospectively identified 604 D'Amico intermediate risk patients and 355 low risk patients among 1,347 who underwent a preoperative mpMRI and radical prostatectomy in a single institution. Intermediate risk patients were sub-classified according to Gleason score, clinical stage and preoperative PSA level and the positivity of mpMRI. The final pathology from each RP specimen of each sub-classified group was compared with that of D'Amico low risk group. The MRIs were considered negative when no suspicious lesion was seen or when PI-RAD Version 2 gradeâ‰¤2. Patients with advanced pathologic stage (pT3-T4 and/or pN1) and/or a pGS 4 + 3 were considered as "unfavorable disease" at RP. Pathologic stage pT3-4 or pN1 was classified as "non-organ-confined disease".
Results: Among 604 intermediate risk group patients, 48 patients were PSA only elevated group (Gleason 6, cT1-cT2b and PSA 10 to 20 ng/dl) with negative MRI. The rate of unfavorable disease was 18.8% (9/48) and non-organ confined disease was 10.4% (5/48) among the subgroup. Pathological profile of this subgroup was comparable with D'Amico low risk group in terms of the risk of unfavorable disease and non-organ-confined disease. The comparability was still consistent even after 1:4 propensity score matching of clinical profiles exceptliterature preoperative PSA (Table). The rate of unfavorable disease or non-organ-confined disease among other subgroups were significantly worse than D'Amico low risk group regardless the findings of mpMRI.
Conclusions: In case of negative mpMRI, If the only violation of D'Amico low risk criterion is moderate PSA elevation (â‰¤20ng/ml), the pathological outcome was comparable with conventional literature group. Our results suggest that the oncological hazard of such specific portion of conventional D'Amico intermediate risk group could be considered as low risk in the era of mpMRI.