MP23-10: Are men with low risk prostate cancer but high PIRADS score lesions at mpMRI still candidate for active surveillance? Resuts from a large, multi-institutional radical prostatectomy series

Armando Stabile, Jeffrey Karnes, Giovanni Motterle, Giorgio Gandaglia, Nicola Fossati, Vito Cucchiara, Simone Scuderi, Francesco Barletta, Giuseppe Fallara, Carlo Bravi, Elio Mazzone, Daniele Robesti, Donato Cannoletta, Giuseppe Rosiello, Francesco Pellegrino, Sabrina Comana, Paolo Dell'Oglio, Andrea Salonia, Giorgio Brembilla, Antonio Esposito, Francesco Montorsi, Francesco De Cobelli, Alberto Briganti

Introduction: The presence of lesion with high PI-RADS score at prostate MRI is a well-known predictor of clinically significant prostate cancer (PCa). However, the role of a high PI-RADS score lesion in men with concomitant proven low grade PCa at targeted and systematic biopsies is still unclear. Whether these patients could still be candidate for active surveillance (AS) is indeed a matter of debate. We aimed at defining the prognostic role of a false positive high PI-RADS score lesion in men submitted to radical prostatectomy (RP) for low risk prostate cancer (PCa).

Methods: We relied on a population of 453 men who received a mp-MRI of the prostate, systematic plus targeted biopsy and subsequent RP at two tertiary referral centre between 2013 and 2019. All men had a PIRADS 3-5 lesion. From these, we included 84 men receiving RP for a PCa Gleason score (GS) 3+3 at targeted and/or systematic biopsy despite positive mp-MRI. All MRI scans were reviewed by experienced radiologists using PI-RADS score v.2. The study outcome was to explore the relationship between the presence of a high PI-RADS score lesion (PI-RADS score =4 vs 3) and adverse outcomes at RP (extracapsular extension[ECE], positive surgical margins [PSM] and lymph-node invasion [LNI]). We used a multivariable logistic regression analysis (MVA) predicting ECE, PSM and LNI using the following covariates: presence of PI-RADS=4, age, and PSA density (PSAd).

Results: Overall median age was 63 (IQR: 58-68) and median PSA was 6.1ng/ml (IQR: 4.9-9.7). Overall, 46%, 38% and 16% of patients had PI-RADS 3, 4 and 5 at MRI. The median percentage of targeted cores involvement was 30% (IQR: 10-55). The rate of ECE, PSM and LNI was 8%, 13% and 5%, respectively. At MVA the presence of PI-RADS=4 was not independently associated with any of the outcomes tested (ECE, PSM and LNI) (all p>0.18). PSAd represented the only factor independently associated with ECE (OR: 1.24; p<0.001).

Conclusions: The presence of a high PI-RADS lesion at MRI is not related with worse outcomes at final pathology in men with a targeted and or systematic biopsy showing Gleason 3+3. Therefore, these men should be reassured that pathological outcomes are favorable and that therefore initial conservative management is feasible and safe. Source of

Funding: none