Mp74-01 Multiparametric Prostate Mri Structured Report Informs Preoperatively of Risk for Positive Apical Surgical Margins During Radical Prostatectomy
Year: 2020
Type: article
Abstract: You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV (MP74)1 Apr 2020MP74-01 MULTIPARAMETRIC PROSTATE MRI STRUCTURED REPORT INFORMS PREOPERATIVELY OF RISK FOR POSITIVE APICAL SURGICAL MARGINS DURING RADICAL PROSTATECTOMY Daniel Costa*, Patrick Arraj, Alberto Diaz de Leon, Debora Recchimuzzi, Yin Xi, Claus Roehrborn, Jeffrey Cadeddu, Vitaly Margulis, Liwei Jia, Kenneth Goldberg, Neil Rofsky, Ivan Pedrosa, and Aditya Bagrodia Daniel Costa*Daniel Costa* More articles by this author , Patrick ArrajPatrick Arraj More articles by this author , Alberto Diaz de LeonAlberto Diaz de Leon More articles by this author , Debora RecchimuzziDebora Recchimuzzi More articles by this author , Yin XiYin Xi More articles by this author , Claus RoehrbornClaus Roehrborn More articles by this author , Jeffrey CadedduJeffrey Cadeddu More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , Liwei JiaLiwei Jia More articles by this author , Kenneth GoldbergKenneth Goldberg More articles by this author , Neil RofskyNeil Rofsky More articles by this author , Ivan PedrosaIvan Pedrosa More articles by this author , and Aditya BagrodiaAditya Bagrodia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000960.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Positive surgical margins (PSM) in men undergoing radical prostatectomy (RP) for prostate cancer (PCa) are an adverse surgical outcome associated with increased risk of recurrence and need for additional therapy. Low apical lesions are challenging due their location near the expected site of the vesicourethral anastomosis, where wide excision margins might be technically difficult and result in postoperative urinary dysfunction. Although mpMRI has been long used for PCa local staging, data regarding its ability to prospectively flag men at risk for PSM beyond the scope of extraprostatic extension are lacking. The goal of this study was to determine the incidence of PSM in men identified as at risk for PSM during prospective mpMRI interpretation. METHODS: This single-center, retrospective study of prospectively collected data included all treatment-naïve men with abnormal 3T mpMRI (PIRADSv2 score ≥3) between Jan/2016-Dec/2018 followed by RP. During routine clinical interpretation, radiologists flagged lesions abutting the apical most gland and/or encircling the distal most prostatic urethra using standardized language available as a ‘pick list’ option in the ‘Impression’ section of the structured report. The statement reads as follows: “This lesion extends to the apical most aspect of the prostate near the expected location of the urethral anastomosis”. Logistic regression was used to compare the rate of PSM in the two groups (flagged vs non-flagged men). Propensity score covariate adjustment was used to correct for potential selection bias according to age, PSA, PSA density, grade group and pT stage. The estimate was further adjusted by including surgeon as a covariate. SM status (- or +) on whole-mount histopathology at a patient level served as the reference standard. RESULTS: 428 men (mean PSA: 9.7 ng/mL, age: 64 y, prostate volume: 44 cc, PSA density: 0.25 ng/mL/cc) were eligible. A higher proportion of PSMs was noted in the flagged (56% [51/91]) compared to non-flagged (31% [105/337]) men (propensity score adjusted odds ratio: 2.5, 95% confidence interval: 1.6, 4.1) (Table 1). The difference in PSM between both groups also varied according to the surgeon performing the RP (Fig. 1), suggesting that modifications to the surgical technique based on the imaging findings may be operator-dependent. CONCLUSIONS: Standard language built into structured reports for mpMRI of the prostate helps identify preoperatively patients at risk for apical PSM, facilitating patient counseling and management. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1131-e1131 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Costa* More articles by this author Patrick Arraj More articles by this author Alberto Diaz de Leon More articles by this author Debora Recchimuzzi More articles by this author Yin Xi More articles by this author Claus Roehrborn More articles by this author Jeffrey Cadeddu More articles by this author Vitaly Margulis More articles by this author Liwei Jia More articles by this author Kenneth Goldberg More articles by this author Neil Rofsky More articles by this author Ivan Pedrosa More articles by this author Aditya Bagrodia More articles by this author Expand All Advertisement PDF downloadLoading ...
Source: The Journal of Urology
Language: English
Subfield: Urology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3022658800