Preoperative Multiparametric Magnetic Resonance Imaging Predicts Biochemical Recurrence in Prostate Cancer after Radical Prostatectomy.

OBJECTIVES:To evaluate the utility of preoperative multiparametric magnetic resonance imaging (MP-MRI) in predicting biochemical recurrence (BCR) following radical prostatectomy (RP). MATERIALS/METHODS:From March 2007 to January 2015, 421 consecutive patients with prostate cancer (PCa) underwent preoperative MP-MRI and RP. BCR-free survival rates were estimated using the Kaplan-Meier method. Cox proportional hazards models were used to identify clinical and imaging variables predictive of BCR. Logistic regression was performed to generate a nomogram to predict three-year BCR probability. RESULTS:Of the total cohort, 370 patients met inclusion criteria with 39 (10.5%) patients experiencing BCR. On multivariate analysis, preoperative prostate-specific antigen (PSA) (p = 0.01), biopsy Gleason score (p = 0.0008), MP-MRI suspicion score (p = 0.03), and extracapsular extension on MP-MRI (p = 0.03) were significantly associated with time to BCR. A nomogram integrating these factors to predict BCR at three years after RP demonstrated a c-index of 0.84, outperforming the predictive value of Gleason score and PSA alone (c-index 0.74, p = 0.02). CONCLUSION:The addition of MP-MRI to standard clinical factors significantly improves prediction of BCR in a post-prostatectomy PCa cohort. This could serve as a valuable tool to support clinical decision-making in patients with moderate and high-risk cancers

Postoperative pathologic patient characteristics of patients undergoing radical prostatectomy.

<p>Postoperative pathologic patient characteristics of patients undergoing radical prostatectomy.</p

Flowchart of patient selection.

<p>MP-MRI = multiparametric magnetic resonance imaging; PSA = prostate-specific antigen; RP = radical prostatectomy.</p

Calibration curve demonstrating performance of predicted probability of 3-year biochemical recurrence versus actual probability noted within the study.

<p>BCR = biochemical recurrence.</p

Kaplan-Meier analysis of biochemical recurrence-free survival for patients after radical prostatectomy.

<p>(A) By multiparametric magnetic resonance imaging suspicion score. (B) By extracapsular extension on magnetic resonance imaging. BCRFS = biochemical recurrence-free survival; mECE = extracapsular extension on magnetic resonance imaging; SVI = seminal vesicle invasion on magnetic resonance imaging.</p

Nomogram to predict biochemical recurrence at 36 months after radical prostatectomy incorporating both clinical and multiparametric magnetic resonance imaging parameters.

<p>MP-MRI = multiparametric magnetic resonance imaging; MRI = magnetic resonance imaging.</p