Advertisement

International Urology and Nephrology

, Volume 51, Issue 8, pp 1349–1355 | Cite as

Index tumor volume on MRI as a predictor of clinical and pathologic outcomes following radical prostatectomy

  • Dordaneh Sugano
  • Abhinav Sidana
  • Amit L. JainEmail author
  • Brian Calio
  • Sonia Gaur
  • Mahir Maruf
  • Maria Merino
  • Peter Choyke
  • Baris Turkbey
  • Bradford J. Wood
  • Peter A. Pinto
Urology - Original Paper

Abstract

Purpose

Index tumor volume (ITV) measured on radical prostatectomy (RP) specimens has been shown to be associated with adverse pathologic and oncologic outcomes. We evaluate the value of ITV calculated from prostate multiparametric MRI (mpMRI) in predicting adverse clinical and pathologic outcomes.

Materials and methods

Data from a prospectively maintained, single-institution database were analyzed for patients who underwent mpMRI prior to RP (2007–2016). Index tumor was defined as a T2-visible lesion with the longest diameter. Adverse pathologic outcomes were extraprostatic extension (EPE), lymph node invasion (LNI), seminal vesicle invasion (SVI), and positive margins (PM). Logistic and Cox proportional hazard regression were used to assess associations with adverse pathology and biochemical recurrence (BCR), respectively.

Results

Of the 455 patients included, EPE, LNI, SVI and PM were present in 23.5%, 6.2%, 5.5% and 15.7% patients, respectively. Patients with adverse pathologic outcomes had larger median ITV. ITV was found to be an independent predictor of EPE (OR 1.22, p = 0.010), LNI (OR 1.39, p = 0.001), and SVI (OR 1.28, p = 0.009), but not PM (OR 1.03, p = 0.522). Combination of ITV and PSA was found to have predictive ability comparable to that of modified Partin tables (EPE:ITV + PSAAUC = 0.71 vs. PartinAUC = 0.71; LNI:ITV + PSAAUC = 0.92 vs. PartinAUC = 0.90, SVI:ITV + PSAAUC = 0.78 vs. PartinAUC = 0.82). 5 year BCR-free survival (median follow-up 24.9 months) was higher for patients with ITV < 2 cc (84.1% vs. 58.5%, p = 0.001). However, ITV was not found to be an independent predictor of BCR (HR 1.69, p = 0.130).

Conclusions

We demonstrate that ITV measured on mpMRI is a predictor of adverse pathologic and clinical outcomes and can aid in preoperative risk assessment.

Keywords

Biomarkers Magnetic resonance imaging Prostatic neoplasms Tumor volume PSA 

Notes

Acknowledgements

Supported by the Intramural Research Program of National Institutes of Health, National Cancer Institute, Center for Cancer Research, Center for Interventional Oncology, and the National Institutes of Health Medical Research Scholars Program, a public–private partnership supported jointly by National Institutes of Health and contributions to the Foundation for National Institutes of Health from Pfizer Inc., The Doris Duke Charitable Foundation, The Alexandria Real Estate Equities Inc., Mr. and Mrs. Joel S. Marcus, the Howard Hughes Medical Institute and other private donors (http://fnih.org/work/education-training-0/medical-research-scholars-program).

Compliance with ethical standards

Conflict of interest

The authors have no affiliation with any organization with a direct or indirect financial interest in the subject matter discussed in the manuscript. NIH, Philips Healthcare have a cooperative research, NIH and Philips share intellectual property in the field and development agreement.

References

  1. 1.
    Knoedler JJ, Karnes RJ, Thompson RH et al (2014) The association of tumor volume with mortality following radical prostatectomy. Prostate Cancer Prostatic Dis 17:144–148CrossRefPubMedGoogle Scholar
  2. 2.
    Wysock JS, Mendhiratta N, Zattoni F et al (2016) Predictive value of negative 3T multiparametric magnetic resonance imaging of the prostate on 12-core biopsy results. BJU Int 118:515–520CrossRefPubMedGoogle Scholar
  3. 3.
    Turkbey B, Mani H, Aras O et al (2012) Correlation of magnetic resonance imaging tumor volume with histopathology. J Urol 188:1157–1163CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Villers A, Puech P, Mouton D et al (2006) Dynamic contrast enhanced, pelvic phased array magnetic resonance imaging of localized prostate cancer for predicting tumor volume: correlation with radical prostatectomy findings. J Urol 176:2432–2437CrossRefPubMedGoogle Scholar
  5. 5.
    Turkbey B, Pinto PA, Mani H et al (2010) Prostate cancer: value of multiparametric MR imaging at 3 T for detection–histopathologic correlation. Radiology 255:89–99CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
  7. 7.
    Cookson MS, Aus G, Burnett AL et al (2007) 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 177:540–545CrossRefPubMedGoogle Scholar
  8. 8.
    Meyer CP, Hansen J, Boehm K et al (2016) Tumor volume improves the long-term prediction of biochemical recurrence-free survival after radical prostatectomy for localized prostate cancer with positive surgical margins. World J Urol 35(2):199–206CrossRefPubMedGoogle Scholar
  9. 9.
    Merrill MM, Lane BR, Reuther AM et al (2007) Tumor volume does not predict for biochemical recurrence after radical prostatectomy in patients with surgical Gleason score 6 or less prostate cancer. Urology 70:294–298CrossRefPubMedGoogle Scholar
  10. 10.
    Jung JW, Lee JK, Hong SK et al (2015) Stratification of patients with intermediate-risk prostate cancer. BJU Int 115:907–912CrossRefPubMedGoogle Scholar
  11. 11.
    Beauval JB, Ploussard G, Cabarrou B et al (2016) Improved decision making in intermediate-risk prostate cancer: a multicenter study on pathologic and oncologic outcomes after radical prostatectomy. World J Urol 35(8):1191–1197CrossRefPubMedGoogle Scholar
  12. 12.
    Somford DM, Hamoen EH, Futterer JJ et al (2013) 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 190:1728–1734CrossRefPubMedGoogle Scholar
  13. 13.
    Pelzer AE, Colleselli D, Bektic J et al (2008) Pathological features of Gleason score 6 prostate cancers in the low and intermediate range of prostate-specific antigen level: is there a difference? BJU Int 101:822–825CrossRefPubMedGoogle Scholar
  14. 14.
    Nakanishi H, Troncoso P, Babaian RJ (2008) Prediction of extraprostatic extension in men with biopsy Gleason score of 8 or greater. J Urol 180:2441–2445 (discussion 2445-6) CrossRefPubMedGoogle Scholar
  15. 15.
    Chun FK, Briganti A, Jeldres C et al (2007) Tumour volume and high grade tumour volume are the best predictors of pathologic stage and biochemical recurrence after radical prostatectomy. Eur J Cancer 43:536–543CrossRefPubMedGoogle Scholar
  16. 16.
    Kongnyuy M, Sidana A, George AK et al (2017) Tumor contact with prostate capsule on magnetic resonance imaging: a potential biomarker for staging and prognosis. Urol Oncol 35:30.e1–30.e8CrossRefGoogle Scholar
  17. 17.
    Abdollah F, Abdo A, Sun M et al (2013) Pelvic lymph node dissection for prostate cancer: adherence and accuracy of the recent guidelines. Int J Urol 20:405–410CrossRefPubMedGoogle Scholar
  18. 18.
    Briganti A, Gallina A, Nazareno S et al (2013) 374 External validation of the eau guidelines for pelvic lymph node dissection among patients treated with robotic assisted radical prostatectomy. J Urol 189:e151–e152Google Scholar
  19. 19.
    Yossepowitch O, Briganti A, Eastham JA et al (2014) Positive surgical margins after radical prostatectomy: a systematic review and contemporary update. Eur Urol 65:303–313CrossRefPubMedGoogle Scholar
  20. 20.
    Boorjian SA, Karnes RJ, Crispen PL et al (2010) The impact of positive surgical margins on mortality following radical prostatectomy during the prostate specific antigen era. J Urol 183:1003–1009CrossRefPubMedGoogle Scholar
  21. 21.
    Chalfin HJ, Dinizo M, Trock BJ et al (2012) Impact of surgical margin status on prostate-cancer-specific mortality. BJU Int 110:1684–1689CrossRefPubMedGoogle Scholar
  22. 22.
    Preston MA, Blute ML (2014) Positive surgical margins after radical prostatectomy: does it matter? Eur Urol 65:314–315CrossRefPubMedGoogle Scholar
  23. 23.
    Novara G, Ficarra V, Mocellin S et al (2012) Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy. Eur Urol 62:382–404CrossRefPubMedGoogle Scholar
  24. 24.
    Ho R, Siddiqui MM, George AK et al (2016) Preoperative Multiparametric Magnetic Resonance Imaging Predicts Biochemical Recurrence in Prostate Cancer after Radical Prostatectomy. PLoS One 11:e0157313CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Meng Y, Li H, Xu P et al (2015) Do tumor volume, percent tumor volume predict biochemical recurrence after radical prostatectomy? A meta-analysis. Int J Clin Exp Med 8:22319–22327PubMedPubMedCentralGoogle Scholar
  26. 26.
    Bhindi B, Mamdani M, Kulkarni GS et al (2015) Impact of the U.S. preventive services task force recommendations against prostate specific antigen screening on prostate biopsy and cancer detection rates. J Urol 193:1519–1524CrossRefPubMedGoogle Scholar
  27. 27.
    Banerji JS, Wolff EM, Massman JD et al (2016) Prostate needle biopsy outcomes in the Era of the U.S. preventive services task force recommendation against prostate specific antigen based screening. J Urol 195:66–73CrossRefPubMedGoogle Scholar
  28. 28.
    Klotz L, Vesprini D, Sethukavalan P et al (2015) Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol 33:272–277CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Dordaneh Sugano
    • 1
  • Abhinav Sidana
    • 1
  • Amit L. Jain
    • 1
    Email author
  • Brian Calio
    • 1
  • Sonia Gaur
    • 2
  • Mahir Maruf
    • 1
  • Maria Merino
    • 3
  • Peter Choyke
    • 2
  • Baris Turkbey
    • 2
  • Bradford J. Wood
    • 4
  • Peter A. Pinto
    • 1
  1. 1.Urologic Oncology Branch, National Cancer InstituteNational Institutes of HealthBethesdaUSA
  2. 2.Molecular Imaging Program, National Cancer InstituteNational Institutes of HealthBethesdaUSA
  3. 3.Center for Cancer Research, National Cancer InstituteNational Institutes of HealthBethesdaUSA
  4. 4.National Cancer Institute and Clinical Center, Center for Interventional OncologyNational Institutes of HealthBethesdaUSA

Personalised recommendations