Article | Published:

Indication to pelvic lymph nodes dissection for prostate cancer: the role of multiparametric magnetic resonance imaging when the risk of lymph nodes invasion according to Briganti updated nomogram is <5%

Prostate Cancer and Prostatic Diseasesvolume 21pages8591 (2018) | Download Citation

Abstract

Background

The Briganti updated nomogram (BN) is the most popular predictive model aiming to predict the presence of lymph node invasion (LNI) in patients with prostate cancer (PCa), but it lacks information obtained by preoperative imaging.

The primary aim of the study was to evaluate the role of multiparametric prostate magnetic resonance imaging (mp-MRI) in the indication to perform pelvic lymph nodes dissection (PLND) or not in patients with risk of LNI according to BN below 5%.

Methods

Since March 2012 and September 2016, 310 patients who underwent a preoperative mp-MRI for staging purpose and subsequent robot-assisted extended PLND (RAEPLND) were retrospectively evaluated. Mp-MRIs were prospectively analyzed by two experienced radiologists. The imaging parameters analyzed were the presence of extracapsular extension (ECE), seminal vesicles invasion (SVI) and predominant Gleason pattern 4 (pG4). All patients underwent RAEPLND by two experienced surgeons with a standardized technique. A dedicated uropathologist performed all pathological analysis. Univariate analysis and multivariate logistic regression analysis were used in order to identify the predictors of LNI in patients with PCa.

Results

In the overall population, 57 (18.4%) patients had histologically proven pN1 disease. 48/250 patients (19.2%) with a risk of LNI ≥5% as calculated by the BN were staged pN1 at final histopathological analysis. 9/60 patients (15.0%) with a risk of LNI <5% as calculated by BN, who underwent RAEPLND anyway according to the findings at mp-MRI, were staged pN1 at final histopathological analysis. At multivariate logistic regression analysis, all the three mp-MRI parameters were significant independent predictors of LNI after RAEPLND.

Conclusions

The role of mp-MRI seemed to be crucial in patients with a risk of LNI <5% as calculated by the BN. The presence of ECE, SVI, or pG4 at mp-MRI was found to be an independent predictor of LNI by itself.

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Acknowledgements

All the Authors thank Daniele Amparore, MD, for assistance with paper illustration.

Author information

Affiliations

  1. Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy

    • Francesco Porpiglia
    • , Matteo Manfredi
    • , Fabrizio Mele
    • , Riccardo Bertolo
    • , Cristian Fiori
    •  & Stefano De Luca
  2. Division of Pathology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy

    • Enrico Bollito
  3. Division of Radiology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy

    • Dario Gned
    •  & Agostino De Pascale
  4. Department of Radiology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, TO, Italy

    • Filippo Russo
  5. Division of Nuclear Medicine, University of Turin, San Giovanni Battista Hospital, Torino, TO, Italy

    • Roberto Passera

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Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Francesco Porpiglia.

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DOI

https://doi.org/10.1038/s41391-017-0026-5