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Histological findings of totally embedded robot assisted laparoscopic radical prostatectomy (RALP) specimens in 1197 men with a negative (low risk) preoperative multiparametric magnetic resonance imaging (mpMRI) prostate lobe and clinical implications

Prostate Cancer and Prostatic Diseases volume 24, pages 398–405 (2021)Cite this article

Subjects

Abstract

Background

Prostate multiparametric magnetic resonance imaging (mpMRI) has become a popular initial investigation of an elevated PSA and is being incorporated into active surveillance protocols. Decisions on prostate cancer investigation and management based solely on a normal mpMRI remains controversial. Histopathological findings of a totally embedded normal mpMRI lobe are rarely described.

Methods

A retrospective review of the histological findings of negative preoperative mpMRI lobes in men treated by robot assisted laparoscopic radical prostatectomy (RALP). Inclusion criteria included a preoperative low risk mpMRI for both lobes (Prostate Imaging–Reporting and Data System (PIRADS) ≤ 2) or one negative lobe (with a PIRADS 3–5 in the opposite lobe).

Results

A single normal mpMRI lobe was identified in 1018 men (PIRADS 3–5 group). Both lobes were normal in 179 men (PIRADS ≤ 2 group). Prostate cancer was identified in 47.6% (485/1018) of the normal mpMRI lobe opposite a PIRADS 3–5 lesion, including 13.2% (134/1018) with >0.5 cc of International Society of Urologic Pathologists (ISUP) grade 2, or a higher grade cancer. ISUP grade 4–5 was only identified in 2% (20/1018). Compared to RALP histology of the PIRADS 3–5 mpMRI tumour, a pathological ISUP upgrade in the normal mpMRI lobe was identified in 58/1018 men (5.7%). In the PIRADS ≤ 2 group extraprostatic extension occurred in 19% (34/179) and seminal vesicle invasion (pT3b) in 3.9% (7/179). There was no difference in margin status between the PIRADS 3–5 and ≤2 groups (p = 0.247).

Conclusions

mpMRI underestimates tumour grade and volume compared to totally embedded histopathological analysis of RALP specimens, although ISUP grade 4–5 cancer is uncommon. Our analysis provides useful insight into the multifocality of prostate cancers, and highlights the utility of systematic biopsy, in addition to targeted biopsies. These results have ramifications for clinical decisions on prostate cancer management based solely on the mpMRI appearance, including active surveillance.

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Acknowledgements

We would like to thank Ricardo Maldonado from PowerStats Pty. Ltd. for his assistance in completing the statistical analysis for this manuscript.

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Authors and Affiliations

  1. The Prince Charles Hospital, Brisbane, QLD, Australia

    William John Yaxley

  2. University of Queensland, School of Medicine, Brisbane, QLD, Australia

    William John Yaxley, Anthony Franklin, Troy Gianduzzo, David Wong, Hemamali Samaratunga, Matthew Roberts & John William Yaxley

  3. Rouen University Hospital, Rouen, France

    François-Xavier Nouhaud

  4. Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

    François-Xavier Nouhaud, Peter Donato, Matthew Roberts & John William Yaxley

  5. Wollongong Hospital, Wollongong, NSW, Australia

    Sheliyan Raveenthiran

  6. Wesley Medical Research, Brisbane, QLD, Australia

    Anthony Franklin

  7. Wesley Hospital, Brisbane, QLD, Australia

    Anthony Franklin, Geoff Coughlin, Boon Kua, Troy Gianduzzo & John William Yaxley

  8. I-MED Radiology Network, Wesley Hospital, Brisbane, QLD, Australia

    David Wong, Robert Parkinson & Nicholas Brown

  9. Aquesta Uropathology, Brisbane, QLD, Australia

    Hemamali Samaratunga

  10. Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand

    Brett Delahunt

  11. Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden

    Lars Egevad

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Correspondence to John William Yaxley.

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Yaxley, W.J., Nouhaud, FX., Raveenthiran, S. et al. Histological findings of totally embedded robot assisted laparoscopic radical prostatectomy (RALP) specimens in 1197 men with a negative (low risk) preoperative multiparametric magnetic resonance imaging (mpMRI) prostate lobe and clinical implications. Prostate Cancer Prostatic Dis 24, 398–405 (2021). https://doi.org/10.1038/s41391-020-00289-x

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