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MRI lesion size is more important than the number of positive biopsy cores in predicting adverse features and recurrence after radical prostatectomy: implications for active surveillance criteria in intermediate-risk patients

Prostate Cancer and Prostatic Diseases (2023)Cite this article

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Abstract

Introduction

To determine associations between prostate cancer (PCa) tumor burden measured on biopsy or multiparametric magnetic resonance imaging (mpMRI) and outcomes in intermediate-risk (IR) International Society of Urological Pathology (ISUP) grade 2 men managed with primary radical prostatectomy (RP).

Methods

This retrospective, multicenter study was conducted in eight referral centers. The cohort included IR PCa patients who had ISUP 2 at biopsy. We defined biopsy tumor burden as low/high based on the absence/presence of more than 25% positive cores. Tumor burden on imaging was defined as low/high based on maximum lesion diameter, <15 mm and ≥15 mm at mpMRI, respectively. The histological endpoint of the study was adverse features at RP, defined as ≥pT3a stage and/or lymph node invasion and/or ISUP ≥3 at final pathology. The clinical endpoint was biochemical recurrence (BCR) after RP.

Results

A total of 698 IR patients was included, of whom 335 (48%) had adverse features. In multivariate logistic regression analysis, there was no statistical association between tumor burden at biopsy and adverse features (p = 0.7). Tumor size ≥15 mm at mpMRI was significantly associated with adverse pathology (OR 1.65, 95%CI 1.14–2.39; p = 0.01). No significant association was observed between tumor burden at biopsy and BCR (p = 0.4). Tumor size ≥15 mm at mpMRI was significantly associated with BCR (HR 1.96, 95% CI 1.01–3.80; p = 0.04).

Conclusions

Our data support extending the inclusion criteria to ISUP 2 men with >25% positive cores, provided they have a low tumor size at mpMRI (<15 mm). Prospective studies should be performed to validate these findings.

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Data availability

Data is available on reasonable request from the corresponding author.

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Authors and Affiliations

  1. Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France

    Michael Baboudjian, Jean-Baptiste Beauval, Alae Touzani & Guillaume Ploussard

  2. Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France

    Michael Baboudjian

  3. Department of Urology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France

    Michael Baboudjian & Eric Lechevallier

  4. Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain

    Alessandro Uleri

  5. Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium

    Romain Diamand, Thierry Roumeguère & Alexandre Peltier

  6. Urology Department, Clinique Saint-Augustin, Bordeaux, France

    Jean-Baptiste Roche

  7. Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy

    Vito Lacetera

  8. Department of Urology, IRCCS “Regina Elena” National Cancer Institute, Rome, Italy

    Giuseppe Simone

  9. Division of Urology, Geneva University Hospitals, Geneva, Switzerland

    Daniel Benamran

  10. Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France

    Alexandre Fourcade

  11. Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France

    Gaelle Fiard

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Contributions

Conceived and designed the analysis: MB, AU, GP; performed the analysis: MB, AU, GP; wrote the manuscript: MB; provided critical feedback in shaping the manuscript: all authors.

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Correspondence to Michael Baboudjian.

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Baboudjian, M., Uleri, A., Beauval, JB. et al. MRI lesion size is more important than the number of positive biopsy cores in predicting adverse features and recurrence after radical prostatectomy: implications for active surveillance criteria in intermediate-risk patients. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00693-z

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