AUA 2018: Multi-Institutional External Validation of the EAU Guidelines for the Use of Staging mpMRI Prior to Radical Prostatectomy in Men with Intermediate and High-Risk Prostate Cancer

San Francisco, CA (  Current EAU guidelines advocate for the use of mpMRI for patients with high risk disease (defined as high risk on D’Amico criteria or >=ISUP Grade 3) for local staging purposes. These recommendations are based on evidence that has not previously been externally validated, though. The presenters, therefore, used a 4-institutional cohort of men in Europe to evaluate the utility of mpMRI for these high-risk men in a real-world setting.

They identified 723 patients who had preoperative MRIs and subsequently underwent radical prostatectomy. The primary outcomes were the presence of seminal vesical invasion (SVI) and extracapsular extension (ECE). Several multivariable models and decision curve analyses were used to define the diagnostic abilities of mpMRI in different patient groups based on risk profiles. 

They found that models using both mpMRI findings in combination with clinical information had the highest predictive ability for both SVI and ECE in high-risk men (all models demonstrated predictive abilities between 0.6 to 0.7). The predictive ability appeared to be a bit more pronounced in men with >= ISUP grade 3 disease. Overall, the findings suggest that the EAU guidelines recommending the use of mpMRI for local staging in high-risk men are appropriate. Nonetheless, the predictive abilities of these tests, even when used in combination with clinical information, are not perfect. Caution should continue to be exercised when counseling patients on risks for adverse pathology using mpMRI data.

Presented by: Paolo Dell’Oglio; Milan, Italy
Co-Authors: Armando Stabile, Milan, Italy, Pietro Grande, Paris, France, Matteo Soligo, Rochester, MN, Giulia Cristel, Anna Damascelli, Milan, Italy, Raphaele Renard-Penna, Paris, France, Laurent Salomon, Créteil, France, Nicola Fossati, Antonio Esposito, Giorgio Gandaglia, Milan, Italy, Jeffrey R. Karnes, Rochester, MN, Francesco De Cobelli, Milan, Italy, Morgan Roupret, Paris, France, Alexandre De La Taille, Créteil, France, Francesco Montorsi, Alberto Briganti, Milan, Italy

Written by:  Shreyas Joshi, MD, Fox Chase Cancer Center, Philadelphia, PA, @ssjoshimd at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA