EAU 2017: Improved recurrence-free survival in locally advanced prostate cancer after robot-assisted radical prostatectomy with 3D-cancer mapping constructed by MRI/US fusion biopsy

London, England (UroToday.com) With the increasing use of MRI prior to the formal diagnosis of prostate cancer, many patients often have a fusion biopsy prior to definitive treatment. In this study, the authors assess whether the use of images from an MRI/US fusion biopsy, in which 3D-mapping is completed, during Robot-assisted radical prostatectomy (RARP) affect surgical outcomes.

In this single institution prospective study, the authors analyze the outcomes from 2 sets of patients: 119 patients who had 3D mapping prior to surgery and 110 patients who did not. Among 119 patients with 3D-Cancer mapping, 39 patients had pT3 lesion which were successfully displayed during surgery with an attachment to the prostatic capsule. Of note, the authors made a point that nerve sparing was completed on the side opposite the index lesion; however, comment on NS on the side of the index lesion was not made.

While no significant difference was seen in cT2 patients, patients with cT3 disease who had pre-operative mapping had lower BCR (2-year recurrence-free survival rate 91% versus 69%, respectively, log-rank test p=0.0287). 

Most surgeons are now considering the role of MRI pre-operatively in setting of high-risk prostate cancer, to help identify ECE and considerations of NS during the procedure. This study adds to that literature.

Limitations / Discussion / Future Directions:

1. The moderator made a very good point that tumor mapping may not be the reason. cT3 disease may have led to wide resection regardless of the mapping studies, thereby confounding the results.
2. Authors note that patients referred to the center who already had a biopsy, if randomized to the mapping study, underwent a separate mapping procedure.


Presented by: K. Kamoi

Co-Authors: Okihara K., Hongo F., Naitoh Y., Iwata A., Kanazawa M., Ushijima S., Ukimura O.

Institution: Kyoto Prefectural University of Medicine, Dept. of Urology, Kyoto, Japan

Written by: Thenappan Chandrasekar, Clinical Fellow, University of Toronto

at the #EAU17 -March 24-28, 2017- London, England

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