To analyse the pathological features and survival of patients with a PI-RADS 5 lesion on pre-biopsy MRI.
We extracted from a European multicentre prospectively gathered database the data of patients with a PI-RADS 5 lesion on pre-biopsy MRI, diagnosed using both systematic and targeted biopsies and subsequently treated by radical prostatectomy. The Kaplan-Meier model was used to assess the biochemical-free survival of the whole cohort and univariable and multivariable Cox models were set up to study factors associated with survival.
Between 2013 and 2019, 539 consecutive patients with a PI-RADS 5 lesion on pre-biopsy MRI were treated by radical prostatectomy and included in the analysis. Follow-up data were available for 448 patients. Radical prostatectomy and lymph node dissection specimens showed non-organ confined disease in 297/539 (55%), (including 2 patients with a locally staged pT2 lesion and lymph node involvement (LNI)). With a median follow-up of 25 months (12-39), the median biochemical recurrence-free survival was 54% at 2 years (95% CI 45-61) and 28% at 5 years (95% CI 18-39). Among the factors studied, MRI T stage [T3a vs T2 HR 3.57 (95%CI 1.78-7.16); T3b vs T2 HR 6.17 (95% CI 2.99-12.72)] and PSA density (HR 4.47 95% CI 1.55-12.89) were significantly associated with a higher risk of biochemical recurrence in multivariable analysis.
Patients with a PI-RADS 5 lesion on pre-biopsy MRI have a high risk of early biochemical recurrence after radical prostatectomy. MRI T stage and PSA density can be used to improve patient selection and counselling.
World journal of urology. 2023 Mar 27 [Epub ahead of print]
G Fiard, A Seigneurin, M Roumiguié, S Albisinni, J Anract, G Assenmacher, N Barry Delongchamps, C Dariane, A Feyaerts, A Fourcade, G Fournier, P Gontero, R Mastroianni, M Oderda, A Peltier, T Roumeguère, T Saussez, G Simone, J Van Damme, J L Descotes, G Ploussard, R Diamand
Department of Urology, Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000, Grenoble, France. ., Department of Medical Assessment, Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000, Grenoble, France., Urology Department, CHU Toulouse, Toulouse, France., Department of Urology, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium., Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France., Department of Urology, Jules Bordet Institute, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium., Department of Urology, Hôpital Européen Georges-Pompidou, APHP, Paris-Paris University-U1151 Inserm-INEM, Necker, Paris, France., Department of Urology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200, Brussels, Belgium., Urology Department, Hôpital Cavale Blanche, CHRU Brest, Brest, France., Urology Department, Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy., Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, RM, Italy., Department of Urology, Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000, Grenoble, France., Department of Urology, La Croix du Sud Hospital, IUCT-O, Quint Fonsegrives, France.