Outcomes of prostate cancer patients with seminal vesicle invasion at multiparametric mri managed with radical prostatectomy. do all patients really need a multi-modal approach?

You have accessJournal of UrologyCME1 Apr 2023MP67-06 OUTCOMES OF PROSTATE CANCER PATIENTS WITH SEMINAL VESICLE INVASION AT MULTIPARAMETRIC MRI MANAGED WITH RADICAL PROSTATECTOMY. DO ALL PATIENTS REALLY NEED A MULTI-MODAL APPROACH? Francesco Barletta, Giorgio Gandaglia, Guillaume Ploussard, Massimo Valerio, Riccardo Campi, Andrea Minervini, Sergio Serni, Alessandro Marquis, Jean-Baptiste Beauval, Arnas Rakauskas, Roderick Van Den Bergh, Timo Soeterik, Mathieu Roumiguiè, Luca Afferi, Junlong Zhuang, Hongqian Guo, Agostino Mattei, Paolo Gontero, Elio Mazzone, Giancarlo Marra, Marco Moschini, Sessa Francesco, Armando Stabile, Vito Cucchiara, Nicola Fossati, Francesco Montorsi, and Alberto Briganti Francesco BarlettaFrancesco Barletta More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Guillaume PloussardGuillaume Ploussard More articles by this author , Massimo ValerioMassimo Valerio More articles by this author , Riccardo CampiRiccardo Campi More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Sergio SerniSergio Serni More articles by this author , Alessandro MarquisAlessandro Marquis More articles by this author , Jean-Baptiste BeauvalJean-Baptiste Beauval More articles by this author , Arnas RakauskasArnas Rakauskas More articles by this author , Roderick Van Den BerghRoderick Van Den Bergh More articles by this author , Timo SoeterikTimo Soeterik More articles by this author , Mathieu RoumiguièMathieu Roumiguiè More articles by this author , Luca AfferiLuca Afferi More articles by this author , Junlong ZhuangJunlong Zhuang More articles by this author , Hongqian GuoHongqian Guo More articles by this author , Agostino MatteiAgostino Mattei More articles by this author , Paolo GonteroPaolo Gontero More articles by this author , Elio MazzoneElio Mazzone More articles by this author , Giancarlo MarraGiancarlo Marra More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Sessa FrancescoSessa Francesco More articles by this author , Armando StabileArmando Stabile More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The presence of seminal vesicle invasion (SVI) at multiparametric MRI (mpMRI) represents one of the strongest risk factors for disease recurrence after radical prostatectomy (RP). According to international guidelines, in patients with suspicion of SVI surgery can be offered only in the context of a multi-modal approach. We hypothesized that a subset of men with SVI at imaging might be instead managed with RP only. METHODS: Overall, 4,334 patients diagnosed with MRI-targeted and concomitant systematic biopsy who underwent radical prostatectomy (RP) with or without an extended pelvic lymph node dissection (PLND) at 10 tertiary referral centers worldwide. Among those, we selected men with SVI at mpMRI who did not receive neoadjuvant or adjuvant treatments (n=169). Clinical and preoperative imaging variables were available for all patients. Biochemical recurrence (BCR) was defined as two consecutive PSA ≥0.2 ng/ml. Kaplan-Meier analyses assessed time from surgery to BCR. Cox regression analyses assessed the impact of preoperative imaging and clinical characteristics on the risk of BCR. RESULTS: Median PSA at diagnosis was 11.5 ng/ml. The median maximum diameter of the index lesion was 20 mm. Overall, 49 (29%) patients had multifocal disease at mpMRI. A total of 62 (37%) and 28 (17%) patients had grade group 4-5 and cT3 disease at DRE, respectively. The median follow-up for survivors was 20 months. Overall, 27 patients experienced BCR. The 3-year BCR-free survival was 75%. Biopsy Grade Group 4-5 (HR: 2.2; 95%CI: 1.1-4.8; p=0.04) and the presence of cT3 at DRE (HR: 2.3; 95%CI: 1.1-5.5; p=0.04) were significant predictors of BCR after adjusting for PSA value at diagnosis and maximum diameter of the index lesion. The BCR-free survival rate was significantly higher for those with biopsy Grade Group 1-3 organ-confined disease (n=79, 47%) compared to their counterparts with biopsy Grade Group 4-5 or cT3 (n=88, 53%; 3-year BCR-free survival: 87% vs. 61%; p=0.015). CONCLUSIONS: The prognosis of patients with SVI at mpMRI managed by RP alone is not invariably poor. Men with biopsy Grade Group ≤3 with organ-confined disease have a substantially lower risk of BCR compared to Grade Group >3 or cT3 and can be considered as the ideal candidates for surgery as monotherapy. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e945 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesco Barletta More articles by this author Giorgio Gandaglia More articles by this author Guillaume Ploussard More articles by this author Massimo Valerio More articles by this author Riccardo Campi More articles by this author Andrea Minervini More articles by this author Sergio Serni More articles by this author Alessandro Marquis More articles by this author Jean-Baptiste Beauval More articles by this author Arnas Rakauskas More articles by this author Roderick Van Den Bergh More articles by this author Timo Soeterik More articles by this author Mathieu Roumiguiè More articles by this author Luca Afferi More articles by this author Junlong Zhuang More articles by this author Hongqian Guo More articles by this author Agostino Mattei More articles by this author Paolo Gontero More articles by this author Elio Mazzone More articles by this author Giancarlo Marra More articles by this author Marco Moschini More articles by this author Sessa Francesco More articles by this author Armando Stabile More articles by this author Vito Cucchiara More articles by this author Nicola Fossati More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...