Is there an impact of the center performing baseline multiparametric MRI on active surveillance outcomes in prostate cancer patients?

You have accessJournal of UrologyCME1 Apr 2023MP38-11 IS THERE AN IMPACT OF THE CENTER PERFORMING BASELINE MULTIPARAMETRIC MRI ON ACTIVE SURVEILLANCE OUTCOMES IN PROSTATE CANCER PATIENTS? Riccardo Leni, Armando Stabile, Giorgio Gandaglia, Vito Cucchiara, Giuseppe Rosiello, Elio Mazzone, Gabriele Sorce, Francesco Pellegrino, Simone Scuderi, Daniele Robesti, Donato Cannoletta, Mario De Angelis, Leonardo Quarta, Paolo Zaurito, Giorgio Brembilla, Francesco De Cobelli, Francesco Montorsi, and Alberto Briganti Riccardo LeniRiccardo Leni More articles by this author , Armando StabileArmando Stabile More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Elio MazzoneElio Mazzone More articles by this author , Gabriele SorceGabriele Sorce More articles by this author , Francesco PellegrinoFrancesco Pellegrino More articles by this author , Simone ScuderiSimone Scuderi More articles by this author , Daniele RobestiDaniele Robesti More articles by this author , Donato CannolettaDonato Cannoletta More articles by this author , Mario De AngelisMario De Angelis More articles by this author , Leonardo QuartaLeonardo Quarta More articles by this author , Paolo ZauritoPaolo Zaurito More articles by this author , Giorgio BrembillaGiorgio Brembilla More articles by this author , Francesco De CobelliFrancesco De Cobelli 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.0000000000003276.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Magnetic resonance imaging (MRI) of the prostate has been incorporated as a tool to confirm eligibility for active surveillance (AS). The impact of radiologist expertise on MRI diagnostic performance has been widely demonstrated. However, the increased number of centers performing MRI has increased the variability of both quality and performance. In this study, we assessed the diagnostic accuracy of MRI performed at a single high volume center vs external centers for patients under AS. METHODS: We identified 535 men on AS at our Institution with baseline MRI and at least one surveillance biopsy (sBx). MRIs were stratified according to centers performing the scan (high volume single center performing > 500 MRIs per year vs external centers) and to the detection of visible lesions (negative: PI-RADS 1-2, positive: PI-RADS 3-5). Reclassification was defined as increase in Gleason score at sBx, or higher disease volume ( >33% of involved cores, or >50% of a single core involved). Reclassification-free survival (RFS) was estimated with the Kaplan-Meier method. A Cox model tested the prognostic impact of the center performing MRI according to lesion visibility, after adjusting for covariates. RESULTS: Median age was 65 years (IQR 59-70), 52% (n=280) and 48% (n=255) of patients underwent baseline MRI at our Institution (internal) vs external Institutions. A lower proportion of negative scans was observed among the external MRI scans (18% vs 35%, p<0.001). After a median follow-up of 43 months, 47% (n=253) of men were reclassified. The 5-year RFS was 76% vs 40% for internal vs external negative MRI scans (p<0.001). A negative external MRI was associated with a 1.98-fold increased risk of reclassification compared to a negative internal MRI (95% CI 1.07-3.65, p=0.03). In contrast, the 5-year RFS was 37% vs 35% for internal vs external positive MRI scans, respectively (p=0.2). CONCLUSIONS: We demonstrated that the negative predictive value of MRI scans performed at high volume centers is significantly higher compared to MRIs performed externally. Our findings indirectly support the need for centralization of MRIs in men on AS, as well as the invariable need of follow-up biopsies for those with negative MRIs performed externally. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e528 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Riccardo Leni More articles by this author Armando Stabile More articles by this author Giorgio Gandaglia More articles by this author Vito Cucchiara More articles by this author Giuseppe Rosiello More articles by this author Elio Mazzone More articles by this author Gabriele Sorce More articles by this author Francesco Pellegrino More articles by this author Simone Scuderi More articles by this author Daniele Robesti More articles by this author Donato Cannoletta More articles by this author Mario De Angelis More articles by this author Leonardo Quarta More articles by this author Paolo Zaurito More articles by this author Giorgio Brembilla More articles by this author Francesco De Cobelli More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...