Pd10-06 a nomogram to predict lymph node involvement in candidates to robot-assisted radical prostatectomy with it3 prostate cancer on preoperative multiparametric mri as unique high-risk feature

You have accessJournal of UrologyCME1 Apr 2023PD10-06 A NOMOGRAM TO PREDICT LYMPH NODE INVOLVEMENT IN CANDIDATES TO ROBOT-ASSISTED RADICAL PROSTATECTOMY WITH IT3 PROSTATE CANCER ON PREOPERATIVE MULTIPARAMETRIC MRI AS UNIQUE HIGH-RISK FEATURE Carlo Andrea Bravi, Adele Piro, Marco Paciotti, Angelo Mottaran, Paolo Dall'Oglio, Elio Mazzone, Luca Sarchi, Eleonora Balestrazzi, Federico Piramide, Maria Peraire Lores, Luigi Nocera, Geert De Naeyer, Ruben De Groote, Andrea Minervini, Marcio Covas Moschovas, Fabrizio Di Maida, Riccardo Schiavina, Francesco Porpiglia, Vipul Patel, Francesco Montorsi, and Alexandre Mottrie Carlo Andrea BraviCarlo Andrea Bravi More articles by this author , Adele PiroAdele Piro More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Angelo MottaranAngelo Mottaran More articles by this author , Paolo Dall'OglioPaolo Dall'Oglio More articles by this author , Elio MazzoneElio Mazzone More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Eleonora BalestrazziEleonora Balestrazzi More articles by this author , Federico PiramideFederico Piramide More articles by this author , Maria Peraire LoresMaria Peraire Lores More articles by this author , Luigi NoceraLuigi Nocera More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Marcio Covas MoschovasMarcio Covas Moschovas More articles by this author , Fabrizio Di MaidaFabrizio Di Maida More articles by this author , Riccardo SchiavinaRiccardo Schiavina More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Vipul PatelVipul Patel More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003250.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients diagnosed with locally advanced prostate cancer (PCa) on preoperative MRI (iT3) are automatically included in the high-risk category. However, we previously showed that 1 in 3 men with iT3 PCa had pT2 disease on final pathology. As such, if iT3 disease is the only high-risk feature in candidates to robot-assisted radical prostatectomy (RARP), it might mislead preoperative counselling, especially when an extended pelvic lymph node dissection (ePLND) in contemplated. Therefore, we assessed predictors of pathologic lymphnode involvement (LNI) in the largest series of men with iT3 PCa treated with RARP. METHODS: We analyzed data of 607 patients with iT3 PCa who received RARP and ePLND at five high-volume centers between 2015 and 2020. Among them, 253 (42%) men had iT3 disease as unique feature of high-risk PCa. In this subgroup of patients, multivariable regression investigated preoperative predictors of LNI on final pathology, namely preoperative PSA, biopsy grade, prostate volume on MRI, index lesion PIRADS score and diameter, location suspicious for iT3 (uni- vs. bi-lateral) and seminal vesicles involvement on MRI. The coefficients were utilized to build a nomogram for the prediction of LNI. RESULTS: Median (interquartile range [IQR]) preoperative PSA was 7.2 (5.0, 10.8) ng/ml, and 42 (17%), 106 (42%) and 105 (42%) men had biopsy ISUP group 1, 2 and 3 disease, respectively. A total of 142 (56%) patients had a PIRADS score 5 lesion, whereas the median (IQR) index lesion diameter was 1.8 (1.3, 2.9) centimeters. After surgery, a total of 40 (16%) patients had LNI on final pathology. The role of preoperative predictors was investigated on multivariable logistic regression analysis, and coefficients were utilized to build a nomogram for the prediction of LNI on final pathology (Figure 1). The area under the curve was 71% (95% confidence interval: 62%, 79%). CONCLUSIONS: In the largest series of candidates to RARP with iT3 PCa as unique high-risk feature, we developed an easy-to-use model for the prediction of LNI on final pathology. The nomogram-derived probability can help physicians to optimize surgical strategy in this subgroup of patients with preoperative imaging suggesting iT3 PCa. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e328 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carlo Andrea Bravi More articles by this author Adele Piro More articles by this author Marco Paciotti More articles by this author Angelo Mottaran More articles by this author Paolo Dall'Oglio More articles by this author Elio Mazzone More articles by this author Luca Sarchi More articles by this author Eleonora Balestrazzi More articles by this author Federico Piramide More articles by this author Maria Peraire Lores More articles by this author Luigi Nocera More articles by this author Geert De Naeyer More articles by this author Ruben De Groote More articles by this author Andrea Minervini More articles by this author Marcio Covas Moschovas More articles by this author Fabrizio Di Maida More articles by this author Riccardo Schiavina More articles by this author Francesco Porpiglia More articles by this author Vipul Patel More articles by this author Francesco Montorsi More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement PDF downloadLoading ...