J Urol. 2019 Feb 4. doi: 10.1097/JU.0000000000000134. [Epub ahead of print]
Defining Prostate Cancer at Favorable Intermediate Risk: the Potential Utility Of Magnetic Resonance Imaging And Genomic Tests.
Falagario UG1,2, Beksac AT1, Martini A1, Cumarasamy S1, Gupta A1, Prasad S1, Thulasidass H, Shah QN1, Jayaratna I1, Lewis S3, Rastinehad AR1, Taouli B3, Cormio L2, Carrieri G2, Tewari AK1.
To determine whether prostate multi parametric MRI (mpMRI) and genomic biomarkers might help further defining patients with favorable intermediate risk patients (FIR) prostate cancer which could safely considered suitable for active surveillance (AS).
PATIENTS & METHODS:
From our institutional database, we identified 509 patients who underwent radical prostatectomy with a preoperative MRI and a postoperative Decipher test (GenomeDx Biosciences, Vancouver, BC). According to NCCN risk stratification, 125 had FIR and 171 had Unfavorable Intermediate Risk (UIR) disease.Univariable and multivariable binary logistic regression analyses was used to test the utility of different variables in predicting AP, defined as Gleason Grade Group >2, pT3b or pN1.
On univariable analysis, FIR, mpMRI and Decipher significantly predicted AP; on multivariable analysis, FIR and Decipher maintained their independent predictive value whereas mpMRI did not meet statistical significance (p=0.059). The 19 FIR patients with high genomic risk had an AP rate slightly higher than UIR patients (42.1% vs. 39.8%, respectively, p=0.56), whereas those with low genomic risk had an AP rate slightly lower than VLR-LR patients (7.5% vs. 10.2%, respectively, p=0.84). The 31 FIR patients with high mpMRI and genomic risk had an AP rate slightly lower than UIR patients (25.8% vs. 39.8%, respectively, p=0.14), whereas those at low mpMRI and genomic risk had an AP rate slightly lower than VLR-LR patients (8.5% vs. 10.2%, respectively, p=0.89).
MpMRI and Decipher allowed to better define the risk of AP in FIR patients being diagnosed with PCa.