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2020 CUA Abstracts






         UP-1.14. Table 1. Patient characteristics            UP-1.14. Table 3. Odds ratios of correctly predicting
                                      TRUS      MRI-fusion    post-RP NCCN risk
                                      (n=503)  biopsy (n=74)                           Odds     95% CI     p
         Median age (range)          62 (41–78)  65 (48–75)                            ratio
         Race (%)                                              TRUS vs. MRI-targeted biopsy  20.064  11.301–35.621 <0.0001
           White                      440 (88)   67 (91)        PSA                    0.998  0.972–1.024  0.8706
           Black                      52 (10)     4 (5)         Age                    1.035  1.001–1.071  0.0414
           Other                      11 (2)      3 (4)
         PSA (ng/dl) (mean ± SD)     9.22±8.6   9.98±8.87    and risk scores 5 and 6 showing slight underprediction. Upstaging raged
         Biopsy Gleason grade group (%)                      from 0.0–37.5% in the MRI-targeted biopsy vs. 65.0–100.0% in the TRUS
           1                         73 (14.5)    0 (0)      cohort. In the TRUS cohort, 28.03% of patients were upstaged by more
           2                          237 (47)   32 (44)     than one stage post-RP compared to only 4.05% in the MRI-targeted
                                                             biopsy cohort . On MVA, the odds ratio for predicting NCCN risk was 20.1
           3                         78 (15.5)   12 (16)     times greater for MRI-targeted biopsy versus TRUS (p<0.0001) (Table 3).
           4                          42 (8.5)    9 (12)     Conclusions: MRI-targeted biopsy was superior to TRUS in correctly pre-
           5                         73 (14.5)   21 (28)     dicting post-RP NCCN risk stratification. Additionally, upstaging occurred
         RP Gleason grade group (%)                          much more often in those undergoing TRUS compared to MRI-targeted
           1                          28 (5.5)   1 (1.3)     biopsy. Ultimately, these outcomes have significant implications for the
           2                         239 (47.5)  31 (42.7)   diagnosis and staging of prostate cancer and emphasize the need for tran-
           3                         108 (21.5)  21 (28)     sition from TRUS biopsies to MRI-fusion biopsies as the standard of care.
                                                             References
           4                          43 (8.5)    3 (4)      1.   Xu N, Wu YP, Li XD, et al. Risk of upgrading from prostate biopsy
           5                          85 (17)    18 (24)         to radical prostatectomy pathology: Is magnetic resonance imaging-
         Biopsy NCCN risk stratification (%)                     guided biopsy more accurate. J Cancer 2018;9:3634-9. https://doi.
           1-Very-low                 23 (4.5)    0 (0)          org/10.7150/jca.26791
           2-Low                     34 (6.75)    0 (0)      2.   Drost FH, Osses D, Nieboer D, et al. Prostate magnetic resonance
           3-Favorable-intermediate   186 (37)  25 (34.7)        imaging, with or without magnetic resonance imaging-targeted
           4-Unfavorable-intermediate  124 (24.65)  19 (25.3)    biopsy, and systematic biopsy for detecting prostate cancer: A
                                                                 Cochrane systematic review and meta-analysis. Eur Urol 2020;77:78-
           5-High                    88 (17.5)  11 (14.7)        94. https://doi.org/10.1016/j.eururo.2019.06.023
           6-Very-high                48 (9.6)  19 (25.3)
         RP NCCN risk stratification (%)                     UP-1.15
           1-Very-low                 1 (0.2)    1 (0.2)     Is confirmatory biopsy useful prior to radical prostatectomy for
           2-Low                      7 (1.4)    7 (1.4)     patients on active surveillance who receive magnetic resonance
           3-Favorable-intermediate  190 (37.8)  190 (37.8)  imaging?
           4-Unfavorable-intermediate  114 (22.6)  114 (22.6)  Paulo H Werlang , Michael Horrigan , Luke T. Lavallée , Ilias Cagiannos ,
                                                                         1
                                                                                      1
                                                                                                              1
                                                                                                  1
           5-High                    124 (24.7)  124 (24.7)  Christopher G. Morash , Rodney H. Breau 1
                                                                             1
           6-Very-high               67 (13.3)  67 (13.3)    1 Urology, University of Ottawa, Ottawa, ON, Canada
                                                             Introduction: Patients on active surveillance for low-grade prostate can-
                                                             cer may receive prostate magnetic resonance imaging (MRI) as part of
        Methods: A retrospective analysis of prostate cancer patients who under-  routine followup or due to suspicion of an occult higher-grade lesion. In
        went radical prostatectomy at UNMC between December 2007 and   patients who underwent MRI and subsequently were treated with radical
        November 2018 identified 503 and 75 patients who received either TRUS   prostatectomy (RP), we aimed to determine if pre-prostatectomy prostate
        or an MRI-fusion biopsy, respectively. Comparisons were made between   biopsy was useful prior to treatment.
        preoperative and postoperative NCCN risk stratification score, and the use   Methods: As part of the prostate cancer Surgeon Report Card (SuRep)
        of multivariable analysis (MVA) was used to assess the ability to preopera-  study, we identified active surveillance patients who had an MRI prior to
        tively predict NCCN Risk and adjust for potential demographic influences.  RP. Based on clinical discretion, some patients received a post-MRI biopsy
        Results: The mean age of the patients was 62 years and the mean prostate-  prior to RP, while others did not. We compared pathologic outcomes
        specific antigen (PSA) level was 9.3 ng/ml (Table 1). MRI-targeted biopsy   between these groups.
        correctly predicted post-RP NCCN risk stratification in 70.0% of patients   Results: Between 2015 and 2019, 70 patients met inclusion criteria.
        compared to 10.6% in the TRUS cohort (Table 2). When stratifying by   Twenty-three (33%) received a prostate biopsy prior to RP. Of the biopsy
        NCCN risk, the ability of TRUS to accurately predict NCCN risk ranged   cohort, the PIRADS were ≤3, 4, and 5 in four (17%), 11 (48%), and
        from 1.1–34.7%, with nearly all incorrect assessments being underpredic-  eight (35%) patients, respectively. Corresponding PIRADS in the no-biopsy
        tions. Conversely, accurate NCCN risk for MRI-targeted biopsy ranged   cohort was six (13%), 11 (23%), and 30 (64%), respectively. In the biopsy
        from 57.1–93.3%, with risk scores 3 and 4 showing slight over prediction   cohort (n=23), only one (4%) had a post-MRI/pre-treatment biopsy with
         UP-1.14. Table 2. NCCN risk stratification before and after radical prostatectomy
                                     -4        -3        -2        -1         0         1         2       Total
         TRUS               #         6        37        98        307       53         2         0        503
                           %         1.19      7.36     19.48     61.03     10.54      0.4        0        100
         MRI                #         0         0         3         3        52         7         9        74
                           %          0         0        4.05      4.05     70.27      9.46     12.16      100



        S48                                     CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)
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