Validation of user-friendly models predicting extracapsular extension in prostate cancer patients

Objective:There are many models to predict extracapsular extension(ECE)in patients with prostate cancer.We aimed to externally validate several models in a Japanese cohort.Methods:We included patients treated with robotic-assisted radical prostatectomy for prostate cancer.The risk of ECE was calculated for each patient in several models(prostate side-specific and non-side-specific).Model performance was assessed by calculating the receiver operating curve and the area under the curve(AUC),calibration plots,and decision curve analyses.Results:We identified ECE in 117(32.9%)of the 356 prostate lobes included.Patients with ECE had a statistically significant higher prostate-specific antigen level,percentage of positive digital rectal examination,percentage of hypoechoic nodes,percentage of magnetic resonance imaging nodes or ECE suggestion,percentage of biopsy positive cores,International Society of Urological Pathology grade group,and percentage of core involvement.Among the sidespecific models,the Soeterik,Patel,Sayyid,Martini,and Steuber models presented AUC of 0.81,0.78,0.77,0.75,and 0.73,respectively.Among the non-side-specific models,the memorial Sloan Kettering Cancer Center web calculator,the Roach formula,the Partin tables of 2016,2013,and 2007 presented AUC of 0.74,0.72,0.64,0.61,and 0.60,respectively.However,the 95%confidence interval for most of these models overlapped.The side-specific models presented adequate calibration.In the decision curve analyses,most models showed net benefit,but it overlapped among them.Conclusion:Models predicting ECE were externally validated in Japanese men.The side-specific models predicted better than the non-side-specific models.The Soeterik and Patel models were the most accurate performing models.

Multi-parametric MRI of the prostate:Factors predicting extracapsular extension at the time of radical prostatectomy

Objective:Extracapsular extension(ECE)of prostate cancer is a poor prognostic factor associated with progression,recurrence after treatment,and increased prostate cancer-related mortality.Accurate staging prior to radical prostatectomy is crucial in avoidance of positive margins and when planning nerve-sparing procedures.Multi-parametric magnetic resonance imaging(mpMRI)of the prostate has shown promise in this regard,but is hampered by poor sensitivity.We sought to identify additional clinical variables associated with pathologic ECE and determine our institutional accuracy in the detection of ECE amongst patients who went on to radical prostatectomy.Methods:mpMRI studies performed between the years 2012 and 2014 were cross-referenced with radical prostatectomy specimens.Predictive properties of ECE as well as additional clinical and biochemical variables to identify pathology-proven prostate cancer ECE were analyzed.Results:The prevalence of ECE was 32.4%,and the overall accuracy of mpMRI for ECE was 84.1%.Overall mpMRI sensitivity,specificity,positive predictive value,and negative predictive value for detection of ECE were 58.3%,97.8%,93.3%,and 81.5%,respectively.Specific mpMRI characteristics predictive of pathologic ECE included primary lesion size((20.73±9.09)mm,mean±SD,p<0.001),T2 PIRADS score(p=0.009),overall primary lesion score(p<0.001),overall study suspicion score(p=0.003),and MRI evidence of seminal vesicle invasion(SVI)(p=0.001).

Added value of shear-wave elastography in the prediction of extracapsular extension and seminal vesicle invasion before radical prostatectomy

The purpose of this study was to analyze the value of transrectal shear-wave elastography(SWE)in combination with multivariable tools for predicting adverse pathological features before radical prostatectomy(RP).Preoperative clinicopathological variables,multiparametric magnetic resonance imaging(mp-MRI)manifestations,and the maximum elastic value of the prostate(Emax)on SWE were retrospectively collected.The accuracy of SWE for predicting adverse pathological features was evaluated based on postoperative pathology,and parameters with statistical significance were selected.The diagnostic performance of various models,including preoperative clinicopathological variables(model 1),preoperative clinicopathological variables+mp-MRI(model 2),and preoperative clinicopathological variables+mp-MRI+SWE(model 3),was evaluated with area under the receiver operator characteristic curve(AUC)analysis.Emax was significantly higher in prostate cancer with extracapsular extension(ECE)or seminal vesicle invasion(SVI)with both P<0.001.The optimal cutoff Emax values for ECE and SVI were 60.45 kPa and 81.55 kPa,respectively.Inclusion of mp-MRI and SWE improved discrimination by clinical models for ECE(model 2 vs model 1,P=0.031;model 3 vs model 1,P=0.002;model 3 vs model 2,P=0.018)and SVI(model 2 vs model 1,P=0.147;model 3 vs model 1,P=0.037;model 3 vs model 2,P=0.134).SWE is valuable for identifying patients at high risk of adverse pathology.

Locally advanced and high risk prostate cancer:The best indication for initial radical prostatectomy?

High risk prostate cancer is a deadly disease that needs aggressive treatment.High risk prostate cancer is often treated with androgen deprivation therapy or combined radiohormonotherapy while there is a place for surgery in cases of operable and resectable locally advanced or high risk disease.This review summarises the results of the different treatment strategies for locally advanced and high risk prostate cancer.Radical prostatectomy monotherapy or in combination with radiotherapy and/or hormonal treatment are analysed.They show that radical prostatectomy is an effective treatment modality for these tumours.After surgery,the results of the pathology and the follow-up of serum PSA may indicate the need of additional adjuvant or salvage treatment strategies.