Pd50-09 a Nomogram to Predict Lymphnode 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 UrologyProstate Cancer: Detection & Screening V (PD50)1 May 2024PD50-09 A NOMOGRAM TO PREDICT LYMPHNODE INVOLVEMENT IN CANDIDATES TO ROBOT-ASSISTED RADICAL PROSTATECTOMY WITH IT3 PROSTATE CANCER ON PREOPERATIVE MULTIPARAMETRIC MRI AS UNIQUE HIGH-RISK FEATURE Carlo Andrea Bravi, Marco Paciotti, Eleonora Balestrazzi, Adele Piro, Federico Piramide, Maria Peraire, Gabriele Sorce, Claudia Colla Ruvolo, Nicola Frego, Marco Ticonosco, Mario Belmonte, Pissavini Alessandro, Silvia Rebuffo, Ruben Groote, Geert De Naeyer, Paolo Dell'Oglio, Andrea Minervini, Fabrizio Di Maida, Francesco Porpiglia, Riccardo Schiavina, Marcio Covas Moschovas, Vipul Patel, Francesco Montorsi, and Alexandre Mottrie Carlo Andrea BraviCarlo Andrea Bravi , Marco PaciottiMarco Paciotti , Eleonora BalestrazziEleonora Balestrazzi , Adele PiroAdele Piro , Federico PiramideFederico Piramide , Maria PeraireMaria Peraire , Gabriele SorceGabriele Sorce , Claudia Colla RuvoloClaudia Colla Ruvolo , Nicola FregoNicola Frego , Marco TiconoscoMarco Ticonosco , Mario BelmonteMario Belmonte , Pissavini AlessandroPissavini Alessandro , Silvia RebuffoSilvia Rebuffo , Ruben GrooteRuben Groote , Geert De NaeyerGeert De Naeyer , Paolo Dell'OglioPaolo Dell'Oglio , Andrea MinerviniAndrea Minervini , Fabrizio Di MaidaFabrizio Di Maida , Francesco PorpigliaFrancesco Porpiglia , Riccardo SchiavinaRiccardo Schiavina , Marcio Covas MoschovasMarcio Covas Moschovas , Vipul PatelVipul Patel , Francesco MontorsiFrancesco Montorsi , and Alexandre MottrieAlexandre Mottrie View All Author Informationhttps://doi.org/10.1097/01.JU.0001008620.35181.96.09AboutPDF 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 patients 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 counseling, especially when an extended pelvic lymph node dissection (ePLND) is 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 on preoperative MRI who received RARP and ePLND at five high-volume centers (2015-2020). 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 ISUP 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. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1060 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Carlo Andrea Bravi More articles by this author Marco Paciotti More articles by this author Eleonora Balestrazzi More articles by this author Adele Piro More articles by this author Federico Piramide More articles by this author Maria Peraire More articles by this author Gabriele Sorce More articles by this author Claudia Colla Ruvolo More articles by this author Nicola Frego More articles by this author Marco Ticonosco More articles by this author Mario Belmonte More articles by this author Pissavini Alessandro More articles by this author Silvia Rebuffo More articles by this author Ruben Groote More articles by this author Geert De Naeyer More articles by this author Paolo Dell'Oglio More articles by this author Andrea Minervini More articles by this author Fabrizio Di Maida More articles by this author Francesco Porpiglia More articles by this author Riccardo Schiavina More articles by this author Marcio Covas Moschovas 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 ...