Validation of novel preoperative risk categories on the prediction of clinical recurrence in patients candidate for radical prostatectomy for clinically localized prostate cancer. results of a large, multi-institutional series

You have accessJournal of UrologyCME1 Apr 2023MP67-04 VALIDATION OF NOVEL PREOPERATIVE RISK CATEGORIES ON THE PREDICTION OF CLINICAL RECURRENCE IN PATIENTS CANDIDATE FOR RADICAL PROSTATECTOMY FOR CLINICALLY LOCALIZED PROSTATE CANCER. RESULTS OF A LARGE, MULTI-INSTITUTIONAL SERIES Elio Mazzone, Giorgio Gandaglia, Francesco Barletta, Andrea Necchi, Daniele Raggi, Laura Marandino, Armando Stabile, Vito Cucchiara, Giuseppe Rosiello, Gabriele Sorce, Francesco Pellegrino, Simone Scuderi, Daniele Robesti, Mario De Angelis, Antony Pellegrino, Mattia Longoni, Pietro Scilipoti, Francesco Montorsi, and Alberto Briganti Elio MazzoneElio Mazzone More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Francesco BarlettaFrancesco Barletta More articles by this author , Andrea NecchiAndrea Necchi More articles by this author , Daniele RaggiDaniele Raggi More articles by this author , Laura MarandinoLaura Marandino More articles by this author , Armando StabileArmando Stabile More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Gabriele SorceGabriele Sorce More articles by this author , Francesco PellegrinoFrancesco Pellegrino More articles by this author , Simone ScuderiSimone Scuderi More articles by this author , Daniele RobestiDaniele Robesti More articles by this author , Mario De AngelisMario De Angelis More articles by this author , Antony PellegrinoAntony Pellegrino More articles by this author , Mattia LongoniMattia Longoni More articles by this author , Pietro ScilipotiPietro Scilipoti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Most of the preoperative risk tools predicting prostate cancer (PCa) recurrence after radical prostatectomy (RP) considered biochemical recurrence (BCR) as the main endpoint when developed. However, not all patients with a BCR ultimately progress to clinical recurrence (CR). We aimed at internally validating a novel preoperative risk classification in predicting CR in patients treated with RP. METHODS: Overall, 2,901 patients treated with RP and who received pre-op mpMRI between 2014 -2022 at eight referral centers were identified. The study outcome was 5-yr CR defined as positive imaging after BCR. Kaplan-Meier and multivariable Cox regression models tested time and predictors of CR. Predictors consisted of PSA, biopsy grade group, MRI stage (organ-confined vs extracapsular extension vs. seminal vesicles invasion) and maximum diameter of lesion at MRI. These variables defined four risk groups based on the novel classification. The tool accuracy was compared to the EAU risk classification and CAPRA score in predicting 5-year CR using Harrel’s c-index. Decision curve analyses (DCA) compared the net-benefit associated with each of the risk tools. RESULTS: Overall, 937 (32%), 1006 (35%), 848 (30%) and 110 (3%) had low, intermediate, high and very-high risk disease according to the novel classification. Median follow-up was 43 months. At KM analyses, 5-year CR-free survival rates were 94, 90, 83 and 71% in, respectively, low, intermediate, high and very-high risk groups (p<0.01). The novel model tested for prediction CR in Cox regression analyses depicted good discrimination at internal validation (c-index 76%). After testing the accuracy of the EAU risk groups and the CAPRA score in our cohort, the novel model showed higher c index (78 vs. 69 vs. 73%). At DCA, our novel model showed a higher net-benefit compared to other models (Figure 1). CONCLUSIONS: We internally validated a novel preoperative risk tool to predict CR after RP. Our model exhibited higher accuracy as compared to available tools in the prediction of stronger oncologic endpoints at mid-term follow-up. This data reinforces the utility of this patient stratification for preoperative counselling and outcome predictions. Source of Funding: no © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e944 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elio Mazzone More articles by this author Giorgio Gandaglia More articles by this author Francesco Barletta More articles by this author Andrea Necchi More articles by this author Daniele Raggi More articles by this author Laura Marandino More articles by this author Armando Stabile More articles by this author Vito Cucchiara More articles by this author Giuseppe Rosiello More articles by this author Gabriele Sorce More articles by this author Francesco Pellegrino More articles by this author Simone Scuderi More articles by this author Daniele Robesti More articles by this author Mario De Angelis More articles by this author Antony Pellegrino More articles by this author Mattia Longoni More articles by this author Pietro Scilipoti More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...