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    Pre-op mpMRI variables predict post-RARP recurrence

    Imaging modality could enhance risk stratification, patient counseling

    Bethesda, MD—Findings from preoperative multiparametric magnetic resonance imaging (mpMRI) may enhance risk stratification, surgical planning, and patient counseling for men with prostate cancer, according to researchers from the National Institutes of Health, Bethesda, MD. 

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    In a study presented at the 2015 AUA annual meeting in New Orleans, the authors reported that three preoperative mpMRI variables—suspicion score, total prostate volume, and extracapsular extension (ECE)—independently predicted biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP). In addition, a nomogram they developed that incorporated the three predictive mpMRI variables with preoperative PSA accurately predicted the risk of BCR (concordance index=0.79).

    “Going forward, it will be important to validate our nomogram using data from other institutions and to compare its performance with existing instruments for predicting BCR,” said first author Richard Ho, who was an NIH National Cancer Institute medical research scholar at the time of the study.

    “However, we believe our findings provide strong support for the idea that preoperative mpMRI can have a role for staging patients and supporting clinical decision-making,” added Ho, who worked on the study with Peter Pinto, MD, and colleagues.

    He added that the information provided by the NIH mpMRI nomogram might also be useful for helping to set patient expectations prior to surgery.

    “The decision on who should get adjuvant therapy is ultimately guided by findings at surgery. Use of this nomogram, however, may augment our ability to accurately counsel men preoperatively about their risk and minimize the chance that they will be surprised and disappointed if adjuvant therapy is recommended postoperatively,” said Ho, currently a medical student at Albert Einstein College of Medicine, New York.

    The study assessing the utility of findings from preoperative mpMRI for predicting BCR after RARP included data from 370 men operated on at the NCI between May 2007 and January 2015. All of the men evaluated for the study had PSA follow-up, a good-quality mpMRI, and no history of receiving preoperative radiation or hormonal therapy or postoperative adjuvant therapy.

    Also see: Placement of a hydrogel rectal spacer before RT for prostate Ca

    During a median follow-up of 23.1 months, 39 men (10.5%) developed BCR, which was defined as a serum PSA ≥0.2 ng/mL with a subsequent confirmatory value.

    Next: BCR, no BCR subgroups compared

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