Introduction: Extraprostatic extension (EPE) on radical prostatectomy (RP) pathology is an established prognostic indicator of recurrence and metastasis. Furthermore, suspicion of EPE guides neurovascular preservation during surgery. Here we investigate whether capsular ‘abutment’ on pre-operative mpMRI of the prostate predicts pathological findings.
Methods: We queried our prospectively collected institutional database from 2018 for all men undergoing radical prostatectomy (RP) who had undergone preoperative prostate MRI. Statistics were performed using t-test, chi-squared analysis, and logistical regressions with significance defined as p<0.05.
Results: 539 men underwent RP since March 2018. 307 (56%) men had pre-operative MRI. 163 (53.1%) had abutment of the capsule on MRI. For men with capsular abutment, 75 (46.25%) had EPE at prostatectomy (matched laterality in 42 (56%), on the contralateral side from their MRI lesion in 33 (44%)). 65/144 (45.1%) of men without capsular abutment on MRI had EPE on RP pathology. Men with ipsilateral EPE to their MRI lesions with capsular abutment were more likely to have a higher total prostate health index (PHI) (mean 64.20 vs. 50.95, p-value 0.024), and higher Gleason Grade Group (GG) lesion on diagnostic biopsy (p-value 0.001). Independent predictors of having ipsilateral EPE on multivariable logistic regression analysis include GG3 (OR 3.65, 95%CI 1.2-11.1) and GG4 (OR 4.7, 95%CI 1.2-18.8) on primary biopsy. On multivariable logistic regression analysis, MRI PIRADS scores were not predictive of either presence of ‘any’ EPE or ipsilateral EPE on final RP pathology.
Conclusions: : In our series, the presence or absence of “capsular abutment” alone read on MRI was a poor indicator of extra-prostatic extension on final pathology.
Source of Funding: UROLOGY CARE FOUNDATION RESIDENCY RESEARCH AWARD
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