A nomogram to predict pathologic T2 stage in candidates to robot-assisted radical prostatectomy with iT3 prostate cancer on preoperative multiparametric MRI: results from a multi-institutional collaboration

Minerva Urology and Nephrology, vol. 75, pp. 231–234

Abstract

In candidates to robot-assisted radical prostatectomy (RARP) for locally advanced (iT3) prostate cancer on preoperative MRI, the performance of MRI for local staging is demonstrably suboptimal, and currently no prediction tools that might help surgeons in preoperative planning are available. We analyzed data of 685 patients with iT3 prostate cancer (PCa) who received RARP at five participating institutions between 2012 and 2020. Multivariable logistic regression model investigated predictors of pT2 disease among variables available before surgery (i.e.: preoperative PSA, biopsy ISUP group, clinical T stage on digital rectal examination-DRE, prostate volume on MRI, PIRADS score of index lesion, seminal vesicles invasion on MRI, location suspicious for T3 disease on MRI). Coefficients from such model were used to build a nomogram to predict organ-confined (i.e. pT2) disease on final pathology. Internal validation was performed using the leave-one-out cross-validation. Median (interquartile range) preoperative PSA was 7.5 (5.2, 11.9) ng/mL, and 280 (41%) and 216 (32%) had biopsy ISUP group 4-5 disease and palpable disease on DRE, respectively. Preoperative MRI was suspicious for iT3 disease on the mid-posterior part of the gland in 485 (71%) men, and 527 (77%) men had a PIRADS 5 lesion. After surgery, a total of 192 (28%) patients had organ-confined disease (i.e. pT2). All variables fitted into the model and were considered to build the nomogram. After internal validation, the AUC was 73% (95% confidence interval: 69%, 77%). Awaiting external validation, we provided data that is relevant to optimize surgical strategy in men diagnosed with iT3 PCa who are scheduled for RARP.

Authors 20

1. Carlo Andrea Bravi corresponding

   Onze Lieve Vrouwziekenhuis Hospital · IRCCS Ospedale San Raffaele · ORSI Academy · Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele

   Affiliation as printed

   Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium - carloandrea.bravi@gmail.com

   ORSI Academy, Ghent, Belgium - carloandrea.bravi@gmail.com

   Unit of Urology, Division of Oncology, IRCCS San Raffaele Hospital, Milan, Italy - carloandrea.bravi@gmail.com

   Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium

   ORSI Academy, Ghent, Belgium

   Unit of Urology, Division of Oncology, IRCCS San Raffaele Hospital, Milan, Italy

2. Elio Mazzone

   IRCCS Ospedale San Raffaele · Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele

   Affiliation as printed

   Unit of Urology, Division of Oncology, IRCCS San Raffaele Hospital, Milan, Italy

3. Paolo Dell’Oglio Aachen Interventional Molecular Imaging Laboratory Department of Radiology, University Medical Center of Leiden, Leiden Interventional Molecular Imaging Laboratory Department of Radiology, University Medical Center of Leiden, Leiden

   Leiden University · Leiden University Medical Center · The Netherlands Cancer Institute · Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda

   Affiliation as printed

   Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy;

   Department of Urology, the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;

   Interventional Molecular Imaging Laboratory, Department of Radiology, University Medical Center of Leiden, Leiden, the Netherlands;

   Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

   Department of Urology, the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

   Interventional Molecular Imaging Laboratory, Department of Radiology, University Medical Center of Leiden, Leiden, the Netherlands

4. Márcio Covas Moschovas

   AdventHealth Celebration · AdventHealth

   Affiliation as printed

   AdventHealth Global Robotics Institute, Celebration, FL, USA

5. Alberto Martini

   IRCCS Ospedale San Raffaele · Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele

   Affiliation as printed

   Unit of Urology, Division of Oncology, IRCCS San Raffaele Hospital, Milan, Italy

6. Giuseppe Rosiello

   IRCCS Ospedale San Raffaele · Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele

   Affiliation as printed

   Unit of Urology, Division of Oncology, IRCCS San Raffaele Hospital, Milan, Italy

7. Pietro Piazza

   ORSI Academy · University of Bologna

   Affiliation as printed

   Division of Urology, IRCCS University Hospital of Bologna, Bologna, Italy

   ORSI Academy, Ghent, Belgium

8. Angelo Mottaran

   ORSI Academy · University of Bologna

   Affiliation as printed

   Division of Urology, IRCCS University Hospital of Bologna, Bologna, Italy

   ORSI Academy, Ghent, Belgium

9. Marco Paciotti

   IRCCS Humanitas Research Hospital · ORSI Academy

   Affiliation as printed

   Department of Urology, Humanitas IRCCS Research Hospital, Rozzano, Milan, Italy

   ORSI Academy, Ghent, Belgium

10. Luca Sarchi

    University of Modena and Reggio Emilia · ORSI Academy

    Affiliation as printed

    Department of Urology, University of Modena and Reggio Emilia, Modena, Italy

    ORSI Academy, Ghent, Belgium

11. Stefano Puliatti

    University of Modena and Reggio Emilia · ORSI Academy

    Affiliation as printed

    Department of Urology, University of Modena and Reggio Emilia, Modena, Italy

    ORSI Academy, Ghent, Belgium

12. Sophie KNIPPER

    University Medical Center Hamburg-Eppendorf · Martini-Klinik · ORSI Academy

    Affiliation as printed

    Martini-Klinik Prostate Cancer Center, University Hospital of Hamburg-Eppendorf, Hamburg, Germany

    ORSI Academy, Ghent, Belgium

13. Ruben DE GROOTE

    Onze Lieve Vrouwziekenhuis Hospital · ORSI Academy

    Affiliation as printed

    Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium

    ORSI Academy, Ghent, Belgium

14. Riccardo Schiavina

    University of Bologna

    Affiliation as printed

    Division of Urology, IRCCS University Hospital of Bologna, Bologna, Italy

15. Bernando ROCCO

    University of Milan · IRCCS Humanitas Research Hospital · Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo

    Affiliation as printed

    Department of Urology, Humanitas IRCCS Research Hospital, Rozzano, Milan, Italy

    Unit of Urological, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy

16. Antonio Galfano

    Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda

    Affiliation as printed

    Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

17. Alberto Briganti

    IRCCS Ospedale San Raffaele · Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele

    Affiliation as printed

    Unit of Urology, Division of Oncology, IRCCS San Raffaele Hospital, Milan, Italy

18. Francesco Montorsi

    IRCCS Ospedale San Raffaele · Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele

    Affiliation as printed

    Unit of Urology, Division of Oncology, IRCCS San Raffaele Hospital, Milan, Italy

19. Vipul Patel

    AdventHealth Celebration · AdventHealth

    Affiliation as printed

    AdventHealth Global Robotics Institute, Celebration, FL, USA

20. Alexandre Mottrie

    Onze Lieve Vrouwziekenhuis Hospital · ORSI Academy

    Affiliation as printed

    Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium

    ORSI Academy, Ghent, Belgium