Background: The combined role of multiparametric magnetic resonance imaging (mp-MRI), and magnetic resonance imaging (MRI)-targeted and concomitant systematic biopsies in the identification of prostate cancer (PCa) patients at a higher risk of adverse pathology at radical prostatectomy (RP) is still unclear. Objective: To develop novel models to predict extracapsular extension (ECE), seminal vesicle invasion (SVI), or upgrading in patients diagnosed with MRI-targeted and concomitant systematic biopsies. Design, setting, and participants: We included 614 men with clinical stage ≤ T2 at digital rectal examination who underwent MRI-targeted biopsy with concomitant systematic biopsy. Outcome measurements and statistical analyses: Logistic regression analyses predicting ECE, SVI, and upgrading (ie, a shift from biopsy International Society of Urological Pathology grade group to any higher grade at RP) based on clinical variables with or without mp-MRI features and systematic biopsy information (the percentage of cores with grade group ≥2 PCa) were developed and internally validated. The area under the curve (AUC) was used to identify the models with the highest discrimination. Decision-curve analyses (DCAs) determined the net benefit associated with their use. Results and limitations: Overall, 333 (54%), 88 (14%), and 169 (27%) patients had ECE, SVI, and upgrading at RP, respectively. The inclusion of mp-MRI data improved the discrimination of clinical models for ECE (67% vs 70%) and SVI (74% vs 76%). Models including mp-MRI, and MRI-targeted and concomitant systematic biopsy information achieved the highest AUC at internal validation for ECE (73%), SVI (81%), and upgrading (73%) and represented the basis for three risk calculators that yield the highest net benefit at DCA. Conclusions: Not only mp-MRI and MRI-targeted sampling, but also concomitant systematic biopsies provide significant information to identify patients at a higher risk of adverse pathology. Although omitting systematic prostate sampling at the time of MRI-targeted biopsy might be associated with a reduced risk of detecting insignificant PCa and lower patient discomfort, it reduces the ability to accurately predict pathological features. Patient summary: The combination of multiparametric magnetic resonance imaging (mp-MRI) with accurate biopsy information on MRI-targeted and systematic biopsies improves the accuracy of multivariable models based on clinical and mp-MRI data alone. Correct mp-MRI interpretation and proper extensive prostate sampling are both needed to predict adverse pathology accurately at radical prostatectomy. The combination of multiparametric magnetic resonance imaging (mp-MRI) data with accurate biopsy information on MRI-targeted and systematic biopsy improves the accuracy of multivariable models based on clinical and mp-MRI data alone predicting extracapsular extension, seminal vesicle invasion, and upgrading. Correct mp-MRI interpretation and proper extensive prostate sampling are needed to accurately predict adverse pathological findings at radical prostatectomy.
- Extracapsular extension
- Magnetic resonance imaging–targeted biopsy
- Multiparametric magnetic resonance imaging
- Prostate cancer
- Radical prostatectomy
- Seminal vesicle invasion
ASJC Scopus subject areas