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Minerva Urology and Nephrology 2023 April;75(2):231-4

DOI: 10.23736/S2724-6051.22.04992-8

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

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

Carlo A. BRAVI ^{1, 2, 3} ✉, Elio MAZZONE ³, Paolo DELL’OGLIO ^{4, 5, 6}, Marcio COVAS MOSCHOVAS ⁷, Alberto MARTINI ³, Giuseppe ROSIELLO ³, Pietro PIAZZA ^{2, 8}, Angelo MOTTARAN ^{2, 8}, Marco PACIOTTI ^{2, 9}, Luca SARCHI ^{2, 10}, Stefano PULIATTI ^{2, 10}, Sophie KNIPPER ^{2, 11}, Ruben DE GROOTE ^{1, 2}, Riccardo SCHIAVINA ⁸, Bernando ROCCO ^{9, 12}, Antonio GALFANO ⁴, Alberto BRIGANTI ³, Francesco MONTORSI ³, Vipul PATEL ⁷, Alexandre MOTTRIE ^{1, 2}

¹ Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ² ORSI Academy, Ghent, Belgium; ³ Unit of Urology, Division of Oncology, IRCCS San Raffaele Hospital, Milan, Italy; ⁴ Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; ⁵ Department of Urology, the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; ⁶ Interventional Molecular Imaging Laboratory, Department of Radiology, University Medical Center of Leiden, Leiden, the Netherlands; ⁷ AdventHealth Global Robotics Institute, Celebration, FL, USA; ⁸ Division of Urology, IRCCS University Hospital of Bologna, Bologna, Italy; ⁹ Department of Urology, Humanitas IRCCS Research Hospital, Rozzano, Milan, Italy; ¹⁰ Department of Urology, University of Modena and Reggio Emilia, Modena, Italy; ¹¹ Martini-Klinik Prostate Cancer Center, University Hospital of Hamburg-Eppendorf, Hamburg, Germany; ¹² Unit of Urological, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy

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.

KEY WORDS: Prostatic neoplasms; Prostatectomy; Robotic surgical procedures; Magnetic resonance imaging; Nomograms; Seminal vesicles