161 Background: Multiparametric magnetic resonance imaging (mpMRI) used in conjunction with MR/TRUS fusion-guided biopsy has improved detection and localization of clinically significant prostate cancer. We aim to evaluate the utility of preoperative MRI characteristics to predict biochemical recurrence (BCR) following radical prostatectomy. Methods: Patients who underwent robotic assisted radical prostatectomy (RARP) between 2007-2014 at the National Institutes of Health were reviewed. We identified patients with BCR defined following the guidelines of the AUA Localized Prostate Cancer Update Panel report (serum PSA ≥0.2 ng/ml with a subsequent confirmatory value). Bivariate analysis and logistic regression were used to determine the association of mpMRI and preoperative patient characteristics with BCR. Results: Of 365 patients who had RARP, 21 met criteria for BCR with a median follow up of 19 months (IQR: 10-34). Mean preoperative PSA (ng/mL) [p<0.001], high MRI suspicion level [p=0.016], presence of extracapsular extension (ECE) on MRI [p=0.003], and total prostate volume by MRI (cc) [p<0.001] were associated with BCR. Increasing MRI suspicion corresponded to increases in rates of BCR within suspicion levels (2.22% of low, 3.88% of moderate, and 10.64% of high). The rates of BCR were significantly greater in men with ECE on final pathology [p<0.001]. Gleason grade trended toward significance [p=0.058]. Controlling for potentially confounding preoperative variables on multivariate analysis, MRI suspicion score, ECE on MRI, and total prostate volume by MRI remained significantly associated with predicting BCR. Conclusions: MRI suspicion score, ECE on mpMRI, and total prostate volume were associated with BCR in patients undergoing RARP. Preoperative mpMRI characteristics aid in risk stratification, patient counseling, and modification of surgical technique in those with high risk imaging features for BCR. The integration of mpMRI characteristics into a comprehensive model of BCR may provide robust tools for preoperative staging and surgical planning.
Association of ERG/PTEN status with biochemical recurrence after radical prostatectomy for clinically localized prostate cancer
