PD34-12 MRI FINDINGS IN DE NOVO SYNCHRONOUS METASTATIC PROSTATE CANCER AND IMPLICATIONS FOR CYTOREDUCTIVE SURGERY

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) III (PD34)1 Sep 2021PD34-12 MRI FINDINGS IN DE NOVO SYNCHRONOUS METASTATIC PROSTATE CANCER AND IMPLICATIONS FOR CYTOREDUCTIVE SURGERY Martin John Connor, Marie Edison, Edward J. Bass, David Eldred-Evans, Mariana Tanaka Bertoncelli, David Hrouda, Bijan Khoubehi, Giles Hellawell, Bhavan Rai, Tim Dudderidge, Henry Tam, Mathias Winkler, and Hashim U. Ahmed Martin John ConnorMartin John Connor More articles by this author , Marie EdisonMarie Edison More articles by this author , Edward J. BassEdward J. Bass More articles by this author , David Eldred-EvansDavid Eldred-Evans More articles by this author , Mariana Tanaka BertoncelliMariana Tanaka Bertoncelli More articles by this author , David HroudaDavid Hrouda More articles by this author , Bijan KhoubehiBijan Khoubehi More articles by this author , Giles HellawellGiles Hellawell More articles by this author , Bhavan RaiBhavan Rai More articles by this author , Tim DudderidgeTim Dudderidge More articles by this author , Henry TamHenry Tam More articles by this author , Mathias WinklerMathias Winkler More articles by this author , and Hashim U. AhmedHashim U. Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002038.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cytoreductive prostate radiotherapy is now often used in de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC), whilst surgery is under trial evaluation. With the use of pre-biopsy prostate mpMRI for biopsy naïve patients referred with a suspicion of prostate cancer, we are able to more accurately describe baseline MRI features and implications for surgical cytoreduction. METHODS: Multicentre prospective study of 1,302 patients, with performance status 0-1, referred with a suspicion of prostate cancer who underwent a pre-biopsy mpMRI (April/2017-June/2020). A transperineal biopsy was advised if mpMRI PI-RADS (v.2.0) score was 4 or 5. Metastatic lesions were confirmed on cross-sectional whole-body CT and bone scintigraphy, with equivocal lesions having Ga68-PSMA PET/CT. RESULTS: 2.84% (37/1,302) were diagnosed with mHSPC. Mean age was 69.0 years (SD 7.4), median prostate volume 52cc (IQR 35.0), median PSA 71ng/ml (IQR 7.0) and PS-0 in 34/37 (91.9%), respectively. Intraprostatic findings were: 37/37 (100%) had PI-RADS=5, MRI-index lesion in 20/37 (54.0%) and diffuse lesion in 17/37 (45.9%). MRI-tumour stage was: T3a 4/37 (10.8%), T3b 13/37 (35.1%), T4 18/37 (48.6%), respectively. MRI-nodal (N1) metastasis were present in 24/37 (64.8%), with irresectable pelvic sidewall disease in 6/37 (16.2%), para-rectal or pre-sacral nodes in 12/37 (32.4%), nodes within extended-pelvic lymph node dissection template in 22/37 (59.4%) and extra-pelvic (M1a) nodal metastasis in 5/37 (13.5%) patients. CONCLUSIONS: Prior to upfront systemic therapy MRI T4-stage disease, surgically irresectable and diffuse intraprostatic lesions are commonplace. Serial prostate MRI combined with PSMA-targeted PET/CT after systemic therapy may have a role in planning for those eligible for cytoreductive surgery. Source of Funding: Wellcome Trust, Imperial College Charity, RM Partners © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e587-e587 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Martin John Connor More articles by this author Marie Edison More articles by this author Edward J. Bass More articles by this author David Eldred-Evans More articles by this author Mariana Tanaka Bertoncelli More articles by this author David Hrouda More articles by this author Bijan Khoubehi More articles by this author Giles Hellawell More articles by this author Bhavan Rai More articles by this author Tim Dudderidge More articles by this author Henry Tam More articles by this author Mathias Winkler More articles by this author Hashim U. Ahmed More articles by this author Expand All Advertisement Loading ...