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67th Annual Meeting Abstracts
Endorectal MRI does not Differentiate between Favorable and Adverse Pathologic Features in Men with Prostate Cancer who would Qualify for Expectant Management
Matthew J Resnick1, Thomas J Guzzo1, Daniel J Canter1, Trinity J Bivalacqua2, *John E Tomaszewski1, Alan J Wein1, S. Bruce Malkowicz1
1The University of Pennsylvania, Philadelphia, PA;2The Johns Hopkins Medical Institutions, Baltimore, MD
Introduction: With the increased diagnosis of potentially non-lethal tumors the concept of active surveillance (AS) has become an increasingly popular alternative for select men with prostate cancer. The lack of precise clinical staging modalities currently makes it difficult to predict exactly which patients are most appropriate for AS. The goal of our study was to evaluate the ability of endorectal MRI (eMRI) in predicting adverse pathologic features for those who would otherwise quality for AS.
Materials & Methods: We retrospectively reviewed our radical prostatectomy (RP) database from 1991-2007, identifying172 patients who would have qualified for AS and had a pre-operative staging eMRI. eMRI findings were correlated to final pathology to access its ability to predict adverse pathologic features in this patient population.
Results: The mean age of our cohort was 59.8+6.2 years. The mean PSA at the time of diagnosis was 5.2+2.2 ng/ml. Fifty-one percent had no tumor visualized on eMRI and 49% had a tumor detected. At the time of RP, Patients with a documented tumor on eMRI did not have an increased incidence of adverse pathologic findings with regard to tumor volume (p=0.31), extra-capsular extension (p=0.82), Gleason upgrading (p=0.92), seminal vesicle invasion (p=0.97) or positive margin rate (p=0.95) compared to those in which no tumor was seen.
Conclusions: Discrete tumor identification on eMRI is not predictive of adverse pathologic features in patients who would otherwise qualify for AS. eMRI likely does not provide additional information when evaluating prospective patients for AS.
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