The Number of Cancer-Involved Regions in Patients With Prostate Cancer Diagnosed by Magnetic Resonance Imaging/Ultrasound-Guided Fusion Prostate Biopsy Is a New Tumor Metric Associated With the Increased Risk of Adverse Pathology at Radical Prostatectomy

Purpose: Current staging systems do not incorporate tumor metrics such as the number of cancer-involved regions and maximum cancer core length from MRI/US-fusion prostate biopsy as criteria for stratifying prostate cancer (PC) patients into risk groups, due to a lack of a standardized biopsy protocol. The study evaluated the association between a new prognostic criterion, the number of cancer-involved regions from MRI/US-fusion prostate biopsy, and the increased risk of postprostatectomy adverse pathology. Materials and Methods: The study involved 131 patients with PC diagnosed by MRI/US-fusion prostate biopsy, who underwent radical prostatectomy (RP). Univariable and multivariable analyses were conducted to identify clinicopathological variables associated with postoperative adverse pathology. The number of cancer-involved regions and maximum cancer core length were assessed as predictors of adverse pathology using ROC and decision curve analyses. Results: Fifty-four patients (41.2%) had adverse pathology at RP. In univariable and multivariable analyses, the number of cancer-involved regions and maximum cancer core length were significantly associated with increased risk of postprostatectomy adverse pathology. ROC analysis indicated that a cutoff of > 3 cancer-involved regions and a maximum cancer core length > 10 mm on MRI/US-fusion prostate biopsy was associated with a higher probability of postprostatectomy adverse pathology. Decision curve analysis demonstrated a net benefit of using these criteria to select appropriate treatments for patients with PC. Conclusions: The number of cancer-involved regions on MRI-fusion prostate biopsy is a criterion associated with an increased risk of postprostatectomy adverse pathology, which will help physicians choose the most appropriate treatment for PC patients in the era of advanced MRI diagnostic technology.