Staging Accuracy of Multiparametric MRI in Caucasian and African American Patients Undergoing Radical Prostatectomy
Menée à partir de données portant sur 975 patients atteints d'un cancer de la prostate traité par prostatectomie radicale entre 2013 et 2019, cette étude évalue, en fonction de l'origine ethnique des patients (type afro-américain ou type caucasien) et du grade de la tumeur à la biopsie, la précision d'une IRM multiparamétrique pré-opératoire pour déceler une extension extra-prostatique
Purpose: to compare the performance of mpMRI for prediction of extra-prostatic extension (EPE) in African (AA) and Caucasian American (CA) men and to evaluate racial disparities in pathologic outcomes after radical prostatectomy (RP).
Methods: we identified 975 patients who underwent RP with preoperative mpMRI between January 2013 and April 2019 at our institution. Multivariable logistic regression analysis was performed predicting pathological EPE, high-grade prostate cancer (PCa) [final pathology Gleason Grade Group (GGG)≥3] in the overall population, and pathological upgrading (defined as final pathology GGG≥3) in patients with diagnosis of GGG1-2 PCa. Adverse pathology was defined as pT3 and/or GGG≥3.
Results: 221 (23%) patients were AA. Preoperatively 594 (60.9%) were GGG1-2 (low-risk group) and 381 (39.1%) GGG≥3 (high-risk group). In the low-risk group, rates of pathological EPE (18%vs12.8%, p-value=0.14), adverse pathology (18%vs13.4%, p-value=0.2) or upgrading (9.4%vs12.1%, p-value=0.4) were similar between races. Similarly, in the high-risk group, there was no difference in the rates of pathological EPE. At multivariable analysis, mpMRI predicted the presence of EPE (OR:1.80; 95% CI: 1.29–2.50) and high-grade PCa (OR:1.82; 95% CI: 1.25–2.67) on final pathology. Conversely, Race did not predict the outcomes of interest (all p-values>0.05). MpMRI showed comparable sensitivity (22.22%vs27.84%), specificity (89.2%vs79.2%), PPV (89.2%vs83.4%), and NPV (89.2%vs83.4%) between AA and CA men.
Conclusions: The accuracy of mpMRI at staging PCa was similar in AA and CA patients and no difference was found between races in pathologic outcomes after RP. These findings suggest that access to and use of advanced diagnostic tests may help mitigate PCa racial disparities.
Journal of Urology , résumé, 2019