Introduction: To evaluate the relationship between the preoperative magnetic resonance imaging (MRI) findings of clinically localized prostate cancer (PC) and the oncological outcomes after radical prostatectomy (RP).
Methods: MRI of patients who underwent RP for localized PC were re-read according to PI-RADS version 2, and the patient groups were divided into 4 groups according to the findings; no focal suspicious lesion, PI-RADS score 3, PI-RADS score 4, PI-RADS score 5 It was intended to evaluate its value as a risk assessment scale for biochemical recurrence (BCR) free survival and metastasis free survival.
Results: From October 2007 to December 2020, 2617 patients were analyzed. The median age at RP was 67 (IQR 41-72). The median follow-up was 51 months (IQR 23-95). The median PSA and PSAD was 7.5 (IQR 5.1-12.4) and 0.23 (IQR 0.14-0.39). BCR occurred in 241 (9.2%) patients, and metastasis was confirmed in 66 (2.5%) patients. In univariate analysis, higher MRI categories of 4 and 5 were associated with a higher likelihood of developing BCR (HR 2.0, 9.7, p= 0.032, <0.001). MRI category of 5 was associated with higher metastasis (HR 8.4, p<0.001). In multivariate analysis, PI-RADS score 5 was higher risk for BCR (HR 4.1, <0.001). Median BCR free survival in the PI-RADS score 5 group was 63.7 months, and was statistically significantly inferior to that of the other groups (p < 0.001). Median metastasis free survival in PI-RADS score 5 group was 75.0 months, and it was statistically significantly inferior to that of other groups (p < 0.001).
Conclusions: MRI grades of localized PC are likely to be related with clinical long-term oncologic outcomes.