MP86-09 INCIDENTAL FINDINGS ON MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING OF THE PROSTATE: PREVALENCE AND CLINICAL RELEVANCE

MP86-09 INCIDENTAL FINDINGS ON MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING OF THE PROSTATE: PREVALENCE AND CLINICAL RELEVANCE

THE JOURNAL OF UROLOGYâ Vol. 193, No. 4S, Supplement, Tuesday, May 19, 2015 e1079 MP86-10 CLINICAL PROSTATE CANCER RISK PREDICTION DERIVED FROM TAR...

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THE JOURNAL OF UROLOGYâ

Vol. 193, No. 4S, Supplement, Tuesday, May 19, 2015

e1079

MP86-10 CLINICAL PROSTATE CANCER RISK PREDICTION DERIVED FROM TARGETED BIOPSY Michael Leapman*, Katsuto Shinohara, Niloufar Ameli, Maxwell Meng, Matthew Cooperberg, Peter Carroll, San Francisco, CA

Source of Funding: None

MP86-09 INCIDENTAL FINDINGS ON MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING OF THE PROSTATE: PREVALENCE AND CLINICAL RELEVANCE Tatiana Martins*, Yves Bohrer, Thais Mussi, Ronaldo Baroni, ~o Paulo, Brazil Sa INTRODUCTION AND OBJECTIVES: Multiparametric magnetic resonance imaging (mpMRI) is a well established modality for location and staging of prostate cancer. The use of mpMRI for the diagnosis and staging of prostate cancer has increased over the past 5 years. Adequate exam protocol includes evaluation of the whole pelvis to evaluate the presence of lymph nodes and bone metastasis. It is not rare to find extraprostatic additional findings, some of them requiring further medical investigation or medical/operative treatment. Our purpose was to determine the prevalence of relevant and non-relevant extra-prostatic findings in patients submitted to prostate mpMRI. METHODS: We retrospectively reviewed the spectrum and incidence of extraprostatic findings of 1171 patients (mean age 61.5 years-old, range 37-100) who underwent mpMRI on a 3-Tesla scanner without an endorectal coil in the last 18 months. The results were divided into clinical categories and also as significant or not significant findings. The findings categorized as significant were those for which most physicians would agree that further investigation or medical/surgical intervention is needed. RESULTS: 712 patients (60,8%) had extraprostatic findings, including 60 (8,5%) significant lesions. The study discovered 20 cases of unsuspected extraprostatic malignancy (1,7% of all patients and 2,8% of incidental findings). Of those suspicious lesions, there were bladder polyps (4 cases), rectal and sigmoideal lesions (3 cases), testicular nodules (4 cases), osseous lesion (4 cases) and pelvic indeterminate lesions (5 cases). In non oncological urological extraprostatic findings there were: ureteral calculus (3 cases), bladder stone (1 case), renal anatomical variants such as horseshoe kidney (3 cases), testicular hydrocele (39 cases), epididymal cysts (21 cases), other testicular alterations such as ectopy and atrophy (16 cases), penile findings (5 cases, including prosthesis and focal lesions) and renal cysts partially evaluated (23 cases). There were 12 cases of abdominal and iliac arteries aneurysms. Regarding colonic findings there were 2 cases of diverticulitis in a total of 229 diverticulosis, and 6 cases of perianal fistulas. CONCLUSIONS: Although incidental findings in patients submitted to mpMRI of the prostate are common, the vast majority of them have no clinical consequence. However, detection of relevant unsuspected extraprostatic findings may require further clinical evaluation and, therefore, systematic evaluation of extraprostatic structures on mpMRI is mandatory for the radiologist. Source of Funding: None.

INTRODUCTION AND OBJECTIVES: The development of novel tools to target and biopsy radiographically-apparent prostate lesions has been shown to reliably identify prostate cancers (PCa), however the implications for clinical risk prediction derived from high probability biopsies are not well understood. METHODS: Under institutional review board approval we retrospectively reviewed biopsy results for men undergoing direct ultrasound targeted, and MR directed (cognitive or fusion) biopsy with discrete radiographic lesions, defined on the basis of hypoechoic ultrasonographic appearance or multi-parametric magnetic resonance imaging (mpMRI) abnormality. All patients underwent simultaneous systematic mapped peripheral zone biopsy with a minimum of 10 cores. We characterized the resulting Cancer of the Prostate Risk Assessment (CAPRA) score generated from targeted biopsy alone, systematic biopsy alone, or combined systematic and targeted sites. RESULTS: We identified 363 patients who underwent TRUS biopsy targeting prostate imaging, with a minimum of one core demonstrating PCa. Mean age was 63 years, median PSA was 5.7 ng/ ml (IQR 4.3-8.2) and median number of cores taken was 15 (IQR 1218). Targeted biopsy yielded PCa in 69% of radiographic lesions, and resulted in Gleason score upgrading compared to systematic biopsy in 45 men (13.4%). The single site percentage of tumor was higher with the inclusion of targeted cores (40.8% vs. 31.8%, p<0.001), and the proportion of patients with >33% positive cores increased in 40 (11.9%). CAPRA category was reclassified in 33 (9.1%) patients based on targeted biopsy: 24 to intermediate CAPRA (3-5) from low (0-2), and 9 to high (6-10) from intermediate. CONCLUSIONS: Targeted biopsy of radiographically suspicious lesions results in Gleason score upgrading and CAPRA reclassification in a subset of patients when compared with systematic biopsy alone. Lesion targeting alone would render a negative result in 31% of patients with detectable disease on systematic biopsy. Source of Funding: This work is supported in part by the US Department of Defense Prostate Cancer Research Program (W81XWH-13-2-0074 and W81XWH-11-1-0489

MP86-11 PROSTATE SPECIFIC ANTIGEN VELOCITY AS A PREDICTIVE BIOMARKER IN A PROSPECTIVE PROSTATE CANCER SCREENING STUDY OF MEN WITH GENETIC PREDISPOSITION Christina G. Selkirk*, Evanston, IL; Christos Mikropoulos, Sibel Saya, Elizabeth Bancroft, Tokhir Dadaev, Sutton, United Kingdom; Charles Brendler, Evanston, IL; Elizabeth Page, Daniel A. Leongamornlert, Natalie Taylor, Edward J. Saunders, Clara Cieza-Borrela, The IMPACT study collaborators, Sutton, United Kingdom; Sue Moss, London, United Kingdom; Zsofia Kote-Jarai, Sutton, United Kingdom; Brian T. Helfand, Evanston, IL; Rosalind A. Eeles, Sutton, United Kingdom INTRODUCTION AND OBJECTIVES: It has been shown that carriers of BRCA1/2 mutations are more likely to develop prostate cancer (PrCa) and that BRCA2 carriers are at risk for aggressive disease. It is unclear whether any of these men exhibit altered PSA kinetics prior to diagnosis. We therefore assessed the clinical application of prostate specific antigen velocity (PSAV) in the IMPACT study (Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted screening in men at higher genetic risk and controls). METHODS: IMPACT is a case-control PrCa screening study for men with a known genetic predisposition to PrCa; participants with a