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Predicting contralateral extraprostatic extension in unilateral high-risk prostate cancer: a multicentric external validation study

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Abstract

Purpose

Accurate prediction of extraprostatic extension (EPE) is crucial for decision-making in radical prostatectomy (RP), especially in nerve-sparing strategies. Martini et al. introduced a three-tier algorithm for predicting contralateral EPE in unilateral high-risk prostate cancer (PCa). The aim of the study is to externally validate this model in a multicentric European cohort of patients.

Methods

The data from 208 unilateral high-risk PCa patients diagnosed through magnetic resonance imaging (MRI)-targeted and systematic biopsies, treated with RP between January 2016 and November 2021 at eight referral centers were collected. The evaluation of model performance involved measures such as discrimination (AUC), calibration, and decision-curve analysis (DCA) following TRIPOD guidelines. In addition, a comparison was made with two established multivariable logistic regression models predicting the risk of side specific EPE for assessment purposes.

Results

Overall, 38%, 48%, and 14% of patients were categorized as low, intermediate, and high-risk groups according to Martini et al.’s model, respectively. At final pathology, EPE on the contralateral prostatic lobe occurred in 6.3%, 12%, and 34% of patients in the respective risk groups. The algorithm demonstrated acceptable discrimination (AUC 0.68), comparable to other multivariable logistic regression models (p = 0.3), adequate calibration and the highest net benefit in DCA. The limitations include the modest sample size, retrospective design, and lack of central revision.

Conclusion

Our findings endorse the algorithm's commendable performance, supporting its utility in guiding treatment decisions for unilateral high-risk PCa patients.

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Data availability

Data are available from the corresponding author upon reasonable request.

References

  1. Vis AN, van den Bergh RCN, van der Poel HG, Mottrie A, Stricker PD, Graefen M et al (2022) Selection of patients for nerve sparing surgery in robot-assisted radical prostatectomy. BJUI Compass 3:6–18. https://doi.org/10.1002/bco2.115

    Article  PubMed  Google Scholar 

  2. Diamand R, Ploussard G, Roumiguié M, Oderda M, Benamran D, Fiard G et al (2021) External validation of a multiparametric magnetic resonance imaging-based nomogram for the prediction of extracapsular extension and seminal vesicle invasion in prostate cancer patients undergoing radical prostatectomy. Eur Urol 79:180–185. https://doi.org/10.1016/j.eururo.2020.09.037

    Article  PubMed  Google Scholar 

  3. Kwong JCC, Khondker A, Meng E, Taylor N, Kuk C, Perlis N et al (2023) Development, multi-institutional external validation, and algorithmic audit of an artificial intelligence-based side-specific extra-prostatic extension risk assessment tool (SEPERA) for patients undergoing radical prostatectomy: a retrospective cohort study. Lancet Digit Heal 5:e435–e445. https://doi.org/10.1016/S2589-7500(23)00067-5

    Article  CAS  Google Scholar 

  4. Diamand R, Roche J-B, Lievore E, Lacetera V, Chiacchio G, Beatrici V et al (2022) External validation of models for prediction of side-specific extracapsular extension in prostate cancer patients undergoing radical prostatectomy. Eur Urol Focus. https://doi.org/10.1016/j.euf.2022.09.006

    Article  PubMed  Google Scholar 

  5. Martini A, Soeterik TFW, Haverdings H, Rahota RG, Checcucci E, De Cillis S et al (2022) An algorithm to personalize nerve sparing in men with unilateral high-risk prostate cancer. J Urol 207:350–357. https://doi.org/10.1097/JU.0000000000002205

    Article  PubMed  Google Scholar 

  6. Turkbey B, Rosenkrantz AB, Haider MA, Padhani AR, Villeirs G, Macura KJ et al (2019) Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2. Eur Urol 76:340–351. https://doi.org/10.1016/j.eururo.2019.02.033

    Article  PubMed  Google Scholar 

  7. Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA (2015) The 2014 international society of urological pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 40:1. https://doi.org/10.1097/PAS.0000000000000530

    Article  Google Scholar 

  8. Collins GS, Reitsma JB, Altman DG, Moons KGM (2015) Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. Eur Urol 67:1142–1151. https://doi.org/10.1016/j.eururo.2014.11.025

    Article  PubMed  Google Scholar 

  9. Soeterik TFW, van Melick HHE, Dijksman LM, Küsters-Vandevelde H, Stomps S, Schoots IG et al (2020) Development and external validation of a novel nomogram to predict side-specific extraprostatic extension in patients with prostate cancer undergoing radical prostatectomy. Eur Urol Oncol. https://doi.org/10.1016/j.euo.2020.08.008

    Article  PubMed  Google Scholar 

  10. Martini A, Gupta A, Lewis SC, Cumarasamy S, Haines KG, Briganti A et al (2018) Development and internal validation of a side-specific, multiparametric magnetic resonance imaging-based nomogram for the prediction of extracapsular extension of prostate cancer. BJU Int 122:1025–1033. https://doi.org/10.1111/bju.14353

    Article  CAS  PubMed  Google Scholar 

  11. DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845

    Article  CAS  PubMed  Google Scholar 

  12. Vickers AJ, Elkin EB (2006) Decision curve analysis: a novel method for evaluating prediction models. Med Decis Mak. https://doi.org/10.1177/0272989X06295361

    Article  Google Scholar 

  13. Mithal P, Howard LE, Aronson WJ, Terris MK, Cooperberg MR, Kane CJ et al (2016) Positive surgical margins in radical prostatectomy patients do not predict long-term oncological outcomes: results from the shared equal access regional cancer hospital (SEARCH) cohort. BJU Int 117:244–248. https://doi.org/10.1111/bju.13181

    Article  CAS  PubMed  Google Scholar 

  14. Würnschimmel C, Wenzel M, Wang N, Tian Z, Karakiewicz PI, Graefen M et al (2021) Radical prostatectomy for localized prostate cancer: 20-year oncological outcomes from a German high-volume center. Urol Oncol Semin Orig Investig 39:830.e17-830.e26. https://doi.org/10.1016/j.urolonc.2021.04.031

    Article  Google Scholar 

  15. van der Slot MA, den Bakker MA, Tan TSC, Remmers S, Busstra MB, Gan M et al (2022) NeuroSAFE in radical prostatectomy increases the rate of nerve-sparing surgery without affecting oncological outcome. BJU Int 130:628–636. https://doi.org/10.1111/bju.15771

    Article  PubMed  PubMed Central  Google Scholar 

  16. Baas DJH, Vreuls W, Sedelaar JPM, Vrijhof HJEJ, Hoekstra RJ, Zomer SF et al (2023) Confocal laser microscopy for assessment of surgical margins during radical prostatectomy. BJU Int 132:40–46. https://doi.org/10.1111/bju.15938

    Article  PubMed  Google Scholar 

  17. Dinneen E, Grierson J, Almeida-Magana R, Clow R, Haider A, Allen C et al (2022) NeuroSAFE PROOF: study protocol for a single-blinded, IDEAL stage 3, multi-centre, randomised controlled trial of NeuroSAFE robotic-assisted radical prostatectomy versus standard robotic-assisted radical prostatectomy in men with localized prostate cancer. Trials 23:584. https://doi.org/10.1186/s13063-022-06421-7

    Article  PubMed  PubMed Central  Google Scholar 

  18. van der Slot MA, den Bakker MA, Klaver S, Kliffen M, Busstra MB, Rietbergen JBW et al (2020) Intraoperative assessment and reporting of radical prostatectomy specimens to guide nerve-sparing surgery in prostate cancer patients (NeuroSAFE). Histopathology 77:539–547. https://doi.org/10.1111/his.14184

    Article  PubMed  PubMed Central  Google Scholar 

  19. Dinneen E, Haider A, Grierson J, Freeman A, Oxley J, Briggs T et al (2021) NeuroSAFE frozen section during robot-assisted radical prostatectomy: peri-operative and histopathological outcomes from the NeuroSAFE PROOF feasibility randomized controlled trial. BJU Int 127:676–686. https://doi.org/10.1111/bju.15256

    Article  PubMed  Google Scholar 

  20. Beyer B, Schlomm T, Tennstedt P, Boehm K, Adam M, Schiffmann J et al (2014) A feasible and time-efficient adaptation of NeuroSAFE for da Vinci robot-assisted radical prostatectomy. Eur Urol 66:138–144. https://doi.org/10.1016/j.eururo.2013.12.014

    Article  PubMed  Google Scholar 

  21. Rocco B, Cimadamore A, Sarchi L, Bonetti LR, Bertoni L, Azzoni P et al (2021) Current and future perspectives of digital microscopy with fluorescence confocal microscope for prostate tissue interpretation: a narrative review. Transl Androl Urol 10:1569–1580. https://doi.org/10.21037/tau-20-1237

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hofman MS, Lawrentschuk N, Francis RJ, Tang C, Vela I, Thomas P et al (2020) Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet 395:1208–1216. https://doi.org/10.1016/S0140-6736(20)30314-7

    Article  CAS  PubMed  Google Scholar 

  23. Sonni I, Felker ER, Lenis AT, Sisk AE, Bahri S, Allen-Auerbach M et al (2022) Head-to-head comparison of 68 Ga-PSMA-11 PET/CT and mpMRI with a histopathology gold standard in the detection, intraprostatic localization, and determination of local extension of primary prostate cancer: results from a prospective single-center imaging. J Nucl Med 63:847–854. https://doi.org/10.2967/jnumed.121.262398

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Lehner F, Crippa A, Sigg S, Eberli D, Mortezavi A (2023) Transperineal template saturation and conventional biopsy for stage prediction in prostate cancer. BJU Int 132:696–704. https://doi.org/10.1111/bju.16181

    Article  CAS  PubMed  Google Scholar 

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Funding

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Author information

Authors and Affiliations

  1. Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Rue Meylemeersch 90, 1070, Brussels, Belgium

    Romain Diamand, Thierry Roumeguère, Alexandre Peltier & Simone Albisinni

  2. Department of Urology, Clinique Saint-Augustin, Bordeaux, France

    Jean-Baptiste Roche

  3. Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy

    Vito Lacetera

  4. Department of Urology, IRCCS “Regina Elena” National Cancer Institute, Rome, Italy

    Giuseppe Simone

  5. Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland

    Olivier Windisch & Daniel Benamran

  6. Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France

    Alexandre Fourcade & Georges Fournier

  7. Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France

    Gaelle Fiard

  8. Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France

    Guillaume Ploussard

  9. Urology Unit, Department of Surgical Sciences, Tor Vergata University, Rome, Italy

    Simone Albisinni

Authors
  1. Romain Diamand
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  2. Jean-Baptiste Roche
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  3. Vito Lacetera
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  4. Giuseppe Simone
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  5. Olivier Windisch
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  6. Daniel Benamran
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  7. Alexandre Fourcade
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  8. Georges Fournier
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  9. Gaelle Fiard
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  10. Guillaume Ploussard
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  11. Thierry Roumeguère
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  12. Alexandre Peltier
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  13. Simone Albisinni
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Contributions

Diamand R.: Project development, Data collection, Data analysis, Manuscript writing. Albisinni S., Peltier A., Roumeguere T.: Manuscript editing. Roche JB, Lacetera V., Simone G., Windisch O., Benamran D., Fourcade A., Fournier G., Fiard G., Ploussard G.: Data collection. Albisinni S.: Project development, Supervision.

Corresponding author

Correspondence to Romain Diamand.

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Ethical approval and informed consent

This is a retrospective study. All the procedures were performed as part of the routine care. Then, our study did not need ethical approval and no formal consent was required. The procedures used in this study adhere to the principles of the Declaration of Helsinki.

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Diamand, R., Roche, JB., Lacetera, V. et al. Predicting contralateral extraprostatic extension in unilateral high-risk prostate cancer: a multicentric external validation study. World J Urol 42, 247 (2024). https://doi.org/10.1007/s00345-024-04966-7

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  • DOI: https://doi.org/10.1007/s00345-024-04966-7

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