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MP62-11 PI-RADS SCORE PREDICTS EXTRAPROSTATIC EXTENSION AND LYMPH NODE METASTASIS IN MEN UNDERGOING RADICAL PROSTATECTOMY

biochemical recurrence (BCR) after radical prostatectomy (RP) in prostate cancer (PCa) patients depict suboptimal characteristics. Moreover, they were developed in men diagnosed with systematic biopsies and their generalizability to patients assessed in the multiparametric MRI (mp-MRI) era is unknown. METHODS: A total of 1,176 patients received mp-MRI and targeted biopsy and underwent RP between 2015 and 2018 at six referral centers. We assessed the discrimination of the EAU risk groups and the CAPRA score in predicting BCR. We then evaluated whether information obtained at mp-MRI (extracapsular extension [ECE] or seminal vesicle invasion [SVI] and the maximum diameter of the index lesion) were associated with BCR. Finally, we assessed whether the inclusion of these information in a multivariable model improved the discrimination in predicting BCR and we developed a novel risk calculator. We compared the discrimination of these models by estimating the concordance index (C-index) and the observed vs. predicted cumulative incidences at 36-month. Decision curve analyses assessed the net benefit associated with the use of each model. RESULTS: Median follow-up was 28 months. Overall, 146 patients experienced BCR. Overall, 8.2 vs. 15.6%, 69.9 vs. 60.4% and 22.2 vs. 23.9% patients had low-, intermediateand high-risk PCa according to the EAU risk groups vs. the CAPRA score. The discrimination of these tools was 68 vs. 65%. A suspicious ECE (HR: 1.7), SVI (HR: 2.0) and the maximum diameter at mp-MRI (HR: 1.05) were associated with BCR (all P 0.02) and were included in a risk score. Points were assigned based on PSA (0: <10; 1: 10-20; 2: >20 ng/ml), biopsy grade group (0: 1; 1: 2-3; 2: >3), mpMRI (0: organ confined; 1: ECE; 2: SVI) and the diameter of the lesion according to tertiles (0: <10; 1: 10-15; 2: >15 mm). The risk score depicted a higher c-index (77%) compared to availabletools (65-68%) and to a model that did not include mp-MRI (70%). At internal validation the risk score depicted an excellent calibration with overestimation of BCR only for high predicted probabilities and was associated with a higher net benefit across all threshold probabilities compared to other models CONCLUSIONS: Models predicting BCR exhibit suboptimal characteristics in men diagnosed with targeted biopsy. We developed and internally validated a novel tool that accounts for mp-MRI information to identify patients at higher risk of experiencing early recurrence after surgery