JCU - Abstracts of the BAUS 2018 Scientific Meeting - June 2018 - 59

Abstracts
Institute of Urology, Keck School of Medicine, USA, 30University
College London Surgical and Interventional Trials Unit, UK,
31University of Birmingham, UK

Introduction: PRECISION aimed to evaluate whether
multiparametric MRI and a targeted biopsy only (MRI±TB)
was non-inferior to TRUS biopsy in the detection of clinically significant prostate cancer in biopsy naïve men.
Patients & Methods: PRECISION was a randomised,
non-inferiority trial, carried out in 25 centres in 11 countries. 500 men were randomly allocated to 10-12 core
TRUS-biopsy or MRI±TB. Men randomised to MRI±TB
underwent MRI followed by targeted biopsy alone (without standard cores) if the PIRADSv2 score was t3. Men
with a PIRADSv2 score of 1-2 were not offered biopsy.The
primary outcome was the proportion of men diagnosed
with clinically significant cancer (Gleason grade t 3+4).
Results: One third of men avoided biopsy in the MRI arm
(71/252, 28%). Clinically significant cancer was detected in
95 (38%) of 252 men in the MRI±TB arm compared to 64
(26%) of 248 men randomised to TRUS-biopsy (intentionto-treat analysis). Adjusting for centre effects, the absolute
difference (MRI±TB versus TRUS-biopsy) in the proportion of men diagnosed with clinically significant prostate
cancer was 11.8% (2-sided 95% CI 3.7 to 20.0; p = 0.005).
The lower bound of the 95% CI for the difference is greater
than -5% therefore MRI±TB was non-inferior to TRUS
biopsy. Furthermore, the range of 95% CI was consistent
with a claim of superiority of MRI±TB over TRUS-biopsy.
Conclusion: An MRI-targeted approach in biopsy naive
men resulted in greater detection of clinically significant
disease, less detection of insignificant disease and required
fewer biopsies.
P6-6 The 4Kscore predicts adverse pathology
at radical prostatectomy in men diagnosed at
biopsy with gleason 6
Galvin D3, Haese A1, Hou D2, Eggener S2
1University Clinic Eppendorf, Martini-Klinik Prostate Cancer Centre,
Hamburg, Germany, 2University of Chicago, Department of Surgery,
Chicago, United States of America, 3Mater and St Vincent's
Hospitals, Dublin, Ireland

Introduction: Men at biopsy (Bx) with Gleason 6 prostate cancer (PCa) would benefit from better understanding their risk for adverse pathology (Gleason score t7 or
Gleason 6 with tpT3a). Our study objective was to
determine if a preoperative 4Kscore from men with
Gleason 6 could predict adverse pathology at radical
prostatectomy (RP).
Methods: Serum samples from 177 men with Bx-detected
Gleason 6 PCa who underwent RP at Martini Klinik (MK)
from 2003 to 2013 were obtained from the MK biorepository and the 4Kscore calculated. Bx and RP

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pathology were read by MK. Primary outcome was adverse
RP pathology. 4Kscore and other clinical and pathologic
characteristics were evaluated for their association with
adverse RP pathology.
Results: 4Kscore, prostate volume, % positive cores, and
total tumor length were significantly associated with
adverse RP pathology (p d0.002). Total PSA, %fPSA ratio,
DRE status and biopsy T stage were not associated (p
t0.2). Age and no previous biopsy trended towards significance (p=0.08 and 0.07, respectively). On multivariate
modelling, 4Kscore (OR=1.75 per 20% increase, 95% CI
1.19-2.57, p=0.004) and prostate volume (OR=0.67 per
20cc of volume, 95% CI 0.54-0.95, p=0.020) were independently associated. Comparing a 4Kscore cut off of 7.5%
with other risk indices (NCCN, D'Amico and CAPRA)
demonstrated 4Kscore had 80% sensitivity, 40% specificity,
63% PPV, and 72% NPV. 4Kscore t7.5% did not miss detection of Gleason 8 PCa and missed 7% (1 of 14) pT3a/b.
Conclusions: The 4Kscore was significantly associated
with adverse pathology at radical prostatectomy in men
with Bx-proven Gleason 6 PCa.
P6-7 Role of 68Ga prostate-specific
membrane antigen-targeted PET/CT imaging
in primary tumour assessment: improved
detection of multifocal disease on whole
gland histology compared to
multiparametric MRI
Donato P1, Roberts M1,2, Coughlin G1, Dunglison N1,
Esler R1, Yaxley J1,2
1Royal Brisbane and Women's Hospital, Queensland, Australia, 2The
University of Queensland, Faculty of Medicine, Brisbane, Australia

Introduction: Positron emission tomography (PET) for
Prostate-Specific Membrane Antigen (PSMA) has emerged
as a promising method for prostate cancer staging.
Evidence regarding PSMA-based tumour characterisation
compared to multiparametric MRI (mpMRI) is limited,
hence this study sought to compare the diagnostic accuracy of 68Ga-PSMA PET/CT to mpMRI against radical
prostatectomy (RP) whole gland histopathology.
Patients and Methods: A retrospective cohort study of
consecutive patients who underwent pre-operative
mpMRI and 68Ga-PSMA PET/CT followed by a RP was
performed.We performed a "per patient" and "per lesion"
analysis for imaging detection and other variables including the apparent diffusion coefficient, according to RP histopathology. Sensitivity, specificity and other measures of
diagnostic accuracy were performed.
Results: 57 patients with mean age 64.8±5.9 years and PSA
11±13.6 ng/ml underwent RP (70% pT3 disease). mpMRI
and PSMA PET/CT correctly identified the index lesion in
91.2% and 94.7% respectively. Considering "per lesion"
analysis, 94 cancer foci were identified of Gleason grades

Table of Contents for the Digital Edition of JCU - Abstracts of the BAUS 2018 Scientific Meeting - June 2018