Risk Biomarkers for Biochemical Recurrence after Radical Prostatectomy for Prostate Cancer Using Clinical and MRI-Derived Semantic Features

SIMPLE SUMMARY: Multiparametric magnetic resonance imaging (mpMRI) is now standard practice for suspected prostate cancer (PCa) patients, significantly enhancing risk assessment and PCa detection. Integrating MRI into clinical staging allows for more precise, personalized treatment planning in cases of extraprostatic cancer extension. Adverse MRI findings, such as a macroscopic extracapsular extension on MRI (mECE+), capsular disruption, extended tumor capsular contact length (TCCL), Grade Group (GG) ≥ 4, positive surgical margins (PSM), and pECE+ on pathology, were associated with higher biochemical recurrence (BCR) risk. Particularly in low/intermediate-risk patients (pECE− and GG < 4), adverse MRI characteristics correlated with elevated BCR risk. This feature highlights the importance of incorporating predictive MRI features pre-surgery to aid clinical decisions and enhance outcomes in prostate cancer. Adverse MRI features assist in identifying low/intermediate-risk patients needing closer monitoring. ABSTRACT: Objectives: This study aimed to assess the impact of the covariates derived from a predictive model for detecting extracapsular extension on pathology (pECE+) on biochemical recurrence-free survival (BCRFS) within 4 years after robotic-assisted radical prostatectomy (RARP). Methods: Retrospective data analysis was conducted from a single center between 2015 and 2022. Variables under consideration included prostate-specific antigen (PSA) levels, patient age, prostate volume, MRI semantic features, and Grade Group (GG). We also assessed the influence of pECE+ and positive surgical margins on BCRFS. To attain these goals, we used the Kaplan–Meier survival function and the multivariable Cox regression model. Additionally, we analyzed the MRI features on BCR (biochemical recurrence) in low/intermediate risk patients. Results: A total of 177 participants with a follow-up exceeding 6 months post-RARP were included. The 1-year, 2-year, and 4-year risks of BCR after radical prostatectomy were 5%, 13%, and 21%, respectively. The non-parametric approach for the survival analysis showed that adverse MRI features such as macroscopic ECE on MRI (mECE+), capsular disruption, high tumor capsular contact length (TCCL), GG ≥ 4, positive surgical margins (PSM), and pECE+ on pathology were risk factors for BCR. In low/intermediate-risk patients (pECE− and GG < 4), the presence of adverse MRI features has been shown to increase the risk of BCR. Conclusions: The study highlights the importance of incorporating predictive MRI features for detecting extracapsular extension pre-surgery in influencing early outcomes and clinical decision making; mECE+, TCCL, capsular disruption, and GG ≥ 4 based on pre-surgical biopsy were independent prognostic factors for early BCR. The presence of adverse features on MRI can assist in identifying low/intermediate-risk patients who will benefit from closer monitoring.