title: Optimizing D'Amico risk groups in radical prostatectomy through the addition of magnetic resonance imaging data.
abstract: OBJECTIVE
  To improve the predictive efficacy of the D'Amico risk classification system with magnetic resonance imaging (MRI) of the pelvis.
  
  
  METHODS
  We studied 729 patients from a series of 1310 radical prostatectomies for T1-T2 prostate cancer who underwent staging pelvic MRI. Each patient was classified with T2, T3a or T3b MRI, and N (+) patients were excluded. We identified the therapeutic factors that affected the biochemical progression-free survival (BPFS) time (prostate specific antigen [PSA] levels>0.4ng/mL) using a univariate and multivariate study with Cox models. We attempted to improve the predictive power of the D'Amico model (low risk: T1; Gleason 2-6; PSA levels<10ng/mL; intermediate risk: T2 or Gleason 7 or PSA levels 10-20ng/mL; high risk: T3 or Gleason 8-10 or PSA levels>20ng/mL).
  
  
  RESULTS
  In the univariate study, the clinical factors that influenced BPFS were the following: Gleason 7 (HR: 1.7); Gleason 8-10 (HR: 2.9); T2 (HR: 1.6); PSA levels 10-20 (HR: 2); PSA levels>20 (HR: 4.3); D'Amico intermediate (HR: 2.1) and high (HR: 4.8) risk; T3a MRI (HR: 2.3) and T3b MRI (HR: 4.5). In the multivariate study, the only variables that affected BPFS were the following: D'Amico intermediate risk (HR: 2; 95% CI 1.2-3.3); D'Amico high risk (HR: 4.1; 95% CI 2.4-6.8); T3a MRI (HR: 1.9; 95% CI 1.2-2.9) and T3b MRI (HR: 3.9; 95% CI 2.5-6.1). Predictive model: Using the multivariate Cox models, we assessed the weight of each variable. A value of 1 was given to D'Amico low risk and T2 MRI; a value of 2 was given to D'Amico intermediate risk and T3a MRI and a value 3 was given to D'Amico high risk and T3b MRI. Each patient had a marker that varied between 2 and 6. The best model included 3 groups, as follows: 494 (67.7%) patients in group 1, with a score of 2-3 points (HR, 1), a BPFS of 86%±2% and 79%±2% at 5 and 10 years, respectively; 179 (24.6%) patients in group 2, with a score of 4 points (HR, 3), a BPFS of 60%±4% and 54%±5% at 5 and 10 years, respectively; and 56 (7.7%) patients in group 3, with a score of 5-6 points (HR, 9.3), a BPFS of 29%±8% and 19%±7% at 5 and 10 years, respectively. The median BPFS time was 1.5 years.
  
  
  CONCLUSIONS
  MRI data significantly improves the predictive capacity of BPFS when using the D'Amico model data.
authors.affiliation: Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España. Electronic address: ralgarra@unav.es.
authors.forename: R
authors.initials: R
authors.lastname: Algarra
authors.affiliation: Servicio de Radiodiagnóstico, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: B
authors.initials: B
authors.lastname: Zudaire
authors.affiliation: Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: A
authors.initials: A
authors.lastname: Tienza
authors.affiliation: Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Velis
authors.affiliation: Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: A
authors.initials: A
authors.lastname: Rincón
authors.affiliation: Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: I
authors.initials: I
authors.lastname: Pascual
authors.affiliation: Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: J
authors.initials: J
authors.lastname: Zudaire
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: Biochemical progression; Clasificación D́Amico; Cáncer de próstata; D’Amico classification; Migración de estadios; Progresión bioquímica; Prostate cancer; Prostatectomía radical; Radical prostatectomy; Stage migration