Association of Genomic Classifiers and Multi-Parametric Prostate MRI Results with Prostatectomy Pathologic Outcomes in Active Surveillance Candidates Who Undergo Upfront Radical Prostatectomy

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVES: There has been rapid uptake and conflicting evidence regarding the use of genomic classifiers (GC) and multi-parametric MRI (mpMRI) to risk stratify candidates for active surveillance (AS) that may harbor aggressive pathology. We assessed the results of GC, mpMRI, or the combination of both with pathologic features in patients who qualified for active surveillance but chose to undergo upfront radical prostatectomy (RP) in a diverse statewide collaborative consistent of community and academic urology practices. METHODS: We identified patients in the Michigan Urological Surgery Improvement Collaborative (MUSIC) database with NCCN very low (VLR), low (LR), or favorable intermediate risk (FIR) prostate cancer (PC) who underwent RP within six months of diagnosis. Pre-operative GC, mpMRI results, and final pathology were included. Results of GC and mpMRI were considered reassuring or non-reassuring consistent with established and previously published MUSIC criteria. The primary outcome was pathologic upstaging; a composite outcome of any of the following: an upgrade in Gleason grade (GG), pathologic T3 or greater, and/or node positive disease. We fit a logistic regression model controlling for baseline characteristics and with an interaction term for Gleason scoring at diagnosis and GC/mpMRI result to investigate potential differences in upgrading in those sub-populations. RESULTS: Among 5,915 men that underwent upfront radical prostatectomy with biopsy NCCN VLR, LR, and FIR PC in the registry,1,867 patients had a GC and/or mpMRI prior to RP and were included in the analytic cohort. The majority of patients had GG2 disease (n=1461,78%). Among men with GG1 disease, 270 (66.5%) had pathological upstaging compared with 244 (16.7%) patients with GG2 disease .Regression analysis revealed no significant differences between GC and/or mpMRI both the GG1 and GG2 groups (Figure).CONCLUSIONS: In AS candidates, pathologic upgrading is predictably higher among patients with GG1 versus GG2 disease, although clinicians should be reassured by the relatively low rate (16%)among men with GG2 disease considering AS. In real world practice, results of GC and/or mpMRI poorly discriminate pathologic upstaging, and results should be taken in the context of other clinical factors when used for clinical decision making.

Volume

215

Issue

5S

First Page

e645

Last Page

e645

Comments

American Urological Association Annual Meeting, May 15-18, 2026, Washington, DC

DOI

10.1097/01.JU.0001191456.93136.76.09

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