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The aim of this study is evaluating the accuracy of preoperative magnetic resonance imaging (MRI) in patients who underwent pelvic lymph node dissection (PLND). Materials and Methods: The medical records of 1,528 patients who underwent radical prostatectomy and PLND from 2003 to 2017 in Seoul National University Bundang Hospital were retrospectively reviewed. We evaluated the various clinicopathologic variables including preoperative MRI findings and pathologic lymph node (LN) metastasis. The prediction model for pathologic LN metastasis was assessed using univariate and multivariable logistic regression analyses and areas under receiver operating characteristic (ROC) curves. Results: The mean age of our cohort was 66.4±6.7 years. Positive LN finding of preoperative MRI finding was observed in 9.4% (145 of 1,528) of patients. 5.3% (81 of 1,528) of patients had confirmed final pathologic LN metastases. Sensitivity and specificity of preoperative MRI were 30.8% and 91.7%, respectively. Multivariable analysis showed that preoperative MRI findings, clinical stage and biopsy Gleason score were independent significant predictors for pathologic LN metastasis (p＜0.001, p=0.002, and p＜0.001, respectively). Prediction model using preoperative MRI findings and National Comprehensive Control Network risk stratification showed fair accuracy using ROC analysis. Conclusions: Preoperative MRI findings for pathologic LN metastasis showed limited prediction value. A large-scale, multicenter, prospective study is needed to fully evaluate the clinical significance of preoperative MRI.

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A total of 391 patients were identified for analysis. The median PSA of all individuals included in the study was 2.05ng/ml. Please refer to table 1 and 2. CONCLUSIONS: The probability of PSMA avid lesions detected on a Ga-68 PSMA PET/CT are correlated to the PSA levels in postprostatectomy patients with biochemical recurrence. Even at low PSA levels (<0.2ng/ml) there is a 42% probability of detecting a PSMA avid lesion, this increases to greater than 90% when PSA levels are >2.0ng/ ml. Further studies are required to investigate how detection of PSMA avid lesions will influence the management of these patients with early disease recurrence.

171 Background: To evaluate the accuracy of preoperative magnetic resonance imaging (MRI) in patients who underwent pelvic lymph node dissection (PLND). Methods: The data of 1528 patients who underwent radical prostatectomy and PLND from 2003 to 2017 in our institution were retrospectively reviewed. We evaluated the various clinicopathologic variables including preoperative MRI and pathologic lymph node metastasis (LNmet). The prediction model for pathologic lymph node (LNmet) was assessed using logistic regression analyses and the areas under receiver operating characteristic curves (AUCs) were evaluated. Results: The mean age of our cohort was 66.4 ± 6.7 years. Positive preoperative MRI finding was observed in 9.4% (145/1528) of patients. 5.3% (81/1528) of patients accompanied confirmed final pathologic LNmet. Sensitivity and specificity of preoperative MRI were 30.8% and 91.7%, respectively. Multivariate analysis showed that preoperative MRI findings, clinical stage, and biopsy Gleason score were independent predictors for pathologic LNmet. Preoperative PSA, which was significantly related to pathologic LNmet in univariate analysis, failed to achieve independent predictor status in multivariate analysis. A better prediction model with greater accuracy was achieved by applying multivariate ROC analysis that included MRI findings, clinical stage, and biopsy Gleason score (AUC: 0.799 vs 0.613, p<0.01). The corresponding newer prediction model showed better sensitivity(77.78%) and specificity(70.74%) within threshold value range when it was compared with the predictor model using conventional Partin triad. Conclusions: Preoperative MRI findings for pathologic LNmet showed limited prediction power, yet the predicting power was significantly increased when additional factors such as clinical stage, and biopsy Gleason score were included in the analysis. [Table: see text]