Supplementary Material for: The role of multiparametric MRI (mpMRI) in the prediction of adverse prostate cancer pathology in radical prostatectomy specimen

Introduction: Prostate cancer (PCa) risk stratification is essential in guiding therapeutic decision. Multiparametric magnetic resonance tomography (mpMRI) holds promise in prediction of adverse pathologies (AP) after prostatectomy (RP). This study aims to identify clinical and imaging markers in the prediction of adverse pathology. Methods: Patients with PCa, diagnosed by targeted biopsy after mpMRI and undergoing RP were included. The predictive accuracy of mpMRI for extraprostatic extension (ECE), seminal vesicle infiltration (SVI) and lymph node positivity was calculated from the final histopathology. Results: 846 patients were involved. Independent risk parameters include imaging findings as ECE (OR 3.12), SVI (OR 2.55) and PI-RADS scoring (4: OR 2.01 and 5: OR 4.34). mpMRI parameters such as ECE, SVI and lymph node metastases showed a high prognostic accuracy (73.28% vs. 95.35% vs. 93.38%) with moderate sensitivity compared to the final histopathology. The ROC-analysis of our combined scoring system (D’Amico classification, PSA density and MRI risk factors) improves prediction of adverse pathology (AUC 0.73 vs. 0.69). Conclusion: Our study supports the use of mpMRI for comprehensive pre-treatment risk assessment in PCa. Due to the high accuracy of factors like ECE, SVI and PI-RADS scoring, utilizing mpMRI data enabled accurate prediction of unfavourable pathology after RP.