Fernando Lista Mateos

MRI before prostatectomy isn’t just staging… it’s prognostic. New meta-analysis in JAMA Oncology shows MRI predicts outcomes independently. 🧵 📌 Study: Pretreatment MRI as prognostic factor after radical prostatectomy 📊 40 studies | 24,941 patients 👨‍⚕️ Population Men undergoing radical prostatectomy with pre-treatment MRI ⚔️ Key MRI features → Strong outcome predictors 🔴 Extraprostatic extension (mrT3a) •BCR: HR 2.16 •Metastasis: HR 3.18 •Cancer-specific mortality: HR 10.9 (!!) 🔴 Seminal vesicle invasion (mrT3b) •BCR: HR 2.74 •Metastasis: HR 5.58 📊 Quantitative MRI also matters •PI-RADS 4–5 → HR ~2.1 •Tumor ≥20 mm → HR ~2.35 •Low ADC → HR ~2.4 💡 Key insight MRI adds independent prognostic value beyond PSA, Gleason, and pathology 👉 Not just imaging 👉 A biologic risk signal before surgery ⚠️ Practice-changing angle MRI T-staging may be stronger than DRE-based clinical staging → Enables better pre-op risk stratification → Potential for treatment intensification / de-escalation 🎯 Takeaway If you’re still using MRI only for staging… You’re underusing it MRI = prognosis + decision-making tool 🔖 Save this for clinic discussions 📖 Full paper in comment ⬇️ #OncoTwitter #MedTwitter #ProstateCancer #UroOncology @OncoAlert @myesmo @esmo_open @asco