Can 3T multiparametric magnetic resonance imaging accurately detect prostate cancer extracapsular extension?

Abstract

Background: Accurate staging is essential to determine the correct management of patients diagnosed with prostate cancer. We assess the accuracy of 3T multiparametric magnetic resonance imaging (MRI) with endorectal coil (3TemMRI) in detecting prostate cancer local extension. Methods: We retrospectively reviewed charts from January 2008 to July 2012 from all patients undergoing radical prostatectomy. Patients were only included if 3TemMRI and radical prostatectomy were performed at our institution. Based on the presence of extracapsular extension (ECE) at 3TemMRI, prostate cancer was dichotomized into locally advanced or organ-confined disease. The accuracy of 3TemMRI local staging was then evaluated using definitive pathology as a reference. Results: Overall, 177 radical prostatectomies were performed within the timeframe. After applying exclusion criteria, 60 patients were included in the final analysis. The mean patient age was 67 ± 7 (standard deviation) years. Mean prostate-specific antigen value was 12.7 ± 12.7 ng/L. Based on preoperative characteristics, we considered 38 of the 60 patients (63%) patients high risk. 3TemMRI identified an organ-confined tumour in 46 patients and locally advanced disease in 14 patients. When correlated to final pathology, 3TemMRI specificity, sensitivity, negative and positive predictive values, and accuracy in detecting locally advanced prostate cancer were 90%, 35%, 57%, 79% and 62%, respectively. Interpretation: This study shows that the use of preoperative 3TemMRI can be used to identify organ-confined prostate cancer when locally advanced disease is suspected.

The efficacy and utilisation of preoperative multiparametric magnetic resonance imaging in robot-assisted radical prostatectomy: does it change the surgical dissection plan?

“…[4,5,[9][10][11] In our study, the specificity, sensitivity, and positive and negative predictive values of ECE were 95%, 25%, 66%, and 77%, respectively. We evaluated the patients who had RARP with or without preoperative MRIguided dissection planning.…”

“…[5][6][7][8][9] It is estimated that mp-MRI detects ECE with 48-76% accuracy. [4,[10][11][12][13][14] Walz et al [15] detailed the anatomy of the prostate and adjacent tissues, especially the fascia and NVB. In light of these studies, preoperative mp-MRI of the prostate may guide surgeons' dissection plans for RARP.…”

Multiparametric magnetic resonance imaging for pre-treatment local staging of prostate cancer: A Cancer Care Ontario clinical practice guideline

“…The impact of pre-treatment local staging by MRI ± DWI, DCE, MRS on clinical and patient outcomes is still not clear. Although studies consistently demonstrated upstaging by imaging compared to clinical staging, this was only correct by pathology in a few studies and the magnitude was highly variable (11% to 85%), 16,17,32,34,38,41,44 thus making any conclusions to be drawn imprecise. There was limited information on the outcome of risk stratification category; 30,34 however, the results were consistent with the trend of upstaging.…”

“…There were 20/21 (95.2%) studies that consistently demonstrated upstaging by MRI, 33,36 and upstaging by MRI compared to routine clinical staging. 12,13,16,17,20,21,23,30,32,34,[37][38][39][40][41][42][43][44][45] Upstaging by MRI was correct by pathology in seven studies, with a range from 11-85%. 16 …”

“…There were 19/49 (38.8%) primary studies of MRI ≥1.5 T + ER ± DWI, DCE, MRS that considered the detection of EPE and/or SVI [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] (Figs. 2, 3).…”