Endorectal magnetic resonance imaging has limited clinical ability to preoperatively predict pT3 prostate cancer

Abstract

to the 982 patients without imaging. Of the 110 patients with histopathologically organ-confined disease, 81 (74%) were correctly diagnosed as such on erMRI, whereas 29 (26%) were felt to have cT3 disease and constituted false-positives. Among the 69 patients with pT3 disease, erMRI correctly predicted 30 (43%), whereas 39 (57%) were incorrectly considered organ-confined.• The overall sensitivity and specificity for diagnosing pT3 disease was 43% and 73%.• When stratified by pT3a and pT3b, the sensitivity and specificity of erMRI to accurately diagnose ECE is 33% and 81%, respectively. In evaluating SVI, erMRI has a sensitivity and specificity of 33% and 89%, respectively. The positive predictive value of erMRI to assess for ECE and SVI is 50% in both, with a negative predictive value of 61% and 63%, respectively.• erMRIs performed at academic centres compared to non-academic locations demonstrated similar rates of sensitivity at 67% vs 77% and specificity at 39% vs 54%, respectively ( P = 0.33). CONCLUSIONS• In the setting of the present study, which was designed to be more reflective of current practice patterns in the USA, erMRI has limited clinical value in preoperatively detecting ECE and SVI.• The accuracy of detecting T3 disease did not improve in academic centres or in highrisk patients. KEYWORDSprostate cancer, neoplasm staging, endorectal magnetic resonance imaging (erMRI), radical prostatectomy Study Type -Diagnostic (nonconsecutive case series) Level of Evidence 3bWhat's known on the subject? and What does the study add? A wide range of performance characteristics has been reported for the preoperative prediction of extraprostatic extension by erMRI, with sensitivities as high as 90%. Our study differs in design from previous investigations in three ways: we examined the performance characteristics of the erMRI on patients with clinical parameters of prostate cancer worrisome for advanced disease; we dichotomized erMRI reports as "positive" or "negative"; and erMRIs were conducted at both academic and community radiology centers, which we believe is more reflective of current practice patterns in the USA. We found the overall accuracy of erMRI to be 62%, with a positive predictive value of 50%, suggesting that pretreatment erMRI offers minimal clinical information. OBJECTIVE• To assess the clinical value of preoperative knowledge of the presence of extracapsular extension (ECE) or seminal vesicle invasion (SVI) in the planning for prostatectomy. MATERIALS AND METHODS• An institutional database of 1161 roboticassisted laparoscopic prostatectomies (RALP) performed by a single surgeon (D.B.S.) was queried for those who underwent endorectal coil magnetic resonance imaging (erMRI) before robotic-assisted laparoscopic prostatectomy.• erMRI reports were dichotomized into positive or negative and compared with the final histopathology. The erMRIs performed at academic centres were compared with those performed in non-academic settings.• A sub-group of high-risk patients was also analyzed for erMRI accuracy.

Value of Endorectal Magnetic Resonance Imaging at 3T for the Local Staging of Prostate Cancer

“…The clinical benefit of preoperative MRI of the prostate is discussed controversially. Although MRI is widely accepted as the most reliable method for the local staging of PCa [1], some authors argue that it has little influence on therapeutic decision making [17]. In our study, both readers reached good sensitivities (80 % and 90 %) and fair specificities (74 % and 82 %) for ECE detection per patient.…”

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

“…[11,25,30] Our results showed that mp-MRI had 95% specificity, 80% positive predictive value for ECE, and 91% specificity regarding primary tumor localization. A previous study reported that the positive predictive value of mp-MRI for ECE was highest in the intermediate-and high-risk groups of patients.…”

The predictability of T3 disease in staging MRI following prostate biopsy decreases in patients with high initial PSA and Gleason score

“…32 However, each technique has one or more limitations, such as no standard parameters or low accuracy in central region of the gland. 33 Particularly for endorectal coil MRI, while it had been reported to have advanced sensitivity and specificity for detecting T3 disease over 90%, controversy still exists over the role of endorectal coil MRI of the prostate in detecting locally advanced disease, 34,35 with unique complications including rectal bleeding, erosion and proctitis. Considering these limitations and cost effectiveness, these functional images and endorectal coil MRI were not routinely conducted in our institution.…”