Extraprostatic extension in prostate cancer: primer for radiologists

Shieh, Alice C; Güler, Ezgi; Ojili, Vijayanadh; Paspulati, Raj Mohan; Elliott, Robin; Ramaiya, Nikhil H.; Tirumani, Sree H.

doi:10.1007/s00261-020-02555-x

Cited by 19 publications

(21 citation statements)

References 59 publications

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“…When compared with the subjective assessment that mainly depends on radiologists’ personal pattern and experience, the quantitative analysis offers several potential advantages of improving accuracy, interobserver agreement, and histopathology correlation. However, different measurement methods and tools, as well as MRI techniques and sequences, all may affect the final results, then lead to widely varied optimal cutoff values ( 18 , 19 ). Regarding LCC, the reported optimal cutoff values ranged from 6 to 20 mm, with corresponding sensitivity of 0.60–0.89 and specificity of 0.44–0.88.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, for localized advantage PCa of EPE, the ESUR PI-RADS demonstrated moderate diagnostic accuracy, and mainly depended on radiologists’ own experience then short of reproducibility and inter-reader agreement ( 16 , 17 ). At present, quantitative assessments of EPE with mpMRI have been intensively studied and demonstrated the potential of improving accuracy, inter-reader agreement, and pathology correlation ( 18 , 19 ). In PI-RADS version 2.1, quantitative metrics such as length of capsular contact (LCC), apparent diffusion coefficient (ADC), tumor size, and tumor volume were included for assisting in prediction of EPE ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

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The Quantitative Assessment of Using Multiparametric MRI for Prediction of Extraprostatic Extension in Patients Undergoing Radical Prostatectomy: A Systematic Review and Meta-Analysis

Sun²,

et al. 2021

Front. Oncol.

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PurposeTo investigate the diagnostic performance of using quantitative assessment with multiparametric MRI (mpMRI) for prediction of extraprostatic extension (EPE) in patients with prostate cancer (PCa).MethodsWe performed a computerized search of MEDLINE, Embase, Cochrane Library, Web of Science, and Google Scholar from inception until July 31, 2021. Summary estimates of sensitivity and specificity were pooled with the bivariate model, and quality assessment of included studies was performed with the Quality Assessment of Diagnostic Accuracy Studies-2. We plotted forest plots to graphically present the results. Multiple subgroup analyses and meta-regression were performed to explore the variate clinical settings and heterogeneity.ResultsA total of 23 studies with 3,931 participants were included. The pooled sensitivity and specificity for length of capsular contact (LCC) were 0.79 (95% CI 0.75–0.83) and 0.77 (95% CI 0.73–0.80), for apparent diffusion coefficient (ADC) were 0.71 (95% CI 0.50–0.86) and 0.71 (95% CI 059–0.81), for tumor size were 0.62 (95% CI 0.57–0.67) and 0.75 (95% CI 0.67–0.82), and for tumor volume were 0.77 (95% CI 0.68–0.84) and 0.72 (95% CI 0.56–0.83), respectively. Substantial heterogeneity was presented among included studies, and meta-regression showed that publication year (≤2017 vs. >2017) was the significant factor in studies using LCC as the quantitative assessment (P=0.02).ConclusionFour quantitative assessments of LCC, ADC, tumor size, and tumor volume showed moderate to high diagnostic performance of predicting EPE. However, the optimal cutoff threshold varied widely among studies and needs further investigation to establish.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Quantitative Assessment of Using Multiparametric MRI for Prediction of Extraprostatic Extension in Patients Undergoing Radical Prostatectomy: A Systematic Review and Meta-Analysis

Sun²,

et al. 2021

Front. Oncol.

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“…These mpMRI quantitative metrics showed moderate-to-high diagnostic accuracy as an independent predictor for the detection of EPE. Nonetheless, various measurement approaches and tools, along with MRI techniques and sequences, result in widely varied optimal cutoff thresholds ( 32 , 33 ). The EPE grading system recommends the quantitative metric of 15-mm curvilinear contact length as a threshold for evaluation of EPE; however, it was unclear how such threshold was derived.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Performance of Extraprostatic Extension Grading System for Detection of Extraprostatic Extension in Prostate Cancer: A Diagnostic Systematic Review and Meta-Analysis

Shang

et al. 2022

Front. Oncol.

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PurposeTo evaluate the diagnostic performance of the extraprostatic extension (EPE) grading system for detection of EPE in patients with prostate cancer (PCa).Materials and MethodsWe performed a literature search of Web of Science, MEDLINE (Ovid and PubMed), Cochrane Library, EMBASE, and Google Scholar to identify eligible articles published before August 31, 2021, with no language restrictions applied. We included studies using the EPE grading system for the prediction of EPE, with histopathological results as the reference standard. The pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR−), and diagnostic odds ratio (DOR) were calculated with the bivariate model. Quality assessment of included studies was performed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.ResultsA total of 4 studies with 1,294 patients were included in the current systematic review. The pooled sensitivity and specificity were 0.82 (95% CI 0.76–0.87) and 0.63 (95% CI 0.51–0.73), with the area under the hierarchical summary receiver operating characteristic (HSROC) curve of 0.82 (95% CI 0.79–0.85). The pooled LR+, LR−, and DOR were 2.20 (95% CI 1.70–2.86), 0.28 (95% CI 0.22–0.36), and 7.77 (95% CI 5.27–11.44), respectively. Quality assessment for included studies was high, and Deeks’s funnel plot indicated that the possibility of publication bias was low (p = 0.64).ConclusionThe EPE grading system demonstrated high sensitivity and moderate specificity, with a good inter-reader agreement. However, this scoring system needs more studies to be validated in clinical practice.

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“…Among these parameters, GG ( 2 ), lymphovascular invasion ( 11 ), EPE, seminal vesicle invasion, and lymph node metastasis ( 12 ) have been established as independent poor prognostic factors. More recently, tertiary Gleason pattern 5 and intraductal carcinoma of the prostate gland (IDC-P) have also been reported as poor prognostic factors ( 3 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

“…Specifically, we initially investigated the relationship between GG and the evaluation parameters. Thereafter, we conducted a multivariate logistic regression analysis to determine the risk factors for lymph node metastasis, which has been strongly established as a poor prognostic factor postoperatively ( 12 ). We also confirmed the status of BCR after RARP, extracted risk factors using multivariate logistic regression analysis, and attempted to integrate the results with morphological analysis.…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological Analysis of the ISUP Grade Group And Other Parameters in Prostate Cancer: Elucidation of Mutual Impact of the Various Parameters

et al. 2021

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BackgroundProstate cancer has become increasingly common worldwide. Although Grade group (GG) is widely accepted as an indicator of prostate cancer grade, there are malignancies that cannot be defined by GG alone. Moreover, the relationship between GG and other parameters remains unclear. Herein, we aimed to explore the biological characteristics of prostate cancer.MethodsThis study included 299 radical prostatectomy cases. The Chi-square test and analysis of variance were used to analyze the association of GG with binary and continuous variables. We then conducted morphological analyses. Multivariate analyses were performed to extract the data on risk factors for biochemical recurrence (BCR) and lymph node metastasis.ResultsThe lymphatic, venous, perineural, and seminal vesicle invasion rates were 37/299 (12.4%), 25/299 (8.4%), 280/299 (93.6%), and 23/299 (7.7%), respectively. The extraprostatic extension (EPE), positive surgical margin, tertiary Gleason pattern 5, intraductal carcinoma of the prostate gland, and lymph node metastasis rates were 89/299 (29.8%), 106/299 (35.5%), 33/260 (12.7%), 56/299 (18.7%), and 23/299 (7.7%), respectively. As GG increased, various parameters became easier to visualize; however, there were differences between the parameters. Postoperative BCR was observed in 31/242 (12.8%) cases without preoperative hormone therapy; GG2, GG3, GG4, and GG5 accounted for 4, 7, 7, and 13 cases, respectively. Multivariate analyses revealed that GG and tumor diameter were significant risk factors for early BCR, whereas lymphatic invasion, EPE, and seminal vesicle invasion were significant risk factors for lymph node metastasis. For BCR, the odds ratios (ORs) for GG and tumor diameter were 2.253 (95% confidence interval (CI]): 1.297–3.912; P=0.004) and 1.074 (95% CI: 1.011–1.142; P=0.022), respectively. For lymph node metastasis, ORs for the presence of lymphatic invasion, EPE, and seminal vesicle invasion were 7.425 (95% CI: 1.688–22.583; P=0.004), 4.391 (95% CI: 1.037–18.589; P=0.044), and 5.755 (95% CI: 1.308–25.316; P=0.021), respectively.ConclusionsWe summarized various parameters correlating with each GG. Through multivariate analyses, we established the independent risk factors for early BCR and lymph node metastasis. In addition to GG, other important indices of malignancy were determined and weighted to provide a basis for future investigations.

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Extraprostatic extension in prostate cancer: primer for radiologists

Cited by 19 publications

References 59 publications

The Quantitative Assessment of Using Multiparametric MRI for Prediction of Extraprostatic Extension in Patients Undergoing Radical Prostatectomy: A Systematic Review and Meta-Analysis

The Quantitative Assessment of Using Multiparametric MRI for Prediction of Extraprostatic Extension in Patients Undergoing Radical Prostatectomy: A Systematic Review and Meta-Analysis

Diagnostic Performance of Extraprostatic Extension Grading System for Detection of Extraprostatic Extension in Prostate Cancer: A Diagnostic Systematic Review and Meta-Analysis

Clinicopathological Analysis of the ISUP Grade Group And Other Parameters in Prostate Cancer: Elucidation of Mutual Impact of the Various Parameters

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