Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer before Robot-Assisted Radical Prostatectomy

Abstract

Background: The accuracy of multi-parametric MRI (mpMRI) in the pre-operative staging of prostate cancer (PCa) remains controversial. Objective: The purpose of this study was to evaluate the ability of mpMRI to accurately predict PCa extra-prostatic extension (EPE) on a side-specific basis using a risk-stratified 5-point Likert scale. This study also aimed to assess the influence of mpMRI scan quality on diagnostic accuracy. Patients and Methods: We included 124 men who underwent robot-assisted RP (RARP) as part of the NeuroSAFE PROOF study at our centre. Three radiologists retrospectively reviewed mpMRI blinded to RP pathology and assigned a Likert score (1–5) for EPE on each side of the prostate. Each scan was also ascribed a Prostate Imaging Quality (PI-QUAL) score for assessing the quality of the mpMRI scan, where 1 represents the poorest and 5 represents the best diagnostic quality. Outcome measurements and statistical analyses: Diagnostic performance is presented for the binary classification of EPE, including 95% confidence intervals and the area under the receiver operating characteristic curve (AUC). Results: A total of 231 lobes from 121 men (mean age 56.9 years) were evaluated. Of these, 39 men (32.2%), or 43 lobes (18.6%), had EPE. A Likert score ≥3 had a sensitivity (SE), specificity (SP), NPV, and PPV of 90.4%, 52.3%, 96%, and 29.9%, respectively, and the AUC was 0.82 (95% CI: 0.77–0.86). The AUC was 0.76 (95% CI: 0.64–0.88), 0.78 (0.72–0.84), and 0.92 (0.88–0.96) for biparametric scans, PI-QUAL 1–3, and PI-QUAL 4–5 scans, respectively. Conclusions: MRI can be used effectively by genitourinary radiologists to rule out EPE and help inform surgical planning for men undergoing RARP. EPE prediction was more reliable when the MRI scan was (a) multi-parametric and (b) of a higher image quality according to the PI-QUAL scoring system.

Picture Perfect: The Status of Image Quality in Prostate MRI

“…Conducting research in non-academic, non-tertiary centers, where image quality is likely to be suboptimal, could determine how applicable this data is to less experienced institutions. The relationship between PI-QUAL and staging is also supported by Dinneen et al 117 Here, PI-QUAL scores ≥4 had a greater sensitivity and specificity for detecting EPE than scans scoring PI-QUAL ≤ 3, although the sample size was smaller. In contrast, recent studies have reported no significant difference between PI-QUAL ≥ 4 and PI-QUAL ≤ 3 scans in the ability to stage PCa 112 or detect EPE.…”

Diagnostic performance of microUltrasound at MRI‐guided confirmatory biopsy in patients under active surveillance for low‐risk prostate cancer

“…Pre‐bioptic MRI and ROI targeting are recommended to complement systematic sampling during any reclassification biopsy 21 . It allows for accurate disease localization without biopsy‐related artifacts, and guides treatment for focal and radical therapies 22,23 …”

“…21 It allows for accurate disease localization without biopsy-related artifacts, and guides treatment for focal and radical therapies. 22,23 mpMRI may nevertheless miss some csPCa, and the search for other imaging modalities has continued with investigations on PSMA-PET and multiparametric US, even if less widely available than mpMRI. [24][25][26] The CADMUS trial showed that multiparametric US was noninferior to mpMRI in detecting csPCa defined as ISUP ≥ 2 disease, with a nonstatistically significant difference of 21.2% missed cancer by mpUS.…”

Self‐supervised multicontrast super‐resolution for diffusion‐weighted prostate MRI

“…This is measured with the PI‐QUAL score, which reflects the extent to which the image assists in ruling in and ruling out clinically significant cancer 4,5 . Studies using the PI‐QUAL score have shown that DWI image quality, including SNR and resolution, significantly impacts the accuracy of cancer detection 6–9 …”