Abstract
Introduction: To examine the use of prostate magnetic resonance imaging (MRI) for staging after a new diagnosis of prostate cancer in our hospital system. There are no universally accepted recommendations to guide the use of MRI for staging purposes. In practice, prostate MRI is used to help distinguish T2 and T3 cancer. Prostate MRI is a modality that could aid in the triage of patients to radical prostatectomy or non-surgical treatments via accurate identification of organ-confined disease.Materials and Methods: We performed a retrospective review of prostate cancer patients who underwent staging MRI with 1.5T MRI with endorectal (ER) coil. We compared patient characteristics in patients who underwent surgery and those who did not, and used pathology reports from prostatectomy samples to calculate the negative predictive value (NPV) for extra-capsular extension (ECE) and seminal vesicle invasion (SVI).Results: We found that patients who underwent radical prostatectomy were younger, had lower Gleason scores, and had lower PSA values at diagnosis than patients who were not treated surgically. We calculated a NPV of 93.7% for SVI and 69.5% for ECE. We found variation in rates of accurate identification of T3 prostate cancer across the seven radiologists who interpreted MRI images in our study.Conclusions: 1.5T MRI with ER coil has a high NPV for SVI and a lower NPV for ECE. The utilization of 3TMRI may enable practitioners to more confidently rule out ECE. Future studies will be necessary to generate guidelines for use of MRI in prostate cancer staging.
Highlights
To examine the use of prostate magnetic resonance imaging (MRI) for staging after a new diagnosis of prostate cancer in our hospital system
We found that 75% of MRIs were ordered by urologists (n=207, 7 different providers), 15% of MRIs were ordered by radiation oncologists (n=41, 3 different providers), and 10% of MRIs were ordered by medical oncologists (n=29, 2 different providers). 129 patients underwent radical prostatectomy
We found that 1.5 T MRI with ER coil had a negative predictive value of 93.7% (95%CI 87.9% to 97.2) when evaluating for seminal vesicle invasion (SVI), and a negative predictive value of 69.5% when evaluating for extra-capsular extension (ECE)
Summary
Patients are often diagnosed at an early stage without symptoms These patients generally have a prolonged disease course[2].prostate cancer is a very heterogeneous disease, ranging from indolent to highly aggressive in nature, which emphasizes the importance of reliable risk stratification methods[3]. The diagnostic algorithm downstream of a positive PSA test is constantly evolving, but one well-accepted triage tool is the use of nomograms to predict ECE, SVI, and lymph node involvement[5]. One study reported a positive predictive value of 79% and a negative predictive value of 91% for ECE with 3T MRI with ER coil[12]. Positive predictive values have been reported ranging between 20 to 83%, and negative predictive values range between 79 to 96%[14] The majority of these data were generated from large tertiary-care centers
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