Abstract
PurposeTo estimate the diagnostic accuracy of multiparametric MRI (mpMRI) for the detection of locally advanced prostate cancer (T-stage 3–4) prior to radical prostatectomy, in a multicenter cohort representing daily clinical practice. In addition, the radiologic learning curve for the detection of locally advanced disease is evaluated.MethodsPreoperative mpMRI findings of 430 patients (2012–2016) were compared to pathology results following radical prostatectomy. The diagnostic accuracy (sensitivity, specificity, PPV, and NPV) for the detection of locally advanced disease was calculated and compared for all years separately, to evaluate the presence of a radiological learning curve.ResultsOf all 137 patients with locally advanced disease, 62 patients were preoperatively detected with mpMRI [sensitivity 45.3% (95% CI 36.9–53.6%), specificity 75.8% (CI 70.9–80.7%), PPV 46.6% (CI 38.1–55.1%), and NPV 74.7% (CI 69.8–79.7%)]. The diagnostic accuracy did not improve significantly over time (sensitivity p = 0.12; specificity p = 0.57).ConclusionsIn daily clinical practice, the diagnostic accuracy of mpMRI for the detection of locally advanced prostate cancer remains limited. It, therefore, seems questionable whether mpMRI is adequate to guide preoperative decision-making. No significant radiologic learning curve for the detection of locally advance disease was observed.
Highlights
Prostate cancer (PCa) is the most common cancer in men of older age in Western countries [1]
A PI-RADS classification was given in 60.0% of all cases
The presence of malignancy was correctly detected by multiparametric MRI (mpMRI) in n = 358 patients
Summary
Prostate cancer (PCa) is the most common cancer in men of older age in Western countries [1]. Accurate staging of the primary tumor is of vital importance, as the distinction between organ-confined disease (T-stage 1–2) versus locally advanced tumors (T3–4) influences both prognosis [2] and treatment planning [3]. When considering a radical prostatectomy, the presence of locally advanced disease warrants a concomitant extended pelvic lymph node dissection (ePLND), as there is an increased risk of lymph node metastasis [3,4,5]. Local tumor stage guides surgical planning regarding the preservation of the neurovascular bundle. Nerve-sparing surgery is generally restricted to patients with organ-confined disease. Extension of PCa outside the prostatic capsule requires dissection of the neurovascular bundle, for nerve-sparing surgery would increase the risk of positive surgical margins [3, 4, 6]. The assessment of the local tumor stage is important
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
