Abstract
ObjectiveThe objective of the study was to evaluate the diagnostic accuracy of preoperative magnetic resonance imaging (MRI) for detecting uni- and bilateral extraprostatic disease (T3) in patients with prostate cancer (PCa).Materials and methodsThis prospective study included 199 patients with biopsy-proven PCa who underwent MRI prior to radical prostatectomy from December 2009 to July 2012. Extraprostatic extension and seminal vesicle invasion represented T3 disease, and was classified as uni- (right or left) or bilateral. MRI detection of T3 disease was assessed by descriptive statistics and odds ratio (OR). Whole-mount histopathology was used as the reference standard.ResultsThe overall prevalence of pT3 was 105/199 (53 %), unilateral in 81/105 (77 %) and bilateral in 24/105 (23 %). The sensitivity of MRI for predicting pT3 was 76/105 (72 %), specificity 61/94 (65 %), accuracy 137/199 (69 %), and OR 4.8 (95 % CI 2.7–8.8). A complete match with respect to the laterality of pT3 was found in 52/105 (50 %), and the side-specific accuracy was 113/199 (57 %). When unilateral pT3 was found, MRI falsely suggested contralateral T3 in 4/81 (5 %) and bilateral in 8/81 (10 %). When bilateral pT3 was found, MRI falsely suggested unilateral T3 in 12/24 (50 %).ConclusionMagnetic resonance imaging (MRI) detected 72 % of all patients with T3 disease, and the accuracy dropped from 69 to 57 % when considering the laterality of T3. Thus far, the MRI technique is not yet adequate to meet the increasing demands of accurate diagnosis of locally advanced disease, and the contemporary MRI staging should be careful.
Highlights
Accurate staging of prostate cancer (PCa) is essential for treatment planning
Whole-mount histopathology sections were prepared perpendicular to the urethra and compared to the axial magnetic resonance imaging (MRI)
It was five times more likely to be pT3 when T3 was suggested at MRI (OR = 4.8), whereas Digital rectal examination (DRE) could not predict pT3
Summary
Accurate staging of prostate cancer (PCa) is essential for treatment planning. Extraprostatic extension (EPE) and/or seminal vesicle invasion (SVI) are criteria for extraprostatic disease, classified as T3. These patients have traditionally been treated with external beam radiation therapy (EBRT) and/or hormonal therapy. Surgery is increasingly being performed, and more sensitive methods for detecting T3 disease are desirable. Detecting T3 disease remains challenging, and the sensitivity and specificity range from 23 to 90 % and 30 to 95 %, largely dependent upon patient selection and the method used [4,5,6,7,8,9,10]. No MRI studies have stratified the detection of T3 disease according to uni- or bilateral condition, which is highly relevant when planning treatment. Nerve-sparing surgery or focal therapy would most probably be avoided on the same side as MRI suggests T3
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