What is the accuracy of multi-parametric magnetic resonance imaging in predicting adverse pathology in patients undergoing radical prostatectomy?

Abstract

139 Background: Few studies have examined the accuracy of preoperative multi-parametric magnetic resonance imaging (MP-MRI) in predicting adverse pathological features in patients undergoing radical prostatectomy (RP) for localized prostate cancer (PCa). Methods: We retrospectively analyzed the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of preoperative MP-MRI for adverse pathologic features [extracapsular extension (ECE), seminal vesicle invasion (SVI), lymph node involvement (LNI) and high Gleason score) on postoperative pathologic staging after RP in 30 patients with localized PCa . Results: The median age and preoperative PSA were 62.5 years and 8.5 ng/mL, respectively.17 patients had ECE, 5 had SVI, 5 had LNI, and 15 had high risk Gleason score (4+3, tertiary pattern 5, 4+4 or higher). The sensitivity, specificity, PPV and NPV of MP-MRI for ECE was 64.71% (95%CI 38.33 - 65.79), 92.31% (95% CI 63.97 - 99.81), 91.67% (95% CI 61.52 - 99.79), and 66.67% (95% CI 40.89 - 86.96) respectively. For the detection of SVI on MP-MRI, the sensitivity, specificity, PPV, and NPV were 60% (95% CI 14.66 - 94.73), 96% (95% CI 76.95 - 99.90), 75% (95% CI 19.41 - 99.37), and 92.31% (95% CI 74.87 - 99.05) respectively. For the detection of LNI, the sensitivity of MP-MRI was 100% (95% CI 47.82 - 100), specificity was 96% (95% CI 79.65 - 99.90), PPV was 83.33% (95% CI 35.88 - 99.58), NPV was 100% (95% CI 85.75 - 100). For detection of of high risk Gleason score the sensitivity of MP-MRI was 94.44% (95% CI 72.71 - 99.86), specificity was 66.67% (95% CI 34.89 - 90.08), PPV was 80.95% (95% CI 58.09 - 94.55), and NPV was 88.89% (95% CI 51.75 - 99.72). Conclusions: MP-MRI has a reasonable sensitivity, specificity, and NPV for the preoperative detection of adverse pathologic features at prostatectomy. This could provide assistance in the selection of patients appropriate for Active Surveillance as well as in the preoperative counseling regarding multimodality treatment for PCa.