Diagnostic accuracy of multiparametric magnetic resonance imaging in detecting extracapsular extension in intermediate and high – risk prostate cancer

 Vol. 44 (x): 2018 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0485


Cristina Dominguez 1, Mauricio Plata 1, Juan Guillermo Cataño 1, Mauricio Palau 2, Diego Aguirre 3, Jorge Narvaez 3, Stephanie Trujillo 3, Felipe Gómez 1, Carlos Gustavo Trujillo 1, Juan Ignacio Caicedo 1, Camilo Medina 1
1 Department of Urology; 2 Department of Pathology; 3 Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia, CO


Objectives: To evaluate the diagnostic performance of preoperative multiparametric magnetic resonance imaging (mp-MRI) as a predictor of extracapsular extension (ECE) and unfavorable Gleason score (GS) in patients with intermediate and high-risk pros­tate cancer (PCa).

Materials and Methods: Patients with clinically localized PCa who underwent radi­cal prostatectomy (RP) and had preoperative mp-MRI between May-2011 and Decem­ber-2013. Mp-MRI was evaluated according to the European Society of Urogenital Ra­diology MRI prostate guidelines by two different readers. Histopathological RP results were the standard reference.

Results: 79 patients were included; mean age was 61 and median preoperative prosta­te-specific antigen (PSA) 7.0. On MRI, 28% patients had ECE evidenced in the mp-MRI, 5% seminal vesicle invasion (SVI) and 4% lymph node involvement (LNI). At RP, 39.2% had ECE, 26.6% SVI and 12.8% LNI. Sensitivity, specificity, accuracy, positive predic­tive value (PPV), and negative predictive value (NPV) of mp-MRI for ECE were 54.9%, 90.9%, 76%, 81% and 74.1% respectively; for SVI values were 19.1%, 100%, 77.3%, 100% and 76.1% respectively and for LNI 20%, 98.4%, 86.7%, 66.7% and 88.7%.

Conclusions: Major surgical decisions are made with digital rectal exam (DRE) and ultrasound studies before the use of Mp-MRI. This imaging study contributes to rule out gross extraprostatic extension (ECE, SVI, LNI) without competing with pathological studies. The specificity and NPV are reasonable to decide surgical approach. A highly experienced radiology team is needed to provide accurate estimations of tumor exten­sion and aggressiveness.

Keywords: Prostatic Neoplasms; Magnetic Resonance Imaging; Prostatectomy

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