Integration of MRI to clinical nomogram for predicting pathological stage before radical prostatectomy
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Debate persists regarding whether MRI should be used routinely for preoperative evaluation of prostate cancer.
The aim is to assess the role of prostatic magnetic resonance imaging (MRI) and other preoperative data in extra-prostatic extension (EPE) evaluation.
Patients and methods
From 2000 to 2013, 1743 patients operated for radical prostatectomy had a preoperative MRI. Age, clinical stage with digital rectal exam (DRE), PSA, prostate weight, biopsy, MRI and pathological findings of the surgical specimen were noticed. A multiparametric score of the variables independently associated with EPE was built with or without MRI on a random sample test population and internally validated.
With mean age of 62.9 years and mean PSA of 9.6 ng/ml, the population was distributed as follows: 1424 DRE T1, 254 T2, 32 T3; on biopsy 990 Gleason score = 6 and 717 ≥ 7; on MRI 1322 iT2, 290 iT3A and 131 iT3B; on prostatectomy 15 pT0, 998 pT2, 548 pT3A, 181 pT3B and 1 pT4A. In multivariate analysis, DRE, PSA, Gleason score, prostate weight and MRI were independently associated with EPE and integrated in a score with an area under curve (AUC) of 0.74 [95% CI 0.71–0.77] (0.72 without MRI, p < 0.01) a positive predictive value of 61% and a negative predictive value of 74%, internally validated. The Hosmer–Lemeshow goodness-of-fit test showed good accuracy (p = 0.77).
Integration of MRI with clinical data for predicting pathological stage before radical prostatectomy permits to exclude accurately EPE in 74% of cases.
KeywordsEPE MRI Nerve sparing Preoperative system score Prostate cancer Staging
We acknowledge urologists and residents of department of Urology at CHU Mondor for data collection.
CL and LS involved in project development, data collection and management, data analysis and manuscript writing and editing; FR-T performed data management, data analysis and manuscript editing; AM and MB edited the manuscript; ADLT contributed to project development, data collection and management and manuscript editing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
For this type of study, formal consent is not required.
- 7.Cornud F, Rouanne M, Beuvon F, Eiss D, Flam T, Liberatore M et al (2012) Endorectal 3D T2-weighted 1 mm-slice thickness MRI for prostate cancer staging at 1.5 Tesla: Should we reconsider the indirects signs of extracapsular extension according to the D’Amico tumor risk criteria? Eur J Radiol 81:e591–e597. doi: 10.1016/j.ejrad.2011.06.056 CrossRefPubMedGoogle Scholar
- 10.Yossepowitch O, Eggener SE, Bianco FJ, Carver BS, Serio A, Scardino PT et al (2007) Radical prostatectomy for clinically localized, high risk prostate cancer: critical analysis of risk assessment methods. J Urol 178:493–499. doi: 10.1016/j.juro.2007.03.105 (discussion 499) CrossRefPubMedGoogle Scholar
- 11.Joniau S, Hsu CY, Lerut E, Van Baelen A, Haustermans K, Roskams T et al (2007) A pretreatment table for the prediction of final histopathology after radical prostatectomy in clinical unilateral T3a prostate cancer. Eur Urol 51:388, 394–396. doi: 10.1016/j.eururo.2006.06.051
- 12.Nakanishi H, Troncoso P, Babaian RJ (2008) Prediction of extraprostatic extension in men with biopsy Gleason score of 8 or greater. J Urol 180:2441, 2445–2446. doi: 10.1016/j.juro.2008.08.023
- 26.Freedland SJ, Isaacs WB, Platz EA, Terris MK, Aronson WJ, Amling CL et al (2005) Prostate size and risk of high-grade, advanced prostate cancer and biochemical progression after radical prostatectomy: a search database study. J Clin Oncol Off J Am Soc Clin Oncol 23:7546–7554. doi: 10.1200/JCO.2005.05.025 CrossRefGoogle Scholar
- 27.Kayat Bittencourt L, Litjens G, Hulsbergen-van de Kaa CA, Turkbey B, Gasparetto EL, Barentsz JO (2015) Prostate cancer: the European Society of Urogenital Radiology prostate imaging reporting and data system criteria for predicting extraprostatic extension by using 3-T multiparametric MR imaging. Radiology 276:479–489. doi: 10.1148/radiol.15141412 CrossRefPubMedGoogle Scholar
- 28.Tay KJ, Gupta RT, Brown AF, Silverman RK, Polascik TJ (2016) Defining the incremental utility of prostate multiparametric magnetic resonance imaging at standard and specialized read in predicting extracapsular extension of prostate cancer. Eur Urol 70:211–213. doi: 10.1016/j.eururo.2015.10.041 CrossRefPubMedGoogle Scholar