World Journal of Urology

, Volume 35, Issue 9, pp 1409–1415 | Cite as

Integration of MRI to clinical nomogram for predicting pathological stage before radical prostatectomy

  • Cedric Lebacle
  • Françoise Roudot-Thoraval
  • Anissa Moktefi
  • Mohamed Bouanane
  • Alexandre De La Taille
  • Laurent Salomon
Original Article



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.


EPE MRI Nerve sparing Preoperative system score Prostate cancer Staging 



We acknowledge urologists and residents of department of Urology at CHU Mondor for data collection.

Author’s contribution

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.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

345_2016_1981_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 20 kb)


  1. 1.
    Alsaid B, Karam I, Bessede T, Abdlsamad I, Uhl JF, Delmas V et al (2010) Tridimensional computer-assisted anatomic dissection of posterolateral prostatic neurovascular bundles. Eur Urol 58:281–287. doi: 10.1016/j.eururo.2010.04.002 CrossRefPubMedGoogle Scholar
  2. 2.
    Yossepowitch O, Briganti A, Eastham JA, Epstein J, Graefen M, Montironi R et al (2014) Positive surgical margins after radical prostatectomy: a systematic review and contemporary update. Eur Urol 65:303–313. doi: 10.1016/j.eururo.2013.07.039 CrossRefPubMedGoogle Scholar
  3. 3.
    Ristau BT, Tomaszewski JJ, Chen Y-F, Bertolet M, Woldemichael E, Nelson JB (2014) Prostate biopsy perineural invasion is not independently associated with positive surgical margins following radical retropubic prostatectomy. World J Urol. doi: 10.1007/s00345-014-1430-2 PubMedGoogle Scholar
  4. 4.
    Eifler JB, Feng Z, Lin BM, Partin MT, Humphreys EB, Han M et al (2013) An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU Int 111:22–29. doi: 10.1111/j.1464-410X.2012.11324.x CrossRefPubMedGoogle Scholar
  5. 5.
    Bloch BN, Genega EM, Costa DN, Pedrosa I, Smith MP, Kressel HY et al (2012) Prediction of prostate cancer extracapsular extension with high spatial resolution dynamic contrast-enhanced 3-T MRI. Eur Radiol 22:2201–2210. doi: 10.1007/s00330-012-2475-5 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Rud E, Baco E, Klotz D, Rennesund K, Svindland A, Berge V et al (2015) Does preoperative magnetic resonance imaging reduce the rate of positive surgical margins at radical prostatectomy in a randomised clinical trial? Eur Urol. doi: 10.1016/j.eururo.2015.02.039 Google Scholar
  7. 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
  8. 8.
    Ruprecht O, Weisser P, Bodelle B, Ackermann H, Vogl TJ (2012) MRI of the prostate: interobserver agreement compared with histopathologic outcome after radical prostatectomy. Eur J Radiol 81:456–460. doi: 10.1016/j.ejrad.2010.12.076 CrossRefPubMedGoogle Scholar
  9. 9.
    Ward JF, Slezak JM, Blute ML, Bergstralh EJ, Zincke H (2005) Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate-specific antigen testing: 15-year outcome. BJU Int 95:751–756. doi: 10.1111/j.1464-410X.2005.05394.x CrossRefPubMedGoogle Scholar
  10. 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. 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. 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
  13. 13.
    Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V et al (2011) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 59:61–71. doi: 10.1016/j.eururo.2010.10.039 CrossRefPubMedGoogle Scholar
  14. 14.
    Salomon L, Bastide C, Beuzeboc P, Cormier L, Fromont G, Hennequin C et al (2013) CCAFU Recommendations 2013: prostate cancer. Prog Urol 24:S69–S101CrossRefGoogle Scholar
  15. 15.
    Chun FK-H, Karakiewicz PI, Briganti A, Gallina A, Kattan MW, Montorsi F et al (2006) Prostate cancer nomograms: an update. Eur Urol 50:914–926. doi: 10.1016/j.eururo.2006.07.042 (discussion 926) CrossRefPubMedGoogle Scholar
  16. 16.
    Guillonneau B (2007) Ceteris paribus and nomograms in medicine. Eur Urol 52:1287–1289. doi: 10.1016/j.eururo.2007.04.085 CrossRefPubMedGoogle Scholar
  17. 17.
    Ohori M, Kattan MW, Koh H, Maru N, Slawin KM, Shariat S et al (2004) Predicting the presence and side of extracapsular extension: a nomogram for staging prostate cancer. J Urol 171:1844–1849. doi: 10.1097/01.ju.0000121693.05077.3d (discussion 1849) CrossRefPubMedGoogle Scholar
  18. 18.
    Steuber T, Graefen M, Haese A, Erbersdobler A, Chun FK-H, Schlom T et al (2006) Validation of a nomogram for prediction of side specific extracapsular extension at radical prostatectomy. J Urol 175:939–944. doi: 10.1016/S0022-5347(05)00342-3 (discussion 944) CrossRefPubMedGoogle Scholar
  19. 19.
    Kattan MW, Stapleton AM, Wheeler TM, Scardino PT (1997) Evaluation of a nomogram used to predict the pathologic stage of clinically localized prostate carcinoma. Cancer 79:528–537CrossRefPubMedGoogle Scholar
  20. 20.
    Billing A, Buchner A, Stief C, Roosen A (2014) Preoperative mp-MRI of the prostate provides little information about staging of prostate carcinoma in daily clinical practice. World J Urol. doi: 10.1007/s00345-014-1448-5 PubMedGoogle Scholar
  21. 21.
    Wang L, Hricak H, Kattan MW, Chen H-N, Scardino PT, Kuroiwa K (2006) Prediction of organ-confined prostate cancer: incremental value of MR imaging and MR spectroscopic imaging to staging nomograms. Radiology 238:597–603. doi: 10.1148/radiol.2382041905 CrossRefPubMedGoogle Scholar
  22. 22.
    Pak S, Park S, Ryu J, Hong S, Song SH, You D et al (2013) Preoperative factors predictive of posterolateral extracapsular extension after radical prostatectomy. Korean J Urol 54:824–829. doi: 10.4111/kju.2013.54.12.824 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Feng TS, Sharif-Afshar AR, Wu J, Li Q, Luthringer D, Saouaf R et al (2015) Multiparametric MRI improves accuracy of clinical nomograms for predicting extracapsular extension of prostate cancer. Urology 86:332–337. doi: 10.1016/j.urology.2015.06.003 CrossRefPubMedGoogle Scholar
  24. 24.
    Newton MR, Phillips S, Chang SS, Clark PE, Cookson MS, Davis R et al (2010) Smaller prostate size predicts high grade prostate cancer at final pathology. J Urol 184:930–937. doi: 10.1016/j.juro.2010.04.082 CrossRefPubMedGoogle Scholar
  25. 25.
    Briganti A, Chun FK-H, Suardi N, Gallina A, Walz J, Graefen M et al (1990) Prostate volume and adverse prostate cancer features: fact not artifact. Eur J Cancer Oxf Engl 2007(43):2669–2677. doi: 10.1016/j.ejca.2007.09.022 Google Scholar
  26. 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. 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. 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
  29. 29.
    de Rooij M, Hamoen EHJ, Witjes JA, Barentsz JO, Rovers MM (2015) Accuracy of magnetic resonance imaging for local staging of prostate cancer: a diagnostic meta-analysis. Eur Urol. doi: 10.1016/j.eururo.2015.07.029 Google Scholar
  30. 30.
    Brajtbord JS, Lavery HJ, Nabizada-Pace F, Senaratne P, Samadi DB (2011) Endorectal magnetic resonance imaging has limited clinical ability to preoperatively predict pT3 prostate cancer. BJU Int 107:1419–1424. doi: 10.1111/j.1464-410X.2010.09599.x CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Urology, CHU Mondor, Assistance Publique des Hôpitaux de ParisUniversité Paris-EstCréteilFrance
  2. 2.Department of Public Health, CHU Mondor, Assistance Publique des Hôpitaux de ParisUniversité Paris-EstCréteilFrance
  3. 3.Department of Pathology, CHU Mondor, Assistance Publique des Hôpitaux de ParisUniversité Paris-EstCréteilFrance
  4. 4.Department of Radiology, CHU Mondor, Assistance Publique des Hôpitaux de ParisUniversité Paris-EstCréteilFrance

Personalised recommendations