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Prostate MRI: staging and decision-making

  • Special Section: Male pelvis
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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Multi-parametric prostate MRI (mpMRI) plays a critical role in the diagnosis, staging, and evaluation of treatment response in patients with prostate cancer. Radiologists, through an accurate and standardized interpretation of mpMRI, can clinically stage prostate cancer and help to risk stratify patients who may benefit from more invasive treatment or exclude patients who may be harmed by overtreatment. The purpose of this article is to describe key findings to accurately stage prostate cancer with mpMRI and to describe the contexts in which mpMRI is best applied.

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References

  1. Turkbey B, Rosenkrantz AB, Haider MA, Padhani AR, Villeirs G, Macura KJ, et al. Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2. Eur Urol. 2019 Mar 18;

  2. Oberlin DT, Casalino DD, Miller FH, Meeks JJ. Dramatic increase in the utilization of multiparametric magnetic resonance imaging for detection and management of prostate cancer. Abdom Radiol N Y. 2017;42(4):1255–8.

    Article  Google Scholar 

  3. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al., editors. AJCC Cancer Staging Manual [Internet]. 8th ed. Springer International Publishing; 2017 [cited 2019 Aug 31]. Available from: https://www.springer.com/gp/book/9783319406176

  4. Gupta RT, Faridi KF, Singh AA, Passoni NM, Garcia-Reyes K, Madden JF, et al. Comparing 3-T multiparametric MRI and the Partin tables to predict organ-confined prostate cancer after radical prostatectomy. Urol Oncol. 2014 Nov;32(8):1292–9.

    Article  Google Scholar 

  5. Duvnjak P, Schulman AA, Holtz JN, Huang J, Polascik TJ, Gupta RT. Multiparametric Prostate MR Imaging: Impact on Clinical Staging and Decision Making. Radiol Clin North Am. 2018 Mar;56(2):239–50.

    Article  Google Scholar 

  6. Thompson IM, Ankerst DP, Chi C, Goodman PJ, Tangen CM, Lucia MS, et al. Assessing prostate cancer risk: results from the Prostate Cancer Prevention Trial. J Natl Cancer Inst. 2006 Apr 19;98(8):529–34.

    Article  Google Scholar 

  7. Williams SB, Salami S, Regan MM, Ankerst DP, Wei JT, Rubin MA, et al. Selective detection of histologically aggressive prostate cancer: an Early Detection Research Network Prediction model to reduce unnecessary prostate biopsies with validation in the Prostate Cancer Prevention Trial. Cancer. 2012 May 15;118(10):2651–8.

    Article  Google Scholar 

  8. Partin AW, Mangold LA, Lamm DM, Walsh PC, Epstein JI, Pearson JD. Contemporary update of prostate cancer staging nomograms (Partin Tables) for the new millennium. Urology. 2001 Dec;58(6):843–8.

    Article  CAS  Google Scholar 

  9. Eifler JB, Feng Z, Lin BM, Partin MT, Humphreys EB, Han M, et al. An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU Int. 2013 Jan;111(1):22–9.

    Article  Google Scholar 

  10. Cooperberg MR, Pasta DJ, Elkin EP, Litwin MS, Latini DM, Du Chane J, et al. The University of California, San Francisco Cancer of the Prostate Risk Assessment score: a straightforward and reliable preoperative predictor of disease recurrence after radical prostatectomy. J Urol. 2005 Jun;173(6):1938–42.

    Article  Google Scholar 

  11. Ohori M, Kattan MW, Koh H, Maru N, Slawin KM, Shariat S, et al. Predicting the presence and side of extracapsular extension: a nomogram for staging prostate cancer. J Urol. 2004 May;171(5):1844–9; discussion 1849.

  12. Bjurlin M, Wysock J, Sakar S, Venkataraman R, Mendhiratta N, Meng X, et al. MP53-11 A PRE-BIOPSY NOMOGRAM FOR PREDICTION OF THE RISK OF GLEASON SCORE = 7 PROSTATE CANCER ON COMBINED MRI-US FUSION TARGETED AND SYSTEMATIC PROSTATE BIOPSY AMONG MEN WITH NO PREVIOUS BIOPSY. J Urol [Internet]. 2016 Apr [cited 2019 Feb 22]; Available from: https://www.auajournals.org/doi/abs/10.1016/j.juro.2016.02.508

  13. Salami SS, Vira MA, Turkbey B, Fakhoury M, Yaskiv O, Villani R, et al. Multiparametric magnetic resonance imaging outperforms the Prostate Cancer Prevention Trial risk calculator in predicting clinically significant prostate cancer. Cancer. 2014 Sep 15;120(18):2876–82.

    Article  Google Scholar 

  14. NCCN Clinical Practice Guidelines in Oncology (NCCN Gudelines) Prostate Cancer Version 3.2019 [Internet]. National Comprehensive Cancer Network; 2019 [cited 2019 Aug 14]. Available from: https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf

  15. de Rooij M, Hamoen EHJ, Witjes JA, Barentsz JO, Rovers MM. Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis. Eur Urol. 2016;70(2):233–45.

    Article  Google Scholar 

  16. Somford DM, Hamoen EH, Fütterer JJ, van Basten JP, Hulsbergen-van de Kaa CA, Vreuls W, et al. The predictive value of endorectal 3 Tesla multiparametric magnetic resonance imaging for extraprostatic extension in patients with low, intermediate and high risk prostate cancer. J Urol. 2013 Nov;190(5):1728–34.

  17. Davis R, Salmasi A, Koprowski C, Kim S, Kwon YS, Faiena I, et al. Accuracy of Multiparametric Magnetic Resonance Imaging for Extracapsular Extension of Prostate Cancer in Community Practice. Clin Genitourin Cancer. 2016;14(6):e617–22.

    Article  Google Scholar 

  18. Feng TS, Sharif-Afshar AR, Smith SC, Miller J, Nguyen C, Li Q, et al. Multiparametric magnetic resonance imaging localizes established extracapsular extension of prostate cancer. Urol Oncol. 2015 Mar;33(3):109.e15-22.

    Article  Google Scholar 

  19. Morlacco A, Sharma V, Viers BR, Rangel LJ, Carlson RE, Froemming AT, et al. The Incremental Role of Magnetic Resonance Imaging for Prostate Cancer Staging before Radical Prostatectomy. Eur Urol. 2017;71(5):701–4.

    Article  Google Scholar 

  20. Boesen L, Chabanova E, Løgager V, Balslev I, Mikines K, Thomsen HS. Prostate cancer staging with extracapsular extension risk scoring using multiparametric MRI: a correlation with histopathology. Eur Radiol. 2015 Jun;25(6):1776–85.

    Article  Google Scholar 

  21. Lee H, Kim CK, Park BK, Sung HH, Han DH, Jeon HG, et al. Accuracy of preoperative multiparametric magnetic resonance imaging for prediction of unfavorable pathology in patients with localized prostate cancer undergoing radical prostatectomy. World J Urol. 2017 Jun;35(6):929–34.

    Article  Google Scholar 

  22. Tanaka K, Shigemura K, Muramaki M, Takahashi S, Miyake H, Fujisawa M. Efficacy of using three-tesla magnetic resonance imaging diagnosis of capsule invasion for decision-making about neurovascular bundle preservation in robotic-assisted radical prostatectomy. Korean J Urol. 2013 Jul;54(7):437–41.

    Article  Google Scholar 

  23. Kayat Bittencourt L, Litjens G, Hulsbergen-van de Kaa CA, Turkbey B, Gasparetto EL, Barentsz JO. 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. 2015 Aug;276(2):479–89.

  24. Schieda N, Quon JS, Lim C, El-Khodary M, Shabana W, Singh V, et al. Evaluation of the European Society of Urogenital Radiology (ESUR) PI-RADS scoring system for assessment of extra-prostatic extension in prostatic carcinoma. Eur J Radiol. 2015 Oct;84(10):1843–8.

    Article  Google Scholar 

  25. Sala E, Akin O, Moskowitz CS, Eisenberg HF, Kuroiwa K, Ishill NM, et al. Endorectal MR imaging in the evaluation of seminal vesicle invasion: diagnostic accuracy and multivariate feature analysis. Radiology. 2006 Mar;238(3):929–37.

    Article  Google Scholar 

  26. Wang L, Hricak H, Kattan MW, Chen HN, Kuroiwa K, Eisenberg HF, et al. Prediction of seminal vesicle invasion in prostate cancer: incremental value of adding endorectal MR imaging to the Kattan nomogram. Radiology. 2007 Jan;242(1):182–8.

    Article  Google Scholar 

  27. Jager GJ, Ruijter ET, van de Kaa CA, de la Rosette JJ, Oosterhof GO, Thornbury JR, et al. Local staging of prostate cancer with endorectal MR imaging: correlation with histopathology. AJR Am J Roentgenol. 1996 Apr;166(4):845–52.

    Article  CAS  Google Scholar 

  28. Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al. PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. Eur Urol. 2016 Jan;69(1):16–40.

    Article  Google Scholar 

  29. Matsuoka Y, Ishioka J, Tanaka H, Kimura T, Yoshida S, Saito K, et al. Impact of the Prostate Imaging Reporting and Data System, Version 2, on MRI Diagnosis for Extracapsular Extension of Prostate Cancer. AJR Am J Roentgenol. 2017 Aug;209(2):W76–84.

    Article  Google Scholar 

  30. Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G, et al. ESUR prostate MR guidelines 2012. Eur Radiol. 2012 Apr;22(4):746–57.

    Article  Google Scholar 

  31. Radtke JP, Hadaschik BA, Wolf MB, Freitag MT, Schwab C, Alt C, et al. The Impact of Magnetic Resonance Imaging on Prediction of Extraprostatic Extension and Prostatectomy Outcome in Patients with Low-, Intermediate- and High-Risk Prostate Cancer: Try to Find a Standard. J Endourol. 2015 Dec;29(12):1396–405.

    Article  Google Scholar 

  32. Costa DN, Passoni NM, Leyendecker JR, de Leon AD, Lotan Y, Roehrborn CG, et al. Diagnostic Utility of a Likert Scale Versus Qualitative Descriptors and Length of Capsular Contact for Determining Extraprostatic Tumor Extension at Multiparametric Prostate MRI. Am J Roentgenol. 2018 Feb 28;210(5):1066–72.

    Article  Google Scholar 

  33. Mehralivand S, Shih JH, Harmon S, Smith C, Bloom J, Czarniecki M, et al. A Grading System for the Assessment of Risk of Extraprostatic Extension of Prostate Cancer at Multiparametric MRI. Radiology. 2019 Mar;290(3):709–19.

    Article  Google Scholar 

  34. Ohori M, Scardino PT, Lapin SL, Seale-Hawkins C, Link J, Wheeler TM. The mechanisms and prognostic significance of seminal vesicle involvement by prostate cancer. Am J Surg Pathol. 1993 Dec;17(12):1252–61.

    Article  CAS  Google Scholar 

  35. Kim CK, Park SY, Park JJ, Park BK. Diffusion-weighted MRI as a predictor of extracapsular extension in prostate cancer. AJR Am J Roentgenol. 2014 Mar;202(3):W270-276.

    Article  Google Scholar 

  36. Soylu FN, Peng Y, Jiang Y, Wang S, Schmid-Tannwald C, Sethi I, et al. Seminal vesicle invasion in prostate cancer: evaluation by using multiparametric endorectal MR imaging. Radiology. 2013 Jun;267(3):797–806.

    Article  Google Scholar 

  37. Sankineni S, Brown AM, Fascelli M, Law YM, Pinto PA, Choyke PL, et al. Lymph Node Staging in Prostate Cancer. Curr Urol Rep. 2015 May;16(5):30.

    Article  Google Scholar 

  38. Hövels AM, Heesakkers R a. M, Adang EM, Jager GJ, Strum S, Hoogeveen YL, et al. The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol. 2008 Apr;63(4):387–95.

  39. Thoeny HC, Froehlich JM, Triantafyllou M, Huesler J, Bains LJ, Vermathen P, et al. Metastases in normal-sized pelvic lymph nodes: detection with diffusion-weighted MR imaging. Radiology. 2014 Oct;273(1):125–35.

    Article  Google Scholar 

  40. Park SY, Shin S-J, Jung DC, Cho NH, Choi YD, Rha KH, et al. PI-RADS version 2: Preoperative role in the detection of normal-sized pelvic lymph node metastasis in prostate cancer. Eur J Radiol. 2017 Jun;91:22–8.

    Article  Google Scholar 

  41. Park SY, Oh YT, Jung DC, Cho NH, Choi YD, Rha KH. Prediction of Micrometastasis (< 1 cm) to Pelvic Lymph Nodes in Prostate Cancer: Role of Preoperative MRI. AJR Am J Roentgenol. 2015 Sep;205(3):W328-334.

    Article  Google Scholar 

  42. Woo S, Suh CH, Kim SY, Cho JY, Kim SH. The Diagnostic Performance of MRI for Detection of Lymph Node Metastasis in Bladder and Prostate Cancer: An Updated Systematic Review and Diagnostic Meta-Analysis. Am J Roentgenol. 2018 Jan 30;210(3):W95–109.

    Article  Google Scholar 

  43. Schiavina R, Bianchi L, Borghesi M, Dababneh H, Chessa F, Pultrone CV, et al. MRI Displays the Prostatic Cancer Anatomy and Improves the Bundles Management Before Robot-Assisted Radical Prostatectomy. J Endourol. 2017 Dec 19;32(4):315–21.

    Article  Google Scholar 

  44. Kozikowski M, Malewski W, Michalak W, Dobruch J. Clinical utility of MRI in the decision-making process before radical prostatectomy: Systematic review and meta-analysis. PLOS ONE. 2019 Jan 7;14(1):e0210194.

    Article  CAS  Google Scholar 

  45. Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, et al. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. N Engl J Med. 2016 13;375(15):1415–24.

  46. Couñago F, Sancho G, Catalá V, Hernández D, Recio M, Montemuiño S, et al. Magnetic resonance imaging for prostate cancer before radical and salvage radiotherapy: What radiation oncologists need to know. World J Clin Oncol. 2017 Aug 10;8(4):305–19.

    Article  Google Scholar 

  47. Westphalen AC, Koff WJ, Coakley FV, Muglia VF, Neuhaus JM, Marcus RT, et al. Prostate cancer: prediction of biochemical failure after external-beam radiation therapy–Kattan nomogram and endorectal MR imaging estimation of tumor volume. Radiology. 2011 Nov;261(2):477–86.

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Abdominal Radiology, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA

    Michael J. Magnetta, Roberta Catania, Amir A. Borhani & Alessandro Furlan

  2. Division of Abdominal Radiology, Department of Radiology, Northwestern University, Chicago, IL, USA

    Michael J. Magnetta

  3. Institute of Radiology, Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy

    Roberta Catania

  4. Institute of Radiology, Department of Medicine, University of Udine, University Hospital, S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, UD, Italy

    Rossano Girometti

  5. Departments of Radiology and Biomedical Imaging, and Urology, Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, USA

    Antonio C. Westphalen

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  1. Michael J. Magnetta
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Correspondence to Alessandro Furlan.

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Alessandro Furlan is a consultant for Bracco Diagnostic (not related to this manuscript) and received royalties from Elsevier. All other authors have no financial or other disclosures relationship with any commercial organization that may have a direct or indirect interest in this manuscript. There is no conflict of interest to declare for this manuscript.

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Magnetta, M.J., Catania, R., Girometti, R. et al. Prostate MRI: staging and decision-making. Abdom Radiol 45, 2143–2153 (2020). https://doi.org/10.1007/s00261-020-02431-8

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