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A preoperative scoring system for predicting the extraprostatic extension of prostate cancer following radical prostatectomy using magnetic resonance imaging and clinical factors

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Abstract

Purpose

We aimed to develop a preoperative prediction model for extraprostatic extension (EPE) in prostate cancer (PCa) patients following radical prostatectomy (RP) using MRI and clinical factors.

Methods

This retrospective study enrolled 266 consecutive patients who underwent RP for PCa in 2022. These patients were divided into a training set (n = 187) and a test set (n = 79) through random assignment. The evaluated variables included age, prostate-specific antigen (PSA) level, prostate volume, PSA density (PSAD), index tumor length on MRI, Prostate Imaging-Reporting and Data System (PI-RADS) category, and EPE-related MRI features as defined by PI-RADS v2.1. A predictive model was constructed through multivariable logistic regression and subsequently translated into a scoring system. The performance of this scoring system in terms of prediction and calibration was assessed using C statistics and the Hosmer‒Lemeshow test.

Results

Among patients in the training and test cohorts, 74 (39.6%) and 25 (31.6%), respectively, exhibited EPE after RP. The formulated scoring system incorporated the following factors: PSAD, index tumor length, bulging prostatic contour, and tumor-capsule interface > 10 mm as identified on MRI. This scoring system demonstrated strong prediction performance for EPE in both the training (C statistic, 0.87 [95% confidence interval, 0.86–0.87]) and test cohorts (C statistic, 0.85 [0.83–0.89]). Furthermore, the scoring system exhibited good calibration in both cohorts (P = 0.988 and 0.402, respectively).

Conclusion

Our scoring system, built upon MRI features defined by the PI-RADS, offers valuable assistance in assessing the likelihood of EPE after RP.

Graphical Abstract

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Abbreviations

CI:

Confidence interval

DCE:

Dynamic contrast-enhanced imaging

DWI:

Diffusion-weighted imaging

EPE:

Extraprostatic extension

IRE:

Irreversible electroporation

ISUP:

International Society of Urological Pathology

MRI:

Magnetic resonance imaging

mpMRI:

Multiparametric MRI

OR:

Odds ratio

PI-RADS:

Prostate Imaging-Reporting and Data System

PI-QUAL:

Prostate Image Quality

PCa:

Prostate cancer

PSA:

Prostate-specific antigen

PSAD:

Prostate-specific antigen density

RP:

Radical prostatectomy

TCI:

Tumor-capsule interface

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Authors and Affiliations

  1. Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea

    Hyong Woo Moon & Ji Youl Lee

  2. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea

    Dong Hwan Kim

  3. Department of Statistics and Data Science, Yonsei University, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea

    Jeewuan Kim

  4. Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea

    Bohyun Kim, Soon Nam Oh, Joon-Il Choi & Sung Eun Rha

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Correspondence to Dong Hwan Kim.

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Moon, H.W., Kim, D.H., Kim, J. et al. A preoperative scoring system for predicting the extraprostatic extension of prostate cancer following radical prostatectomy using magnetic resonance imaging and clinical factors. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04345-1

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