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Extracapsular extension of transitional zone prostate cancer miss-detected by multiparametric magnetic resonance imaging

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Abstract

Objectives

To demonstrate the importance of extracapsular extension (ECE) of transitional zone (TZ) prostate cancer (PCa), examine the causes of its missed detection by Mp-MRI, and develop a new predictive model by integrating multi-level clinical variables.

Materials and methods

This retrospective study included 304 patients who underwent laparoscopic radical prostatectomy after 12 + X needle transperineal transrectal ultrasound (TRUS)-MRI-guided targeted prostate biopsy from 2018 to 2021 in our center was performed.

Results

In this study, the incidence rates of ECE were similar in patients with MRI lesions in the peripheral zone (PZ) and TZ (P = 0.66). However, the missed detection rate was higher in patients with TZ lesions than in those with PZ lesions (P < 0.05). These missed detections result in a higher positive surgical margin rate (P < 0.05). In patients with TZ lesions, detected MP-MRI ECE may have grey areas: the longest diameters of the MRI lesions were 16.5–23.5 mm; MRI lesion volumes were 0.63–2.51 ml; MRI lesion volume ratios were 2.75–8.86%; PSA were 13.85–23.05 ng/ml. LASSO regression was used to construct a clinical prediction model for predicting the risk of ECE in TZ lesions from the perspective of MRI and clinical features, including four variables: the longest diameter of MRI lesions, TZ pseudocapsule invasion, ISUP grading of biopsy pathology, and number of positive biopsy needles.

Conclusions

Patients with MRI lesions in the TZ have the same incidence of ECE as those with lesions in the PZ, but a higher missed detection rate.

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Data availability

The data are available from the corresponding author on reasonable request.

Abbreviations

PCa:

Prostate cancer

TZ:

Transitional zone

PZ:

Peripheral zone

ECE:

Extracapsular extension

IQR:

Interquartile

Mp-MRI:

Multiparametric MRI

PI-RADS:

Prostate imaging reporting and data system

tPSA:

Total prostate-specific antigen

SVI:

Seminal vesicle invasion

NPN:

Number of positive biopsy needles

ISUP:

International Society of Urological Pathology

LDL:

Largest dimension of index lesion

PNI:

Positive nerve invasion

PSM:

Positive surgical margins

PCI:

Pseudocapsule invasion

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Funding

This work was supported by two grants from the Jiangsu Provincial Key Research and Development Program (No.BE2020655 and No. BE2020654) and a grant from the General Program of Jiangsu Health Commission (No. H2019040) and a grant from the Gusu Health Personnel Training Project of Suzhou City (No. GSWS2019033) and a grant from the National Natural Science Foundation of China (No. 32200533).

Author information

Author notes

  1. Xin Chen and Wei Li have contributed equally to this work. Xuedong Wei, Yuhua Huang and Jianquan Hou are co-authors of communication.

Authors and Affiliations

  1. Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People’s Republic of China

    Xin Chen, Wei Li, Jiajian Yang, Chen Huang, Chenchao Zhou, Yuxin Lin, Jianquan Hou, Yuhua Huang & Xuedong Wei

  2. Department of Urology, Changshu No. 2 People’s Hospital, Suzhou, 215006, People’s Republic of China

    Yongchang Chen

  3. Department of Urology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, 215006, People’s Republic of China

    Jianquan Hou

Authors
  1. Xin Chen
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  2. Wei Li
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  4. Chen Huang
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Contributions

XC and WL contributed equally to this work. Conceptualization, XW, YH, JH, and XC; methodology, XW, XC, and WL; data curation, XC, WL, JY, CH, and CZ; formal analysis: XC, WL, JY, YC, and YL; validation, XC, WL, YC, YL, CH and CZ; writing—original draft preparation, all authors; writing—review and editing, all authors; supervision, XW, YH, and JH. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Jianquan Hou, Yuhua Huang or Xuedong Wei.

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Conflict of interest

The authors report no conflicts of interest in this work.

Ethical approval

This study was approved by the Institutional Review Board of First Affiliated Hospital of Soochow University (approval number: NO. 2022 (239)).

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Supplementary Information

Below is the link to the electronic supplementary material.

432_2023_4573_MOESM1_ESM.tif

Supplement 1 Analysis of various factors revealed the missed detection of ECE in the study cohort. The missed detection of ECE may be related to smaller lesion volume ratio, NPN, lesion volume, LDL, tPSA, PSAD and ISUP (biopsy) grade and larger TZ volume ratio (P<0.05), but not with age, prostate volume, TZ volume, PZ volume and f/tPSA (P>0.05). Supplementary file1 (TIF 1704 KB)

432_2023_4573_MOESM2_ESM.tif

Supplement 2 Correlation analysis of various factors and missed ECE in the TZ group. The missed detection of ECE in TZ tumors was related to smaller PZV and PSAD (P<0.05), but not related to NPN, prostate volume, TZ volume, TZ volume ratio, PZ volume ratio, age, ISUP grade (biopsy), tPSA, and the location of TZ lesions on MRI scans(P>0.05). LTZ, left transition zone; RTZ, right transition zone; TZa, front transition zone; TZp, back transition zone, divided according to the PI-RADS guidelines. Supplementary file2 (TIF 1299 KB)

432_2023_4573_MOESM3_ESM.tif

Supplement 3 Correlation analysis of various factors and pECE occurrence in mECE- patients with TZ tumors. pECE occurrence was not related to age, f/tPSA, PSAD, prostate volume, TZ volume, TZ volume ratio, PZ volume ratio, and the location of TZ lesions on MRI scans (P>0.05). Supplementary file3 (TIF 918 KB)

432_2023_4573_MOESM4_ESM.tif

Supplement 4 Establishment of a clinical risk prediction model for pECE in mECE- patients with TZ tumors. (a) Single-factor logistics regression analysis of pECE-related factors in mECE- patients with TZ tumors. (b) Multivariate logistic regression analysis of pECE-related factors in mECE- patients with TZ tumors. (c) Correlation analysis of significant factors for pECE in mECE- patients with TZ tumors. Supplementary file4 (TIF 2155 KB)

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Chen, X., Li, W., Yang, J. et al. Extracapsular extension of transitional zone prostate cancer miss-detected by multiparametric magnetic resonance imaging. J Cancer Res Clin Oncol 149, 6943–6952 (2023). https://doi.org/10.1007/s00432-023-04573-w

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  • DOI: https://doi.org/10.1007/s00432-023-04573-w

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