Head‐to‐head comparison between multiparametric MRI, the partin tables, memorial sloan kettering cancer center nomogram, and CAPRA score in predicting extraprostatic cancer in patients undergoing radical prostatectomy

Abstract

Background It is unclear whether clinical models including the Partin tables (PT), the Memorial Sloan Kettering Cancer Center nomogram (MSKCCn), and the cancer of the prostate risk assessment (CAPRA) can benefit from incorporating multiparametric magnetic resonance imaging (mpMRI) when staging prostate cancer (PCa). Purpose To compare the accuracy of clinical models, mpMRI, and mpMRI plus clinical models in predicting stage ≥pT3 of PCa. Study Type Prospective monocentric cohort study. Population Seventy‐three patients who underwent radical prostatectomy between 2016–2018. Field Strength/Sequence 3.0T using turbo spin echo (TSE) imaging, single‐shot echoplanar diffusion‐weighted imaging, and T1‐weighted high‐resolution‐isotropic‐volume‐examination (THRIVE) contrast‐enhanced imaging. Assessment We calculated the probability of extraprostatic extension (EPE) using the PT and MSKCC, as well as the CAPRA score. Three readers with 2–8 years of experience in mpMRI independently staged PCa on imaging. Statistical Tests Receiver operating characteristics analysis and logistic regression analysis to investigate the per‐patient accuracy of mpMRI vs. clinical models vs. mpMRI plus clinical models in predicting stage ≥pT3. The alpha level was 0.05. Results Median probability for EPE and MSKCCn was 27.3% and 47.0%, respectively. Median CAPRA score was 3. Stage ≥pT3 occurred in 32.9% of patients. Areas under the curve (AUCs) were 0.62 for PT, 0.62 for MSKCCn, 0.64 for CAPRA, and 0.73–0.75 for mpMRI (readers 1–3) (P > 0.05 for all comparisons). Compared with mpMRI, the combination of mpMRI with PT or MSKCCn provided lower AUCs (P > 0.05 for all the readers), while the combination with CAPRA provided significantly higher (P < 0.05) AUCs in the case of readers 1 and 3. On multivariable analysis, mpMRI by reader 1 was the only independent predictor of stage ≥pT3 (odds ratio 7.40). Data Conclusion mpMRI was more accurate than clinical models and mpMRI plus clinical models in predicting stage ≥pT3, except for the combination of mpMRI and CAPRA in two out of three readers. Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1604–1613.

The Role of Magnetic Resonance Imaging and Positron Emission Tomography/Computed Tomography in the Primary Staging of Newly Diagnosed Prostate Cancer: A Systematic Review of the Literature

“…A comparison of or incorporation into commonly used clinical risk stratification tools such as the Partin tables and MSKCC nomogram that rely on clinical parameters and biopsy results was performed in ten studies [19,21,23,27,30,33,45,78,88,89]. All but two reported better performance for imaging techniques (mostly MRI), although external validation is pending [19,21,23,27,30,33,45,78,88,89]. Highest accuracy was achieved when imaging was incorporated into existing models.…”

Role of Multiparametric Magnetic Resonance Imaging in Predicting Pathologic Outcomes in Prostate Cancer

“…Radiographic assessments always depend on high quality images and the experience of the interpreter. Zanelli et al [55] showed that this applies to local staging for PC as well with a difference in sensitivity between any two radiologists that differs between 0.583 to 0.667 for pathological stage T3 disease. Ma et al [56] attempted to circumvent this limitation with an automated analysis after contouring of the prostate.…”

“…Counterintuitively, Zanelli et al [55] found that add- ing clinical scoring to mpMRI did not improve results in most combinations. Her group evaluated three different readers of the same images alone and in combination with Partin tables and Cancer of the Prostate Risk Assessment (CAPRA) scores.…”

“…With an AUC of 0.73-0.75 for mpMRI alone CAPRA scoring improved the AUCs of two readers to 0.76. The remaining combinations did not provide any benefit [55]. Feng et al [57] showed significant improvement of the AUC of clinical assessment tools by adding mpMRI leading to an AUC of 0.92 compared to 0.85 for Partin tables alone.…”

Prostate MRI added to CAPRA, MSKCC and Partin cancer nomograms significantly enhances the prediction of adverse findings and biochemical recurrence after radical prostatectomy

“…The use of the PI-RADS approach is based upon literature evidence and consensus expert opinions [6]. However, only a few studies have assessed the value of mpMRI to predict adverse pathology and biochemical recurrence (BCR) in men undergoing RP, and even fewer studies have evaluated the added value of MRI over the pre-existing clinical variables and nomograms, and the results have been conflicting [7][8][9][10][11]. Further, combination of mpMRI and predictive nomograms in outcome assessment have not been studied in detail.…”