Magnetic resonance imaging (MRI) for local staging before salvage radical prostatectomy: a meta-analysis

Abstract

Purpose The reliability of magnetic resonance imaging (MRI) as a local and nodal staging tool in radio-recurrent prostate cancer (PCa) is still unclear. The present study aims at evaluating the predictive value of MRI in the detection of extracapsular extension (ECE), seminal vesical invasion (SVI) and nodal involvement (LNI) in patients after primary radio (EBRT) and/or brachytherapy (BT) before salvage radical prostatectomy (SRP). Methods This systematic review and meta-analysis were performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Pubmed, Scopus, and Web of Science databases were systemically reviewed to extract the data on diagnostic performance of MRI in radio-recurrent PCa. Results Four studies comprising 94 radio-recurrent PCa patients were included. The pooled prevalence of ECE, SVI, and LNI was 61%, 41%, and 20%, respectively. The pooled sensitivity for ECE, SVI and LNI detection was 53% (CI 95% 19.8–83.6%), 53% (CI 95% 37.2–68%) and 33% (CI 95% 4.7–83.1%) respectively, whereas specificity was 75% (CI 95% 40.6–92.6%), 88% (CI 95% 71.7–95.9%) and 92% (CI 95% 79.6–96.8%). The sensitivity analysis revealed that a single outlying study using only T2-weighted imaging instead of multiparametric MRI reported significantly higher sensitivity with significantly lower specificity. Conclusions This is the first meta-analysis reporting reliability of staging MRI in a radio-recurrent setting. MRI provides poor sensitivity while maintaining high specificity for local and nodal staging before SRP. However, current evidence is limited to the low number of heterogenous studies at meaningful risk of bias.

Salvage robot‐assisted radical prostatectomy after carbon ion radiotherapy to the prostate

“…A meta-analysis assessing the diagnostic performance of MRI in radiorecurrent prostate cancer reported that the sensitivities for extracapsular extension, seminal vesicle invasion, and lymph node involvement were 53%, 53%, and 33%, respectively. 12 Preoperative T-staging using MRI was similar or inferior in the present study. Regarding the discordance of the Gleason grade group in salvage RARP, the data from the Martini-Klinik Prostate Cancer Center showed downgrading, concordance, and upgrading of 19.6%, 45.1%, and 35.3%, respectively.…”

Evaluation of Recurrent Disease after Radiation Therapy for Patients Considering Local Salvage Therapy: Past vs. Contemporary Management

“…Further, it can be challenging to detect recurrence in the field of brachytherapy implants. A recent meta-analysis of mpMRI of radiorecurrent PCa demonstrated that mpMRI has high specificity but limited sensitivity for local and nodal radiorecurrent PCa [35]. The use of novel positron emission tomography (PET) agents in combination with mpMRI has been shown to improve the sensitivity, specificity, and localization for primary PCa [36][37][38].…”