Multiparametric magnetic resonance imaging for pre-treatment local staging of prostate cancer: A Cancer Care Ontario clinical practice guideline

Abstract

Introduction: The utility of T2-weighted magnetic resonance imaging (MRI) in the local staging of prostate cancer is controversial. Due to the success of multiparametric MRI in cancer localization, there is renewed interested in MRI (± functional sequences) for local staging. Guidance on pre-treatment local staging of prostate cancer by MRI was developed using systematic review methodology and expert consultation. Methods: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and other databases were searched to identify studies comparing: (1) MRI staging vs. radical prostatectomy staging on diagnostic accuracy outcomes; and (2) MRI staging vs. routine clinical staging on clinical and patient outcomes. Studies meeting inclusion criteria were synthesized by outcome and sensitivity/ specificity analysis by tumour location was performed. Evidence quality of included studies was assessed and considered in recommendation formulation. Results: The literature search identified 2510 citations; 62 studies were included. Analysis of MRI ≥1.5 T plus endorectal coil (ER) (± functional sequences) in the detection of extraprostatic extension or seminal vesicle invasion showed modest sensitivities (≥50%) and excellent specificities (>85%) among patients scheduled for radical prostatectomy. MRI upstaging was shown in 20/21 studies, with large variation in correctness (11-85%). Scarcity of clinical and patient outcomes among studies limited synthesis and evaluation. Quality assessment found non-trivial biases. Conclusions: Modest imaging performance was shown for MRI (1.5 T + ER and 3 T ± ER) ± functional sequences in regards to sensitivity. Limitations in study design, reporting of clinical and patient outcomes, and the heterogeneous use of MRI tempered the strength of the recommendations.

T-staging of prostate cancer: Identification of useful signs to standardize detection of posterolateral extraprostatic extension on prostate MRI

“…A more recent meta-analysis by de Rooij et al [7] included a total of 75 studies with different field-strengths, imaging protocols and study designs, showing sensitivities ranging from 14% to 91% and specificities ranging from 56% to 100%. Almost concurrently, a similar meta-analysis of 61 primary studies by Salerno et al reported sensitivities ranging from 14% to 90% and specificities ranging from 74% to 98% [19]. These analyses indicate that over a 15-year period, no real advances have been made.…”

Evaluation of MRI for diagnosis of extraprostatic extension in prostate cancer

“…Magnetic resonance imaging (MRI) is the reference standard imaging test for local staging of prostate cancer . The diagnosis of EPE with MRI remains limited and is comparatively inferior to assessment of seminal vesicle invasion .…”

“…8 Magnetic resonance imaging (MRI) is the reference standard imaging test for local staging of prostate cancer. [9][10][11] The diagnosis of EPE with MRI remains limited 12,13 and is comparatively inferior to assessment of seminal vesicle invasion. 14 Anatomic-based subjective evaluation of EPE using T 2weighted (T 2 W) MRI when interpreted by experienced radiologists is specific, but lacks sensitivity and is plagued by low interobserver agreement.…”

Peplau’s interpersonal relationship theory combined with bladder function training on patients with prostate cancer

“…The patients were 54–82 years of age, with a mean age of 70.26 ± 6.45 years. Patients presented with a mean Gleason score of prostate cancer[ 6 ] of 5.78 ± 1.76, and a mean prostate-specific antigen (PSA) level of 13.84 ± 2.78 ng/mL. There were 55 cases of adenocarcinoma, 22 cases of epithelial cancer, 8 cases of squamous cell carcinoma, and 4 cases of other cancers.…”

“…The inclusion criteria were as follows: (1) meet the diagnostic criteria of prostate cancer[ 6 ]; (2) PSA < 20 ng/mL, Gleason score[ 7 ] ≤ 7 points, and clinical stage of T1-T2c; (3) undergo TURP before receiving nursing care; and (4) having availability of complete medical records. The exclusion criteria were as follows: (1) heart, liver, or kidney abnormalities, coagulation dysfunction, other malignant tumors, systemic immunity, or severe infection; (2) cognitive dysfunction or mental illness with inability to complete the questionnaire independently; and (3) diagnosis of other diseases that cause dysuria, urinary incontinence, or other symptoms, such as bladder or urethral stones.…”