Preoperative Prediction of Pathological Tumor Volume and Stage in Clinically Localized Prostate Cancer: Comparison of Digital Rectal Examination, Transrectal Ultrasonography and Magnetic Resonance Imaging

Abstract

Accurate preoperative staging is important for proper selection of patients for radical retropubic prostatectomy. Preoperative staging by digital rectal examination, transrectal ultrasound, magnetic resonance imaging (MRI), Gleason grade and prostate specific antigen was compared to pathological stage for 25 patients who underwent radical retropubic prostatectomy. The predictive value for tumor confinement was 36% by rectal examination, 37% by ultrasound and 30% by MRI. The predictive value for extracapsular disease was 100% by rectal examination, 83% by ultrasound and 66% by MRI. Preoperative determinations of tumor volume by any modality did not correlate with pathological tumor volume. Digital rectal examination, ultrasound and MRI clinically understage the disease in most patients but they may be reliable to predict extracapsular disease.

Dynamic TurboFLASH subtraction technique for contrast-enhanced MR imaging of the prostate: correlation with histopathologic results.

“…It was confirmed that tu mors located ventrally and centrally in histopathologic specimens were Tumor volume is a predictor of pathologic stage (22). Except for one study performed with an externalarray coil (23), studies performed with endorectal coil (13) and body coil MR imaging (24)(25)(26)(27) reported a poor cor relation between MR tumor volume and the volume as calculated from the pathologic specimen. Mirowitz et al (6) who studied postcontrast Tlweighted images also reported poor correlation between the estimated and calculated volume.…”

Local staging of prostate cancer with endorectal MR imaging: correlation with histopathology.

“…When tumor volume is smaller than 4 cc metastasis is highly unlikely, whereas when tumor volume exceeds 12 cc metastasis is highly likely [20]. MR sequences with standard body coil and conventional spinecho techniques have not given accurate images for estimating tumor volume before surgery [5,[21][22][23][24][25]. However, fast spin-echo MR images obtained with a phased-array coil estimated tumor volume better [8].…”

Percentage of Cancer on Biopsy Cores Accurately Predicts Extracapsular Extension and Biochemical Relapse after Radical Prostatectomy for T1–T2 Prostate Cancer

“…However, 20–50% of patients operated on for clinical T1–T2 tumors show extraprostatic spread at pathological examination. Current clinical methods used preoperatively to predict the extent of disease are still of limited value for a given patient [1, 2, 3]. Biopsy features have been extensively studied for this purpose and the usefulness of some of these characteristics (number of positive biopsy cores, length of invaded tissue within biopsy cores) has been clearly confirmed [4, 5, 6].…”