The Impact of Magnetic Resonance Imaging on Prediction of Extraprostatic Extension and Prostatectomy Outcome in Patients with Low-, Intermediate- and High-Risk Prostate Cancer: Try to Find a Standard

Radtke, Jan Philipp; Hadaschik, Boris; Wolf, M.; Freitag, Martin T.; Schwab, Constantin; Alt, Céline D.; Roth, Wilfried; Duensing, Stefan; Pahernik, Sascha; Roethke, Matthias; Schlemmer, Heinz Peter; Hohenfellner, Markus; Teber, Doğu

doi:10.1089/end.2015.0358

Cited by 34 publications

(17 citation statements)

References 31 publications

(36 reference statements)

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“…Retrospective review showed 25.7% of men who had no evidence of ECE on mpMRI and who underwent a non-nerve-sparing procedure due to high-risk features, ultimately had OC disease at final pathology. Conversely, mpMRI was able to predict pathologic ECE in low or intermediate risk patients in patients who underwent nerve-sparing procedures and subsequently had a positive surgical margin [35] .…”

Section: Discussionmentioning

confidence: 91%

Multi-parametric MRI of the prostate: Factors predicting extracapsular extension at the time of radical prostatectomy

Gaunay

Patel

Shah

et al. 2017

Asian Journal of Urology

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ObjectiveExtracapsular extension (ECE) of prostate cancer is a poor prognostic factor associated with progression, recurrence after treatment, and increased prostate cancer-related mortality. Accurate staging prior to radical prostatectomy is crucial in avoidance of positive margins and when planning nerve-sparing procedures. Multi-parametric magnetic resonance imaging (mpMRI) of the prostate has shown promise in this regard, but is hampered by poor sensitivity. We sought to identify additional clinical variables associated with pathologic ECE and determine our institutional accuracy in the detection of ECE amongst patients who went on to radical prostatectomy.MethodsmpMRI studies performed between the years 2012 and 2014 were cross-referenced with radical prostatectomy specimens. Predictive properties of ECE as well as additional clinical and biochemical variables to identify pathology-proven prostate cancer ECE were analyzed.ResultsThe prevalence of ECE was 32.4%, and the overall accuracy of mpMRI for ECE was 84.1%. Overall mpMRI sensitivity, specificity, positive predictive value, and negative predictive value for detection of ECE were 58.3%, 97.8%, 93.3%, and 81.5%, respectively. Specific mpMRI characteristics predictive of pathologic ECE included primary lesion size ((20.73 ± 9.09) mm, mean ± SD, p < 0.001), T2 PIRADS score (p = 0.009), overall primary lesion score (p < 0.001), overall study suspicion score (p = 0.003), and MRI evidence of seminal vesicle invasion (SVI) (p = 0.001).ConclusionWhile mpMRI is an accurate preoperative assessment tool for the detection of ECE, its overall sensitivity is poor, likely related to the low detection rate of standard protocol MRI for microscopic extraprostatic disease. The additional mpMRI findings described may also be considered in surgical margin planning prior to radical prostatectomy.

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Section: Discussionmentioning

confidence: 91%

Multi-parametric MRI of the prostate: Factors predicting extracapsular extension at the time of radical prostatectomy

Gaunay

Patel

Shah

et al. 2017

Asian Journal of Urology

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“…Our analyses showed that for 5 studies using the PI-RADS guidelines to diagnosis of PCa, the diagnostic accuracy was lower than quantitative assessment. Moreover, sensitivity and specificity varied widely as whether PI-RADS score 3 lesions were regarded as positive or not, and many studies demonstrated that counted score 3 lesions as positive would result in higher sensitivity but lower specificity, and vice versa 2,25,38. Another widely used scoring system was Likert scale, and a study conducted by Costa et al showed that it perhaps outperforms PI-RADS but the difference was not substantial; moreover, the absence of objective criteria raises the concerns about the reproducibility of it, and then a strategy to standardize the Likert scoring system would be desirable 33.…”

Section: Discussionmentioning

confidence: 99%

<p>Apparent diffusion coefficient in extraprostatic extension of prostate cancer: a systematic review and diagnostic meta-analysis</p>

Bai

Sun²,

et al. 2019

CMAR

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Objective: To evaluate the diagnostic performance of apparent diffusion coefficient (ADC) for local staging of prostate cancer. Methods: Databases of Web of Science, MEDLINE (Ovid and PubMed), Cochrane Library, EMBASE, and Google Scholar were searched up to May 31, 2018, with language restricted to English. All studies concerning multiparametric magnet resonance imaging (mpMRI) with ADC for detection of extracapsular extension (ECE, T3a) and/or extraprostatic extension (EPE, overall stage of T3) were identified by two reviewers independently, and quality of included studies was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2 tool. True positive, false positive, false negative and true negative of each study were extracted to reconstruct the 2×2 tables for evaluating diagnostic accuracy. Summary estimates of sensitivity, specificity, and corresponding 95% CIs were calculated with bivariate model and hierarchical summary receiver operating characteristic model, then presented in forest plots. Multiple subgroup analyses and meta-regression were performed, and publication bias was evaluated with Deeks funnel. Results: A total of 18 studies were included, with 6 involved ECE and 12 for EPE. Pooled sensitivity was 80.5% (95% CI 76.5–83.9%) with specificity of 69.1% (95% CI 62.3–75.2%). Multiple subgroup analyses showed that if ADC and length of capsular contact are regarded as independent predictors, pooled sensitivity was 85% (95% CI 77–90%) and 81.1% (95% CI 76.0–85.3%), with specificity of 70.8% (95% CI 56.3–82.0%) and 66.6% (95% CI 57.6–74.5%), respectively. Meta-regression demonstrated that there was no substantially significant difference in types of coil, magnet field strength (1.5T versus 3.0T), and analysis method (per-lesion versus per-patient). Conclusion: By introducing ADC to MRI, we could obtain favorable sensitivity for diagnostic performance of EPE, but with a little decreased specificity.

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“…To overcome this issue, better preoperative patient selection is mandatory, not only for hydrodissection but also for the indication of nervesparing procedure. Recent publications showed the impact of multiparametric magnetic resonance imaging (MRI) on prediction of extraprostatic extension with a positive predictive value of 50.0%, 90.0%, and 88.8% for the low‐, intermediate‐ and high‐risk cohort . Other authors report an overall sensivity of 60.0% and specifity of 86.0% and therefore suggest preoperative MRI to guide decision‐making about NVB preservation .…”

Section: Discussionmentioning

confidence: 99%

A prospective randomized controlled trial for assessment of perineal hydrodissection technique for nervesparing robot assisted radical prostatectomy

Hatiboglu

Simpfendörfer

Uhlmann

et al. 2017

Robotics Computer Surgery

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The Impact of Magnetic Resonance Imaging on Prediction of Extraprostatic Extension and Prostatectomy Outcome in Patients with Low-, Intermediate- and High-Risk Prostate Cancer: Try to Find a Standard

Cited by 34 publications

References 31 publications

Multi-parametric MRI of the prostate: Factors predicting extracapsular extension at the time of radical prostatectomy

Multi-parametric MRI of the prostate: Factors predicting extracapsular extension at the time of radical prostatectomy

<p>Apparent diffusion coefficient in extraprostatic extension of prostate cancer: a systematic review and diagnostic meta-analysis</p>

A prospective randomized controlled trial for assessment of perineal hydrodissection technique for nervesparing robot assisted radical prostatectomy

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