Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 17;14(16):3966.
doi: 10.3390/cancers14163966.

Multiparametric MRI for Staging of Prostate Cancer: A Multicentric Analysis of Predictive Factors to Improve Identification of Extracapsular Extension before Radical Prostatectomy

Marina Triquell  1   2 , Lucas Regis  1   2 , Mathias Winkler  3 , Nicolás Valdés  1   2 , Mercè Cuadras  1   2 , Ana Celma  1   2 , Jacques Planas  1   2 , Juan Morote  1   2 , Enrique Trilla  1   2
Affiliations

Multiparametric MRI for Staging of Prostate Cancer: A Multicentric Analysis of Predictive Factors to Improve Identification of Extracapsular Extension before Radical Prostatectomy

Marina Triquell et al. Cancers (Basel). .

Abstract

The correct identification of extracapsular extension (ECE) of prostate cancer (PCa) on multiparametric magnetic resonance imaging (mpMRI) is crucial for surgeons in order to plan the nerve-sparing approach in radical prostatectomy. Nerve-sparing strategies allow for better outcomes in preserving erectile function and urinary continence, notwithstanding this can be penalized with worse oncologic results. The aim of this study was to assess the ability of preoperative mpMRI to predict ECE in the final prostatic specimen (PS) and identify other possible preoperative predictive factors of ECE as a secondary end-point. We investigated a database of two high-volume hospitals to identify men who underwent a prostate biopsy with a pre-biopsy mpMRI and a subsequent RP. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI in predicting ECE were calculated. A univariate analysis was performed to find the association between image staging and pathological staging. A multivariate logistic regression was performed to investigate other preoperative predictive factors. A total of 1147 patients were selected, and 203 out of the 1147 (17.7%) patients were classified as ECE according to the mpMRI. ECE was reported by pathologists in 279 out of the 1147 PS (24.3%). The PPV was 0.58, the NPV was 0.72, the sensitivity was 0.32, and the specificity was 0.88. The multivariate analysis found that PSA (OR 1.057, C.I. 95%, 1.016-1.100, p = 0.006), digital rectal examination (OR 0.567, C.I. 95%, 0.417-0.770, p = 0.0001), ratio of positive cores (OR 9.687, C.I. 95%, 3.744-25.006, p = 0.0001), and biopsy grade in prostate biopsy (OR 1.394, C.I. 95%, 1.025-1.612, p = 0.0001) were independent factors of ECE. The mpMRI has a great ability to exclude ECE, notwithstanding that low sensitivity is still an important limitation of the technique.

Keywords: extracapsular extension; multiparametric magnetic resonance; prostate cancer; tumor staging.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Mottet N., van den Bergh R.C.N., Briers E., Van den Broeck T., Cumberbatch M.G., De Santis M., Fanti S., Fossati N., Gandaglia G., Gillessen S., et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer—2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur. Urol. 2021;79:243–262. doi: 10.1016/j.eururo.2020.09.042. - DOI - PubMed
    1. Tosoian J.J., Chappidi M., Feng Z., Humphreys E.B., Han M., Pavlovich C.P., Epstein J.I., Partin A.W., Trock B.J. Prediction of Pathological Stage Based on Clinical Stage, Serum Prostate-Specific Antigen, and Biopsy Gleason Score: Partin Tables in the Contemporary Era. BJU Int. 2017;119:676–683. doi: 10.1111/bju.13573. - DOI - PubMed
    1. Marenco J., Orczyk C., Collins T., Moore C., Emberton M. Role of MRI in Planning Radical Prostatectomy: What Is the Added Value? World J. Urol. 2019;37:1289–1292. doi: 10.1007/s00345-019-02762-2. - DOI - PubMed
    1. Mikel Hubanks J., Boorjian S.A., Frank I., Gettman M.T., Houston Thompson R., Rangel L.J., Bergstralh E.J., Jeffrey Karnes R. The Presence of Extracapsular Extension Is Associated with an Increased Risk of Death from Prostate Cancer after Radical Prostatectomy for Patients with Seminal Vesicle Invasion and Negative Lymph Nodes. Urol. Oncol. Semin. Orig. Investig. 2014;32:26.e1–26.e7. doi: 10.1016/j.urolonc.2012.09.002. - DOI - PubMed
    1. McEvoy S.H., Raeside M.C., Chaim J., Ehdaie B., Akin O. Preoperative Prostate MRI: A Road Map for Surgery. Am. J. Roentgenol. 2018;211:383–391. doi: 10.2214/AJR.17.18757. - DOI - PubMed