To investigate the value of multiparametric magnetic resonance imaging (mpMRI) and to predict extracapsular extension (ECE), seminal vesicle (SV) infiltration, and a negative surgical margin (SM) status at radical prostatectomy (RP) for different prostate cancer (PC) risk groups.
In the study, 805 men underwent 3 tesla mpMRI without endorectal coil before MRI/transrectal ultrasonography-fusion guided prostate biopsy MRIs were analyzed using the prostate imaging reporting and data system The cohort was classified into risk groups according to National Comprehensive Cancer Network (NCCN) criteria Of 132 men who subsequently underwent RP, pathologic stage and SM status at RP were used as reference Retrospectively, we investigated a European Society of Urogenital Radiology (ESUR) score for ECE and SV-infiltration Statistical analyses included regression analyses, receiver operating characteristics (ROC), and Youden Index to assess an ESUR-score cutoff
Area under the curve in ROC curve analyses was 0 82 for ESUR-ECE score to detect pT3a-disease and 0 77 for ESUR-SV score for pT3b Using a cutoff of 4 for ECE and of 2 for SV, the positive predictive value of the ECE-score for harboring pT3 was 50 0%, 90 0%, and 88 8% for the low-, intermediate- and high-risk cohort Retrospectively, the use of the ESUR-ECE score preoperatively would have changed the initial surgical plan, according to NCCN criteria, in 31 1% of patients In the high-risk subgroup, 9/35 (25 7%) patients were correctly assessed as not harboring pT3 by imaging (ECE score <4), and would have allowed secure robot-assisted radical prostatectomy and nerve-sparing surgery (NSS) When T3 suspicion on preoperative MRI would be taken into account, intraoperative frozen-sections (IFS) might avoid positive SM in 12/18 high-risk patients and an oncologic secure NSS in 8/20 intermediate-risk patients
Prediction of pT3 disease is crucial to plan NSS and to achieve negative SM in RP Standardized ECE scoring on mpMRI is an independent predictor of pT3 and may help to plan RP with oncologic security, even in high-risk patients In addition, it allows more accurate selection of a subgroup of patients for systematic and MRI-guided IFS
Journal of endourology / Endourological Society 2015 Aug 20 [Epub ahead of print]
Jan Philipp Radtke, Boris A Hadaschik, Maya B Wolf, Martin T Freitag, Constantin Schwab, Celine Alt, Wilfried Roth, Stefan Duensing, Sascha A Pahernik, Matthias C Roethke, Heinz-Peter Schlemmer, Markus Hohenfellner, Dogu Teber
1 Department of Urology, University Hospital Heidelberg , Heidelberg, Germany , 1 Department of Urology, University Hospital Heidelberg , Heidelberg, Germany , 2 Department of Radiology, German Cancer Research Center (DKFZ) , Heidelberg, Germany , 2 Department of Radiology, German Cancer Research Center (DKFZ) , Heidelberg, Germany , 1 Department of Urology, University Hospital Heidelberg , Heidelberg, Germany , 3 Hanseatic Radiology , Hamburg, Germany , 4 Institute of Pathology, University Hospital Heidelberg , Heidelberg, Germany , 1 Department of Urology, University Hospital Heidelberg , Heidelberg, Germany , 1 Department of Urology, University Hospital Heidelberg , Heidelberg, Germany , 2 Department of Radiology, German Cancer Research Center (DKFZ) , Heidelberg, Germany , 2 Department of Radiology, German Cancer Research Center (DKFZ) , Heidelberg, Germany , 1 Department of Urology, University Hospital Heidelberg , Heidelberg, Germany , 1 Department of Urology, University Hospital Heidelberg , Heidelberg, Germany