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01.10.2013 | Original Article

Accuracy of preoperative endorectal MRI in predicting extracapsular extension and influence on neurovascular bundle sparing in radical prostatectomy

verfasst von: Matthias C. Roethke, Matthias P. Lichy, Michaela Kniess, Matthias K. Werner, Claus D. Claussen, Arnulf Stenzl, Heinz-Peter Schlemmer, David Schilling

Erschienen in: World Journal of Urology | Ausgabe 5/2013

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Abstract

Purpose

To evaluate the accuracy of presurgical endorectal MRI (eMRI) for local staging before radical prostatectomy (RP) and its influence on neurovascular bundle (NVB) resection during radical prostatectomy.

Patients and methods

A total of 385 patients with histologically proven prostate cancer (PCa) have been included in this retrospective study between 2004 and 2008. All patients underwent preoperative eMRI at 1.5 T before open RP. Staging results by eMRI were compared with the histopathological findings. The presence of positive surgical margins and extent of nerve-sparing procedure were evaluated. Subgroup analysis of low–risk group and intermediate to high-risk group based on D’Amico criteria was conducted.

Results

In 294 (76.4%) patients, pathological stage was correctly predicted, 69 patients (17.9%) were understaged and 22 (5.7%) overstaged. Overall sensitivity, specificity, negative and positive predictive value for predicting extracapsular extension (ECE) were 41.5, 91.8, 78.0 and 69.0%, respectively. One hundred and fifty-two (48.4%) of the patients classified as stage cT2 by eMRI underwent bilateral NVB sparing, whereas 14 (19.7%) patients with reported ECE underwent bilateral NVB sparing (P < 0.01). Overall positive surgical margin rate was 14.8%. Sensitivity of predicting ECE and positive predictive value were lower in the low-risk group than in the intermediate and high-risk group.

Conclusions

eMRI is effective in predicting extracapsular extension in an intermediate to high-risk group. Preoperative eMRI in patients with low-risk criteria is not recommended as a routine assessment modality. eMRI findings did appear to influence surgical strategy as patients with imaging findings suggesting >cT2 disease were less likely to undergo NVB sparing.

Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics. CA Cancer J Clin 60:277–300PubMedCrossRef

Labanaris AP, Zugor V, Takriti S et al (2009) The role of conventional and functional endorectal magnetic resonance imaging in the decision of whether to preserve or resect the neurovascular bundles during radical retropubic prostatectomy. Scand J Urol Nephrol 43:25–31PubMedCrossRef

Brown JA, Rodin DM, Harisinghani M, Dahl DM (2009) Impact of preoperative endorectal MRI stage classification on neurovascular bundle sparing aggressiveness and the radical prostatectomy positive margin rate. Urol Oncol 27:174–179PubMedCrossRef

Hricak H, Wang L, Wei DC et al (2004) The role of preoperative endorectal magnetic resonance imaging in the decision regarding whether to preserve or resect neurovascular bundles during radical retropubic prostatectomy. Cancer 100:2655–2663PubMedCrossRef

Aigner F, Pallwein L, Pelzer A et al (2007) Value of magnetic resonance imaging in prostate cancer diagnosis. World J Urol 25:351–359PubMedCrossRef

Horiguchi A, Nakashima J, Horiguchi Y et al (2003) Prediction of extraprostatic cancer by prostate specific antigen density, endorectal MRI, and biopsy Gleason score in clinically localized prostate cancer. Prostate 56:23–29PubMedCrossRef

Zhang JQ, Loughlin KR, Zou KH, Haker S, Tempany CM (2007) Role of endorectal coil magnetic resonance imaging in treatment of patients with prostate cancer and in determining radical prostatectomy surgical margin status: report of a single surgeon’s practice. Urology. 69:1134–1137PubMedCrossRef

Masterson TA, Touijer K (2008) The role of endorectal coil MRI in preoperative staging and decision-making for the treatment of clinically localized prostate cancer. MAGMA 21:371–377PubMedCrossRef

Roethke MC, Lichy MP, Jurgschat L et al (2010) Tumorsize dependent detection rate of endorectal MRI of prostate cancer—a histopathologic correlation with whole-mount sections in 70 patients with prostate cancer. Eur J Radiol

10.

Nakashima J, Tanimoto A, Imai Y et al (2004) Endorectal MRI for prediction of tumor site, tumor size, and local extension of prostate cancer. Urology 64:101–105PubMedCrossRef

11.

Outwater EK, Petersen RO, Siegelman ES, Gomella LG, Chernesky CE, Mitchell DG (1994) Prostate carcinoma: assessment of diagnostic criteria for capsular penetration on endorectal coil MR images. Radiology 193:333–339PubMed

12.

D’Amico AV, Whittington R, Malkowicz SB et al (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280:969–974PubMedCrossRef

13.

Applegate KE, Tello R, Ying J (2003) Hypothesis testing III: counts and medians. Radiology 228:603–608PubMedCrossRef

14.

Ahmed HU, Kirkham A, Arya M et al (2009) Is it time to consider a role for MRI before prostate biopsy? Nat Rev Clin Oncol 6:197–206PubMedCrossRef

15.

May F, Treumann T, Dettmar P, Hartung R, Breul J (2001) Limited value of endorectal magnetic resonance imaging and transrectal ultrasonography in the staging of clinically localized prostate cancer. BJU Int 87:66–69PubMedCrossRef

16.

Turkbey B, Albert PS, Kurdziel K, Choyke PL (2009) Imaging localized prostate cancer: current approaches and new developments. AJR Am J Roentgenol 192:1471–1480PubMedCrossRef

17.

Futterer JJ, Engelbrecht MR, Huisman HJ et al (2005) Staging prostate cancer with dynamic contrast-enhanced endorectal MR imaging prior to radical prostatectomy: experienced versus less experienced readers. Radiology 237:541–549PubMedCrossRef

18.

Bloch BN, Furman-Haran E, Helbich TH et al (2007) Prostate cancer: accurate determination of extracapsular extension with high-spatial-resolution dynamic contrast-enhanced and T2-weighted MR imaging—initial results. Radiology 245:176–185PubMedCrossRef

19.

Turkbey B, Pinto PA, Mani H et al (2010) Prostate cancer: value of multiparametric MR imaging at 3 T for detection—histopathologic correlation. Radiology 255:89–99PubMedCrossRef

20.

D’Amico AV, Schnall M, Whittington R et al (1998) Endorectal coil magnetic resonance imaging identifies locally advanced prostate cancer in select patients with clinically localized disease. Urology 51:449–454PubMedCrossRef

21.

Cornud F, Flam T, Chauveinc L et al (2002) Extraprostatic spread of clinically localized prostate cancer: factors predictive of pT3 tumor and of positive endorectal MR imaging examination results. Radiology 224:203–210PubMedCrossRef

Titel: Accuracy of preoperative endorectal MRI in predicting extracapsular extension and influence on neurovascular bundle sparing in radical prostatectomy
verfasst von: Matthias C. Roethke
Matthias P. Lichy
Michaela Kniess
Matthias K. Werner
Claus D. Claussen
Arnulf Stenzl
Heinz-Peter Schlemmer
David Schilling
Publikationsdatum: 01.10.2013
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 5/2013
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-012-0826-0

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Accuracy of preoperative endorectal MRI in predicting extracapsular extension and influence on neurovascular bundle sparing in radical prostatectomy