Multiparametric MRI is not sufficient for prostate cancer staging: A single institutional experience validated by a multi-institutional regional collaborative.

Autor: Chandrasekar T; Department of Urology, University of California, Davis, Sacramento, CA. Electronic address: thenappan.chandrasekar@gmail.com., Denisenko A; Department of Urology, Einstein Health Network, Philadelphia PA., Mico V; Department of Internal Medicine, Tufts Medical Center, Boston MA., McPartland C; Department of Urology, Temple University Hospital, Philadelphia PA., Shah Y; Department of Urology, Thomas Jefferson University, Philadelphia, PA., Mark JR; Department of Urology, Thomas Jefferson University, Philadelphia, PA., Lallas CD; Department of Urology, Thomas Jefferson University, Philadelphia, PA., Fonshell C; Health Care Improvement Foundation, Philadelphia, PA., Danella J; Geisinger Medical Center, Danville, PA., Jacobs B; Department of Urology, University of Pittsburgh, Pittsburgh, PA., Lanchoney T; Urology Health Specialists, Hershey, PA., Raman JD; Penn State Milton S. Hershey Medical Center, Hershey, PA., Tomaszewski J; Department of Urology, Cooper University, Camden, NJ., Reese A; Department of Urology, Temple University, Philadelphia, PA., Singer EA; Department of Urology, Ohio State University, Columbus, OH., Ginzburg S; Department of Urology, Einstein Healthcare Network, Philadelphia, PA., Smaldone M; Fox Chase Cancer Center, Philadelphia, PA., Uzzo R; Fox Chase Cancer Center, Philadelphia, PA., Guzzo TJ; Division of Urology, University of Pennsylvania, Philadelphia, PA., Trabulsi EJ; Department of Urology, Einstein Healthcare Network, Philadelphia, PA.
Jazyk: angličtina
Zdroj: Urologic oncology [Urol Oncol] 2023 Aug; Vol. 41 (8), pp. 355.e1-355.e8. Date of Electronic Publication: 2023 Jun 23.
DOI: 10.1016/j.urolonc.2023.05.004
Abstrakt: Objective: Multiparametric magnetic resonance imaging (mpMRI) has been increasingly utilized in prostate cancer (CaP) diagnosis and staging. While Level 1 data supports MRI utility in CaP diagnosis, there is less data on staging utility. We sought to evaluate the real-world accuracy of mpMRI in staging localized CaP.
Materials and Methods: Men who underwent radical prostatectomy (RP) for CaP in 2021 at our institution were identified. Sensitivity, specificity, positive predictive value and negative predictive value of mpMRI in predicting pT2N0 organ confined disease , extracapsular extension , seminal vesicle invasion , lymph node involvement, and bladder neck invasion were evaluated. Associations between MRI accuracy and AUA risk stratification (AUA RS), MRI institution (MRI-I), MRI strength (1.5 vs. 3T) (MRI-S), and MRI timing (MRI-T) were assessed. These analyses were repeated using Pennsylvania Urologic Regional Collaborative (PURC) data.
Results: Institutional and community mpMRI CaP staging data demonstrated poor sensitivity (2.9%-49.2%% vs. 16.8%-24.4%), positive predictive value (40%-100% vs. 35.8%-68.2%), and negative predictive value (56.3%-94.3% vs. 68.4%-96.2%) in predicting surgical pathologic features - in contrast, specificity (89.1%-100% vs. 93.9%-98.6%) was adequate. mpMRI accuracy for extracapsular extension, seminal vesicle invasion, and lymph node involvement was significantly (p < 0.001) associated with AUA RS. There was no association between mpMRI accuracy and MRI-I, MRI-S, and MRI-T.
Conclusion: Despite enthusiasm for its use, in a real-world setting, mpMRI appears to be a poor staging study for localized CaP and is unreliable as the sole means of staging patients prior to prostatectomy. mpMRI should be used cautiously as a staging tool for CaP, and should be interpreted considering individual patient risk strata.
Competing Interests: Declaration of Competing Interests All authors of this manuscript have directly participated in planning, execution, and/or analysis of this study. The contents of this manuscript have not been copyrighted or published previously. The contents of this manuscript are not now under consideration for publication elsewhere. The contents of this manuscript will not be copyrighted, submitted, or published elsewhere while acceptance by Urologic Oncology: Seminars and Original Investigations is under consideration. There are no directly related manuscripts or abstracts, published or unpublished, by any authors of this manuscript. No financial support or incentive has been provided for this manuscript.
(Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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