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.
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.
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.
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.
Urologic oncology. 2023 Jun 23 [Epub ahead of print]
Thenappan Chandrasekar, Andrew Denisenko, Vasil Mico, Connor McPartland, Yash Shah, James R Mark, Costas D Lallas, Claudette Fonshell, John Danella, Bruce Jacobs, Thomas Lanchoney, Jay D Raman, Jeffrey Tomaszewski, Adam Reese, Eric A Singer, Serge Ginzburg, Marc Smaldone, Robert Uzzo, Thomas J Guzzo, Edouard J Trabulsi
Department of Urology, University of California, Davis, Sacramento, CA. Electronic address: ., Department of Urology, Einstein Health Network, Philadelphia PA., Department of Internal Medicine, Tufts Medical Center, Boston MA., Department of Urology, Temple University Hospital, Philadelphia PA., Department of Urology, Thomas Jefferson University, Philadelphia, PA., Health Care Improvement Foundation, Philadelphia, PA., Geisinger Medical Center, Danville, PA., Department of Urology, University of Pittsburgh, Pittsburgh, PA., Urology Health Specialists, Hershey, PA., Penn State Milton S. Hershey Medical Center, Hershey, PA., Department of Urology, Cooper University, Camden, NJ., Department of Urology, Temple University, Philadelphia, PA., Department of Urology, Ohio State University, Columbus, OH., Department of Urology, Einstein Healthcare Network, Philadelphia, PA., Fox Chase Cancer Center, Philadelphia, PA., Division of Urology, University of Pennsylvania, Philadelphia, PA.