Prostate Cancer Smart Surgery Treatment Trifecta

Endorectal MRI diagnosis

BJUI International, May 25, 2010

Endorectal magnetic resonance imaging has limited clinical ability to preoperatively predict pT3 prostate cancer.


Jonathan S. Brajtbord, Hugh J. Lavery, Fatima Nabizada-Pace, Prathibha Senaratne and David B. Samadi Department of Urology, The Mount Sinai Medical Center, New York, NY, USA.


Materials and Methods
An institutional database of 1161 roboticassisted laparoscopic prostatectomies (RALP) performed by a single surgeon (D.B.S.) was queried for those who underwent endorectal coil magnetic resonance imaging (erMRI) before robotic-assisted laparoscopic prostatectomy. erMRI reports were dichotomized into positive or negative and compared with the final histopathology. The erMRIs performed at academic centres were compared with those performed in non-academic settings. A sub-group of high-risk patients was also analyzed for erMRI accuracy.


Results
The 179 patients who underwent erMRI had significantly worse disease compared to the 982 patients without imaging. Of the 110 patients with histopathologically organconfined disease, 81 (74%) were correctly diagnosed as such on erMRI, whereas 29 (26%) were felt to have cT3 disease and constituted false-positives. Among the 69 patients with pT3 disease, erMRI correctly predicted 30 (43%), whereas 39 (57%) were incorrectly considered organ-confined. The overall sensitivity and specificity for diagnosing pT3 disease was 43% and 73%.

When stratified by pT3a and pT3b, the sensitivity and specificity of erMRI to accurately diagnose ECE is 33% and 81%, respectively. In evaluating SVI, erMRI has a sensitivity and specificity of 33% and 89%, respectively. The positive predictive value of erMRI to assess for ECE and SVI is 50% in both, with a negative predictive value of 61% and 63%, respectively. erMRIs performed at academic centres compared to nonacademic locations demonstrated similar rates of sensitivity at 67% vs 77% and specificity at 39% vs 54%, respectively (P=0.33).


Conclusions
In the setting of the present study, which was designed to be more reflective of current practice patterns in the USA, erMRI has limited clinical value in preoperatively detecting ECE and SVI. The accuracy of detecting T3 disease did not improve in academic centres or in high-risk patients.