Adverse Prostate Cancer Pathology Accurately Predicted With MRI
Multiparametric MRI has high positive and negative predictive values for extracapsular extension, seminal vesicle invasion, lymph node involvement, and high-risk Gleason score.
|The following article is part of conference coverage from the 2018 Genitourinary Cancers Symposium in San Francisco. Renal and Urology News' staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from GU 2018.|
SAN FRANCISCO—Multiparametric magnetic resonance imaging (MP-MRI) can accurately predict adverse pathologic features at the time of radical prostatectomy (RP) for localized prostate cancer, data presented at the 2018 Genitourinary Cancers Symposium suggest.
That conclusion is based on a study of 30 patients with localized prostate cancer (PCa) who had MP-MRI scans prior to RP. Samarpit Rai, MD, a Urology resident at the University of Louisville School of Medicine in Kentucky, and colleagues compared MP-MRI findings with postoperative pathologic specimens. The investigators analyzed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of preoperative MP-MRI for adverse pathologic features: extracapsular extension (ECE), seminal vesicle invasion (SVI), lymph node involvement (LNI), and high-risk Gleason score (Gleason 8 or higher).
Patients had a median age and preoperative PSA level of 62.5 years and 8.5 ng/mL, respectively. Of the 30 patients, 17 had ECE, 5 had SVI, 5 had LNI, and 15 had high-risk Gleason score (4+3, tertiary pattern 5, 4+4 or higher). The sensitivity, specificity, PPV, and NPV of MP-MRI for ECE was 64.7%, 91.6%, 91.6%, and 66.6%, respectively. The values were 60%, 96%, 75%, and 92.3%, respectively, for SVI and 100%, 96%, 83.3%, and 100%, respectively, for LNI.
For high-risk Gleason score, the sensitivity, specificity, PPV, and NPV were 94.4%, 66.6%, 80.9%, and 88.9%, respectively.
It is known that patients with PCa and adverse pathologic features, such as ECE, LNI, and high-risk Gleason score have a higher rate of biochemical recurrence after treatment. MP-MRI is an important and emerging imaging tool for determining adverse pathologic features and guiding treatment. “This could provide assistance in the selection of patients appropriate for active surveillance vs active treatment and aid in determining their prognosis,” Dr. Rai told Renal & Urology News.
He noted that there is significant inter-observer variability among radiologists in the interpretation of MP-MRI, which is a limitation of the study.
Rai S, Dervishi A, O'Bryan BE, et al. What is the accuracy of multi-parametric magnetic resonance imaging in predicting adverse pathology in patients undergoing radical prostatectomy? Data presented at the 2018 Genitourinary Cancers Symposium, held in San Francisco Feb. 8-19. Abstract 139.