Multiparametric MRI for Staging of Prostate Cancer: A Multicentric Analysis of Predictive Factors to Improve Identification of Extracapsular Extension before Radical Prostatectomy
The correct identification of extracapsular extension (ECE) of prostate cancer (PCa) on multiparametric magnetic resonance imaging (mpMRI) is crucial for surgeons in order to plan the nerve-sparing approach in radical prostatectomy. Nerve-sparing strategies allow for better outcomes in preserving er...
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| Language: | English |
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MDPI AG
2022-08-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/16/3966 |
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| author | Marina Triquell Lucas Regis Mathias Winkler Nicolás Valdés Mercè Cuadras Ana Celma Jacques Planas Juan Morote Enrique Trilla |
| author_facet | Marina Triquell Lucas Regis Mathias Winkler Nicolás Valdés Mercè Cuadras Ana Celma Jacques Planas Juan Morote Enrique Trilla |
| author_sort | Marina Triquell |
| collection | DOAJ |
| description | The correct identification of extracapsular extension (ECE) of prostate cancer (PCa) on multiparametric magnetic resonance imaging (mpMRI) is crucial for surgeons in order to plan the nerve-sparing approach in radical prostatectomy. Nerve-sparing strategies allow for better outcomes in preserving erectile function and urinary continence, notwithstanding this can be penalized with worse oncologic results. The aim of this study was to assess the ability of preoperative mpMRI to predict ECE in the final prostatic specimen (PS) and identify other possible preoperative predictive factors of ECE as a secondary end-point. We investigated a database of two high-volume hospitals to identify men who underwent a prostate biopsy with a pre-biopsy mpMRI and a subsequent RP. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI in predicting ECE were calculated. A univariate analysis was performed to find the association between image staging and pathological staging. A multivariate logistic regression was performed to investigate other preoperative predictive factors. A total of 1147 patients were selected, and 203 out of the 1147 (17.7%) patients were classified as ECE according to the mpMRI. ECE was reported by pathologists in 279 out of the 1147 PS (24.3%). The PPV was 0.58, the NPV was 0.72, the sensitivity was 0.32, and the specificity was 0.88. The multivariate analysis found that PSA (OR 1.057, C.I. 95%, 1.016–1.100, <i>p</i> = 0.006), digital rectal examination (OR 0.567, C.I. 95%, 0.417–0.770, <i>p</i> = 0.0001), ratio of positive cores (OR 9.687, C.I. 95%, 3.744–25.006, <i>p</i> = 0.0001), and biopsy grade in prostate biopsy (OR 1.394, C.I. 95%, 1.025–1.612, <i>p</i> = 0.0001) were independent factors of ECE. The mpMRI has a great ability to exclude ECE, notwithstanding that low sensitivity is still an important limitation of the technique. |
| first_indexed | 2024-03-09T13:41:56Z |
| format | Article |
| id | doaj.art-06b4e4f63c91418faa64f90317ae49a7 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T13:41:56Z |
| publishDate | 2022-08-01 |
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| series | Cancers |
| spelling | doaj.art-06b4e4f63c91418faa64f90317ae49a72023-11-30T21:04:28ZengMDPI AGCancers2072-66942022-08-011416396610.3390/cancers14163966Multiparametric MRI for Staging of Prostate Cancer: A Multicentric Analysis of Predictive Factors to Improve Identification of Extracapsular Extension before Radical ProstatectomyMarina Triquell0Lucas Regis1Mathias Winkler2Nicolás Valdés3Mercè Cuadras4Ana Celma5Jacques Planas6Juan Morote7Enrique Trilla8Department of Urology, Vall d’Hebron University Hospital, 08035 Barcelona, SpainDepartment of Urology, Vall d’Hebron University Hospital, 08035 Barcelona, SpainImperial Urology, Charing Cross Hospital, Imperial Urology, Imperial College Healthcare NHS, London W6 8RF, UKDepartment of Urology, Vall d’Hebron University Hospital, 08035 Barcelona, SpainDepartment of Urology, Vall d’Hebron University Hospital, 08035 Barcelona, SpainDepartment of Urology, Vall d’Hebron University Hospital, 08035 Barcelona, SpainDepartment of Urology, Vall d’Hebron University Hospital, 08035 Barcelona, SpainDepartment of Urology, Vall d’Hebron University Hospital, 08035 Barcelona, SpainDepartment of Urology, Vall d’Hebron University Hospital, 08035 Barcelona, SpainThe correct identification of extracapsular extension (ECE) of prostate cancer (PCa) on multiparametric magnetic resonance imaging (mpMRI) is crucial for surgeons in order to plan the nerve-sparing approach in radical prostatectomy. Nerve-sparing strategies allow for better outcomes in preserving erectile function and urinary continence, notwithstanding this can be penalized with worse oncologic results. The aim of this study was to assess the ability of preoperative mpMRI to predict ECE in the final prostatic specimen (PS) and identify other possible preoperative predictive factors of ECE as a secondary end-point. We investigated a database of two high-volume hospitals to identify men who underwent a prostate biopsy with a pre-biopsy mpMRI and a subsequent RP. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI in predicting ECE were calculated. A univariate analysis was performed to find the association between image staging and pathological staging. A multivariate logistic regression was performed to investigate other preoperative predictive factors. A total of 1147 patients were selected, and 203 out of the 1147 (17.7%) patients were classified as ECE according to the mpMRI. ECE was reported by pathologists in 279 out of the 1147 PS (24.3%). The PPV was 0.58, the NPV was 0.72, the sensitivity was 0.32, and the specificity was 0.88. The multivariate analysis found that PSA (OR 1.057, C.I. 95%, 1.016–1.100, <i>p</i> = 0.006), digital rectal examination (OR 0.567, C.I. 95%, 0.417–0.770, <i>p</i> = 0.0001), ratio of positive cores (OR 9.687, C.I. 95%, 3.744–25.006, <i>p</i> = 0.0001), and biopsy grade in prostate biopsy (OR 1.394, C.I. 95%, 1.025–1.612, <i>p</i> = 0.0001) were independent factors of ECE. The mpMRI has a great ability to exclude ECE, notwithstanding that low sensitivity is still an important limitation of the technique.https://www.mdpi.com/2072-6694/14/16/3966prostate cancertumor stagingmultiparametric magnetic resonanceextracapsular extension |
| spellingShingle | Marina Triquell Lucas Regis Mathias Winkler Nicolás Valdés Mercè Cuadras Ana Celma Jacques Planas Juan Morote Enrique Trilla Multiparametric MRI for Staging of Prostate Cancer: A Multicentric Analysis of Predictive Factors to Improve Identification of Extracapsular Extension before Radical Prostatectomy Cancers prostate cancer tumor staging multiparametric magnetic resonance extracapsular extension |
| title | Multiparametric MRI for Staging of Prostate Cancer: A Multicentric Analysis of Predictive Factors to Improve Identification of Extracapsular Extension before Radical Prostatectomy |
| title_full | Multiparametric MRI for Staging of Prostate Cancer: A Multicentric Analysis of Predictive Factors to Improve Identification of Extracapsular Extension before Radical Prostatectomy |
| title_fullStr | Multiparametric MRI for Staging of Prostate Cancer: A Multicentric Analysis of Predictive Factors to Improve Identification of Extracapsular Extension before Radical Prostatectomy |
| title_full_unstemmed | Multiparametric MRI for Staging of Prostate Cancer: A Multicentric Analysis of Predictive Factors to Improve Identification of Extracapsular Extension before Radical Prostatectomy |
| title_short | Multiparametric MRI for Staging of Prostate Cancer: A Multicentric Analysis of Predictive Factors to Improve Identification of Extracapsular Extension before Radical Prostatectomy |
| title_sort | multiparametric mri for staging of prostate cancer a multicentric analysis of predictive factors to improve identification of extracapsular extension before radical prostatectomy |
| topic | prostate cancer tumor staging multiparametric magnetic resonance extracapsular extension |
| url | https://www.mdpi.com/2072-6694/14/16/3966 |
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