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Adverse Prostate Cancer Pathology Accurately Predicted With MRI

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.

He noted that there is significant inter-observer variability among radiologists in the interpretation of MP-MRI, which is a limitation of the study.

Reference

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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.