Prostate cancer: incremental value of endorectal MR imaging findings for prediction of extracapsular extension.

PURPOSE To assess the incremental value of endorectal magnetic resonance (MR) imaging findings in addition to clinical variables for prediction of extracapsular extension (ECE) in patients with prostate cancer. MATERIALS AND METHODS In this cohort study, 344 consecutive patients with biopsy-proved prostate cancer underwent endorectal MR imaging prior to surgery; 216 of these patients also underwent MR spectroscopic imaging. MR images were interpreted by 10 attending radiologists. The likelihood of ECE was scored retrospectively on the basis of MR imaging reports. Clinical variables included serum prostate-specific antigen (PSA) level, Gleason score, clinical stage of tumor, greatest percentage of cancer in all core biopsy specimens, percentage of cancer-positive core specimens in all core biopsy specimens, and presence of perineural invasion. For data analysis, receiver operating characteristic (ROC) curves and univariate and multivariate logistic regression analyses were used. Jackknife analysis was used for prediction of probability from a model that included clinical variables as tested comparatively with a model that included the clinical variables plus endorectal MR imaging findings. A difference with P <.05 was considered significant. RESULTS At univariate analysis, all variables were associated with ECE. At ROC univariate analysis, endorectal MR imaging findings had the largest area under the ROC curve. At multivariate analysis, serum PSA level, percentage of cancer in all core biopsy specimens, and endorectal MR imaging findings (P =.001, P =.001, and P <.001, respectively) were predictors of ECE. Areas under ROC curve for two models, with and without endorectal MR imaging findings, were 0.838 and 0.772, respectively (P =.022). CONCLUSION A model containing endorectal MR imaging findings has a significantly larger area under the ROC curve than a model containing only clinical variables; thus, endorectal MR imaging findings add incremental value in the prediction of ECE.

[1]  J. Epstein,et al.  The pathological interpretation and significance of prostate needle biopsy findings: implications and current controversies. , 2001, The Journal of urology.

[2]  A. Partin,et al.  Influence of biopsy perineural invasion on long-term biochemical disease-free survival after radical prostatectomy. , 2002, Urology.

[3]  Pierre I Karakiewicz,et al.  International validation of a preoperative nomogram for prostate cancer recurrence after radical prostatectomy. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[4]  D. Bostwick,et al.  Prediction of extraprostatic extension of prostate cancer based on needle biopsy findings: perineural invasion lacks significance on multivariate analysis. , 1997, The American journal of surgical pathology.

[5]  M. Rubin,et al.  Relationship and significance of greatest percentage of tumor and perineural invasion on needle biopsy in prostatic adenocarcinoma. , 2000, The American journal of surgical pathology.

[6]  J. Kurhanewicz,et al.  Improved water and lipid suppression for 3D PRESS CSI using rf band selective inversion with gradient dephasing (basing) , 1997, Magnetic resonance in medicine.

[7]  T. Tong,et al.  Cancer statistics, 1993 , 1993, CA: a cancer journal for clinicians.

[8]  P. Carroll,et al.  Pretreatment prostate-specific antigen and Gleason score predict the risk of extracapsular extension and the risk of failure following radiotherapy in patients with clinically localized prostate cancer. , 2000, Seminars in urologic oncology.

[9]  T Okada,et al.  Dynamic endorectal magnetic resonance imaging for local staging and detection of neurovascular bundle involvement of prostate cancer: correlation with histopathologic results. , 2001, Urology.

[10]  M W Kattan,et al.  Evaluation of a Nomogram used to predict the pathologic stage of clinically localized prostate carcinoma , 1997, Cancer.

[11]  A. D'Amico,et al.  Endorectal magnetic resonance imaging as a predictor of biochemical outcome after radical prostatectomy in men with clinically localized prostate cancer. , 2000, The Journal of urology.

[12]  A. D'Amico,et al.  Percentage of core lengths involved with prostate cancer: does it add to the percentage of positive prostate biopsies in predicting postoperative prostate-specific antigen outcome for men with intermediate-risk prostate cancer? , 2002, Urology.

[13]  S. Freedland,et al.  Percent prostate needle biopsy tissue with cancer is more predictive of biochemical failure or adverse pathology after radical prostatectomy than prostate specific antigen or Gleason score. , 2002, The Journal of urology.

[14]  P. Humphrey,et al.  Multiple Measures of Carcinoma Extent Versus Perineural Invasion in Prostate Needle Biopsy Tissue in Prediction of Pathologic Stage in a Screening Population , 2003, The American journal of surgical pathology.

[15]  A. D'Amico,et al.  MRI-guided diagnosis and treatment of prostate cancer. , 2001, The New England journal of medicine.

[16]  Michael W Kattan,et al.  Judging new markers by their ability to improve predictive accuracy. , 2003, Journal of the National Cancer Institute.

[17]  O. Hélénon,et al.  Extraprostatic spread of clinically localized prostate cancer: factors predictive of pT3 tumor and of positive endorectal MR imaging examination results. , 2002, Radiology.

[18]  P. Walsh,et al.  Relationship Between Perineural Tumor Invasion on Needle Biopsy and Radical Prostatectomy Capsular Penetration in Clinical Stage B Adenocarcinoma of the Prostate , 1993, The American journal of surgical pathology.

[19]  Jelle O. Barentsz,et al.  Local staging of prostate cancer using magnetic resonance imaging: a meta-analysis , 2002, European Radiology.

[20]  A. D'Amico.  Perineural invasion as a predictor of PSA outcome following local therapy for patients with clinically localized prostate cancer. , 2001, Cancer journal.

[21]  K. Uğurbil,et al.  NMR chemical shift imaging in three dimensions. , 1982, Proceedings of the National Academy of Sciences of the United States of America.

[22]  P. Carroll,et al.  Prostate cancer: localization with three-dimensional proton MR spectroscopic imaging--clinicopathologic study. , 1999, Radiology.

[23]  C. Chastang,et al.  Percentage of Cancer on Biopsy Cores Accurately Predicts Extracapsular Extension and Biochemical Relapse after Radical Prostatectomy for T1–T2 Prostate Cancer , 2000, European Urology.

[24]  A W Partin,et al.  Contemporary update of prostate cancer staging nomograms (Partin Tables) for the new millennium. , 2002, Urology.

[25]  A. Renshaw,et al.  Perineural invasion as a predictor of biochemical outcome following radical prostatectomy for select men with clinically localized prostate cancer. , 2001, The Journal of urology.

[26]  J Kurhanewicz,et al.  Prostate cancer: prediction of extracapsular extension with endorectal MR imaging and three-dimensional proton MR spectroscopic imaging. , 1999, Radiology.

[27]  A. Renshaw,et al.  Perineural invasion in prostate needle biopsy specimens. Correlation with extraprostatic extension at resection. , 1999, American journal of clinical pathology.

[28]  C. Tempany.  MR staging of prostate cancer. How we can improve our accuracy with decisions aids and optimal techniques. , 1996, Magnetic resonance imaging clinics of North America.

[29]  M. Kattan,et al.  Bladder neck involvement in pathological stage pT4 radical prostatectomy specimens is not an independent prognostic factor. , 2002, The Journal of urology.

[30]  P. Unger,et al.  Perineural invasion and seminal vesicle involvement predict pelvic lymph node metastasis in men with localized carcinoma of the prostate. , 1998, The Journal of urology.

[31]  N. Aaronson,et al.  Health related quality of life in men with prostate cancer. , 2003, The Journal of urology.

[32]  Laurence R. Paquette,et al.  Predictors of extracapsular extension and positive margins in African American and white men. , 2003, Urologic oncology.

[33]  P. Dettmar,et al.  Limited value of endorectal magnetic resonance imaging and transrectal ultrasonography in the staging of clinically localized prostate cancer , 2001, BJU international.

[34]  C W Piccoli,et al.  Staging of prostate cancer: results of Radiology Diagnostic Oncology Group project comparison of three MR imaging techniques. , 1994, Radiology.

[35]  J. Oesterling,et al.  Prostate specific antigen: a decade of discovery--what we have learned and where we are going. , 1999, The Journal of urology.

[36]  Alicia Samuels,et al.  Cancer Statistics, 2003 , 2003, CA: a cancer journal for clinicians.

[37]  Michael W Kattan,et al.  Prostate cancer: detection of extracapsular extension by genitourinary and general body radiologists at MR imaging. , 2004, Radiology.

[38]  M. Rubin,et al.  Perineural invasion on prostate needle biopsy: an independent predictor of final pathologic stage. , 1999, Urology.

[39]  K. Nakagawa,et al.  Prediction of extraprostatic cancer by prostate specific antigen density, endorectal MRI, and biopsy Gleason score in clinically localized prostate cancer , 2003, The Prostate.

[40]  M. Rubin,et al.  Can perineural invasion on prostate needle biopsy predict prostate specific antigen recurrence after radical prostatectomy? , 1999, The Journal of urology.