Endorectal 3D T2-weighted 1mm-slice thickness MRI for prostate cancer staging at 1.5Tesla: should we reconsider the indirects signs of extracapsular extension according to the D'Amico tumor risk criteria?

PURPOSE To evaluate the accuracy of a 3D-endorectal 1mm-thick slices MRI acquisition for local staging of low, intermediate and high D'Amico risk prostate cancer (PCa). MATERIALS AND METHODS 178 consecutive patients underwent a multiparametric MRI protocol prior to radical prostatectomy (RP). T2W images were acquired with the 3D sampling perfection with application optimized contrasts using different flip angle evolutions (SPACE) sequence (5mn acquisition time). Direct and indirect MRI signs of extracapsular extension (ECE) were evaluated to predict the pT stage. The likelihood of SVI (seminal vesicle invasion) was also assessed. RESULTS Histology showed ECE and SVI in 38 (21%) and 12 (7%) cases, respectively. MRI sensitivity and specificity to detect ECE were 55 and 96% if direct signs of ECE were used and 84 and 89% (p<0.05), if both direct and indirect signs were combined. D'Amico criteria did not influence MRI performance. Sensitivity and specificity for SVI detection were 83% and 99%. CONCLUSIONS 3D data sets acquired with the SPACE sequence provides a high accuracy for local staging of prostate cancer. The use of indirect signs of ECE may be recommended in low D'Amico risk tumors to optimise patient selection for active surveillance or focal therapy.

[1]  A. Labanaris,et al.  The role of conventional and functional endorectal magnetic resonance imaging in the decision of whether to preserve or resect the neurovascular bundles during radical retropubic prostatectomy , 2009, Scandinavian journal of urology and nephrology.

[2]  H. Hricak,et al.  Incremental value of multiplanar cross-referencing for prostate cancer staging with endorectal MRI. , 2007, AJR. American journal of roentgenology.

[3]  H. Hricak,et al.  Endorectal MR imaging in the evaluation of seminal vesicle invasion: diagnostic accuracy and multivariate feature analysis. , 2006, Radiology.

[4]  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.

[5]  H. Weinmann,et al.  Pharmacokinetics of GdDTPA/dimeglumine after intravenous injection into healthy volunteers. , 1984, Physiological chemistry and physics and medical NMR.

[6]  J R Thornbury,et al.  Local staging of prostate cancer with endorectal MR imaging: correlation with histopathology. , 1996, AJR. American journal of roentgenology.

[7]  M. Knopp,et al.  Estimating kinetic parameters from dynamic contrast‐enhanced t1‐weighted MRI of a diffusable tracer: Standardized quantities and symbols , 1999, Journal of magnetic resonance imaging : JMRI.

[8]  R Alagappan,et al.  Detection of extracapsular extension of prostate carcinoma with endorectal and phased-array coil MR imaging: multivariate feature analysis. , 1997, Radiology.

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

[10]  M. Peyromaure,et al.  [Does transrectal MRI before radical prostatectomy modify the operative technique to decrease the positive margin rate?]. , 2006, Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie.

[11]  M. Reiser,et al.  Per-sextant localization and staging of prostate cancer: correlation of imaging findings with whole-mount step section histopathology. , 2007, AJR. American journal of roentgenology.

[12]  Michael W Kattan,et al.  Prostate cancer: incremental value of endorectal MR imaging findings for prediction of extracapsular extension. , 2004, Radiology.

[13]  A. Renshaw,et al.  Impact of the percentage of positive prostate cores on prostate cancer-specific mortality for patients with low or favorable intermediate-risk disease. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  P. Walsh,et al.  Influence of capsular penetration on progression following radical prostatectomy: a study of 196 cases with long-term followup. , 1993, The Journal of urology.

[15]  Mark A Rubin,et al.  Evaluating localized prostate cancer and identifying candidates for focal therapy. , 2008, Urology.

[16]  Bachir Taouli,et al.  Prostate cancer: Comparison of 3D T2-weighted with conventional 2D T2-weighted imaging for image quality and tumor detection. , 2010, AJR. American journal of roentgenology.