ORLANDO, FL USA (UroToday.com) - In men with prostate cancer (PCa), the surgical margin status is one of the most important prognostic factors for biochemical recurrence after radical prostatectomy. Pre-operative identification of extracapsular extension (ECE) provides critical information for surgical planning allowing the surgeon to modify the dissection if needed. The reported specificity of multiparametric prostate MRI (MP-MRI) for ECE is high (90%), but the sensitivity is comparably low (58%). Dr. Peter Pinto’s group from the National Cancer Institute conducted a study to evaluate which parameters of MP-MRI and MRI/US fusion-guided biopsy aid in the pre-operative assessment of ECE.
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The authors reviewed the records of 370 patients who underwent radical prostatectomy at their institution between May 2007 and March 2014. They identified 116 patients who had pre-operative MP-MRIs suggestive of ECE, and who had MRI/US fusion-guided biopsy and extended sextant 12-core biopsy prior to surgery. The overall prevalence of ECE on final pathology was 23.1%. For the detection of ECE, pre-operative MP-MRI was 48.7% sensitive, 78.9% specific, and had a positive predictive value and negative predictive value of 35.9% and 82.8%, respectively. On multivariate regression analysis, only patient age and targeted biopsy Gleason score were statistically significant predictors of ECE on final pathology when MP-MRI was negative for ECE.
The authors concluded that when MP-MRI fails to detect ECE, MRI/US fusion-guided biopsy, Gleason score, and age are useful pre-operative predictors of ECE on final pathology. This knowledge may guide pre-operative surgical planning and reduce the incidence of positive surgical margins after robotic radical prostatectomy.
Presented by Dima Raskolnikov at the American Urological Association (AUA) Annual Meeting- May 16 - 21, 2014 - Orlando, Florida USA
National Cancer Institute, Bethesda, MD USA
Written by Chinonyerem Okoro, University of California (Irvine), and medical writer for UroToday.com