Multiparametric magnetic resonance imaging (mpMRI) is increasingly used in staging early prostate cancer (PCa) but remains heavily reader-dependent. We aim to define the incremental utility of mpMRI over clinical parameters in determining the pathologic extracapsular extension (pECE) of PCa interpreted in a standard radiologic setting and when further over-read by a specialized reader.
We retrospectively reviewed 120 men with clinically localized PCa undergoing mpMRI and radical prostatectomy. We obtained radiologic prediction of pECE from standard radiologic reports (standard read) and by a specialized reader blinded to clinical and pathologic findings (specialized read). We determined the incremental benefit of standard read and specialized read by sequential addition to a baseline clinical parameters-only logistic regression model predicting pECE. The sensitivity and specificity of standard read were 77% and 44%, respectively, whereas those of specialized read were 86% and 81%. The positive likelihood ratio was 1. 7 at baseline, 1. 7 adding standard read, and 6. 5 adding specialized read. The negative likelihood ratio was 0. 6 at baseline, 0. 5 adding standard read, and 0. 1 adding specialized read. Standard read modestly improved prediction of pECE, whereas specialized read improved it moderately.
PATIENT SUMMARY - The incremental benefit of mpMRI over clinical information is small but increases to moderate with a specialized second opinion. This second opinion may be useful when considering active surveillance, nerve-sparing surgery, or focal therapy.
European urology. 2015 Nov 06 [Epub ahead of print]
Kae Jack Tay, Rajan T Gupta, Alison F Brown, Rachel K Silverman, Thomas J Polascik
Division of Urology, Duke University Medical Center, Durham, NC, USA. Department of Radiology, Duke University Medical Center, Durham, NC, USA. , Department of Radiology, Duke University Medical Center, Durham, NC, USA. , Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. , Division of Urology, Duke University Medical Center, Durham, NC, USA.