[Can preoperative prostate MRI before radical prostatectomy predict extracapsular extension and the side of the index lesion?]

AIM - To evaluate the role of preoperative multi-parametric magnetic resonance imaging (MP-MRI) in patients undergoing radical prostatectomy. Specifically, the accuracy of MP-MRI in detecting extracapsular extension (ECE) and individuating the side of the index lesion have been explored.

METHODS - Thirty-five consecutive patients undergoing radical prostatectomy have been retrospectively analyzed. The MRI exam incorporated T2-weighted imaging, diffusion-weighted imaging and dynamic contrast enhancement in all patients. χ(2) test was performed to assess an association between an MP-MRI suggestive of ECE and pathologic ECE; similar tests were performed to study the association between the MRI-detected side of the index lesion and its true localization on final pathology. Univariate logistic regression models were constructed to evaluate possible predictors of ECE, including MP-MRI suspected ECE.

RESULTS - Seventeen percent (6/35) of men presented ECE on final pathology. MP-MRI was predictive of pathologic ECE with a negative predictive value and specificity of 93% and 90%, respectively. Global accuracy of MP-MRI in predicting ECE was 86%. MRI-detected ECE was significantly predictive of pathologic ECE on logistic regression (OR: 17.3, 95% CI: 2.2-138.2, P=0.007). Moreover, MRI significantly predicted the side of the index lesion (P=0.012).

CONCLUSIONS - In this single center cohort, preoperative MP-MRI was significantly predictive of ECE and side of the index lesion. Further studies are necessary to individuate patients who can benefit from preoperative MP-MRI.

LEVEL OF EVIDENCE - 5.

Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2016 Mar 17 [Epub ahead of print]

S Albisinni, A De Groote, F Deneft, P Thoma, X Catteau, T Roumeguère, T Wildschutz

Département d'urologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique; Département d'urologie, cliniques universitaires de Bruxelles, hôpital Erasme, université libre de Bruxelles, route de Lennik 808, 1070 Bruxelles, Belgique. Département d'urologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique., Département d'urologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique., Département de radiologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique., Département d'anatomopathologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique., Département d'urologie, cliniques universitaires de Bruxelles, hôpital Erasme, université libre de Bruxelles, route de Lennik 808, 1070 Bruxelles, Belgique., Département d'urologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique.

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