Does body-coil magnetic-resonance imaging have a role in the preoperative staging of patients with clinically localized prostate cancer?

Comparison of body-array MRI and Partin tables for predicting extracapsular prostate cancer

Objective:

The objective of this article is to evaluate the performance of magnetic resonance imaging (MRI) and Partin tables at predicting extracapsular disease (ECD) in men with prostate cancer.

Patients and methods:

We identified all patients who had a radical prostatectomy at our institution in 2008. MRI and Partin predictions of ECD were compared with the histopathological stage. Oncological outcome at one year was assessed by biochemical recurrence (BCR) (prostate-specific antigen (PSA) ≥ 0.4 ng/dl followed by another rise).

Results:

Staging and follow-up data were available for 69 of the 80 patients (86%) who had had radical prostatectomy. Thirty-five of 69 patients had a body-array MRI scan. MRI predicted ECD (≥ rT3) with a sensitivity of 41% and specificity of 69%. Partin tables (> 50% risk ECD) had a sensitivity of 81% and specificity of 54%. Of the 35 patients who had an MRI scan, 22 (63%) had ECD and nine (26%) had BCR. Of the 34 men who were not staged with an MRI, only 10 (29%) had ECD and four (12%) had BCR.

Conclusion:

MRI performed no better than Partin tables at predicting ECD. Furthermore, patients who did not have an MRI, because of favourable prognostic clinical variables, had a low risk of ECD and BCR. We question the role of body-array MRI for staging prostate cancer and recognise an urgent need for prospective evaluation of multiparametric MRI.