Phased array magnetic resonance imaging for staging clinically localised prostrate cancer

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Accurate preoperative staging is crucial for patients with intra-capsular prostate cancer (T1-2, N0, M0) considered for curative treatments like radical prostatectomy or radiation therapy.
• Under-staging occurs in up to 40% of patients with clinically localized disease, leading to inappropriate curative surgery.
• Phased array MRI is investigated for its potential to improve preoperative staging accuracy.

Purpose of the Study:

• To evaluate the diagnostic value of preoperative phased array MRI in staging patients eligible for radical prostatectomy.
• To compare MRI findings with postoperative pathological results, specifically for extra-capsular extension (ECE).

Main Methods:

• Ninety-five patients suspected of clinical prostate cancer underwent preoperative phased array MRI staging.
• MRI results were compared with postoperative pathological findings, including ECE.
• Radical prostatectomy was performed within weeks of MRI; MRI results did not influence preoperative staging or treatment decisions.

Main Results:

• Of 38 patients with clinically localized prostate cancer who underwent surgery, 16 (42%) had pathologically proven ECE.
• MRI demonstrated a sensitivity of 24% and specificity of 86% for detecting ECE.
• The positive predictive value (PPV) for ECE was 57%, and the negative predictive value (NPV) was 61%.

Conclusions:

• Phased array MRI, in its current form, lacks the necessary accuracy for preoperative staging of clinically localized prostate cancer.
• The low sensitivity and predictive values of MRI for ECE indicate it is not reliable for guiding treatment decisions in this patient group.