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Updated: Jul 6, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Less qualitative multiparametric magnetic resonance imaging in prostate cancer can underestimate extraprostatic
Stephen Schmit1, Sai Allu1, Joshua Ray Tanzer1
1Warren Alpert Medical School of Brown University, Providence, RI.
Background:
Multiparametric magnetic resonance imaging (mpMRI) is increasingly used for risk stratification and preoperative staging of prostate cancer. It remains unclear how Grade Group (GG) interacts with the ability of mpMRI to determine the presence of extraprostatic extension (EPE) on surgical pathology.
Methods:
A retrospective review of a robotic assisted laparoscopic radical prostatectomy (RALP) database from 2016-2020 was performed. Radiology mpMRI reports by multiple attending radiologists and without clear standardization or quality control were retrospectively assessed for EPE findings and compared with surgical pathology reports. The data were stratified by biopsy-based GG and a multivariable cluster analysis was performed to incorporate additional preoperative variables (age at diagnosis, PSA, etc.). Hazard ratios were calculated to determine how mpMRI findings and radiographic EPE relate to positive surgical margins.
Results:
289 patients underwent at least one mpMRI prior to RALP. Preoperative mpMRI demonstrated sensitivity of 39.3% and specificity of 88.8% for pathological EPE and had a negative predictive value (NPV) of 49.5%, and positive predictive value (PPV) of 84.0%. Stratification of NPV by GG yielded the following values: GG 1-5 (49.5%), GG 3-5 (40.8%), GG 4-5 (43.4%), and GG 5 (30.4%). Additionally, positive EPE on preoperative mpMRI was associated with a significantly decreased risk of positive surgical margins (RR: 0.655; 95% CI: 0.557-0.771).
Conclusions:
NPV of prostate mpMRI for EPE may be decreased for higher grade tumors. A detailed reference reading and image quality optimization may improve performance. However, urologists should exercise caution in nerve sparing approaches in these patients.
Insights
Multiparametric MRI (mpMRI) for prostate cancer may be less accurate in detecting extraprostatic extension (EPE) in higher Grade Group (GG) tumors. This impacts surgical planning and nerve-sparing approaches for patients with advanced prostate cancer.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Multiparametric magnetic resonance imaging (mpMRI) is vital for prostate cancer risk stratification and staging.
- The interplay between Grade Group (GG) and mpMRI's accuracy in detecting extraprostatic extension (EPE) requires further investigation.
Purpose of the Study:
- To evaluate the impact of Grade Group (GG) on the accuracy of multiparametric magnetic resonance imaging (mpMRI) in detecting extraprostatic extension (EPE).
- To assess the relationship between mpMRI findings, EPE, and positive surgical margins in patients undergoing radical prostatectomy.
Main Methods:
- Retrospective analysis of 289 patients undergoing robotic assisted laparoscopic radical prostatectomy (RALP) between 2016-2020.
- Radiology mpMRI reports were assessed for EPE and compared with surgical pathology, stratified by biopsy-based GG.
- Multivariable cluster analysis incorporated preoperative variables; hazard ratios calculated for EPE and positive surgical margins.
Main Results:
- mpMRI showed 39.3% sensitivity and 88.8% specificity for pathological EPE, with a negative predictive value (NPV) of 49.5%.
- NPV decreased with increasing GG: GG 1-5 (49.5%), GG 3-5 (40.8%), GG 4-5 (43.4%), and GG 5 (30.4%).
- Positive EPE on mpMRI correlated with a significantly reduced risk of positive surgical margins (RR: 0.655).
Conclusions:
- The negative predictive value of mpMRI for EPE may be lower in higher-grade prostate tumors.
- Optimizing image quality and standardized readings could enhance mpMRI performance.
- Urologists should exercise caution with nerve-sparing procedures in cases with suspected EPE on mpMRI.
