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A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
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Extraprostatic extension in multiparametric MRI; Is presurgical detection possible?

Muzaffer Ayaz1, Yıldız Gülseren1, İbrahim İnan1

  • 1Department of Radiology, Medical School of Istanbul Medeniyet University, Kadikoy, Istanbul, Turkey.

Journal of Cancer Research and Therapeutics
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Summary

1.5T MRI shows low sensitivity but high specificity for detecting extraprostatic extension (EPE) in prostate cancer (PCa). Lesion length (LL) and tumor-capsule contact length (TCL) may indirectly aid EPE detection, with LL underestimation noted.

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Area of Science:

  • Radiology
  • Oncology
  • Medical Imaging

Background:

  • Extraprostatic extension (EPE) significantly impacts prostate cancer (PCa) prognosis.
  • Accurate preoperative detection of EPE using multiparametric MRI (mpMRI) is crucial.
  • Objective criteria are needed for mpMRI to detect microscopic EPE.

Purpose of the Study:

  • To evaluate the efficacy of 1.5T MRI in detecting EPE in PCa.
  • To assess the utility of lesion length (LL) and tumor-capsule contact length (TCL) for EPE detection.

Main Methods:

  • Retrospective analysis of preoperative mpMRI from 110 PCa patients who underwent radical prostatectomy.
  • Two independent observers evaluated LL and TCL on 1.5T MRI.
  • Radiological findings were correlated with histopathological mapping.

Main Results:

  • 1.5T MRI demonstrated low sensitivity (40.4%) and high specificity (84.5-96.6%) for EPE detection.
  • Mean LL and TCL were significantly higher in patients with EPE.
  • Cutoff values: LL 14.5 mm, TCL 9.5 mm. Radiological LL was underestimated compared to histopathology.

Conclusions:

  • 1.5T MRI has limitations in sensitivity for EPE detection but high specificity.
  • LL and TCL can be indirectly beneficial for EPE assessment.
  • Radiological underestimation of LL should be considered in preoperative planning for PCa surgery.