Extraprostatic extension in multiparametric MRI; Is presurgical detection possible?

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.