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Pretreatment MRI as a Prognostic Factor After Radical Prostatectomy: A Systematic Review and Meta-Analysis.
Georgios Agrotis1,2, Stephan Ursprung1,3, Casper van der Steen1,4
1Department of Radiology, the Netherlands Cancer Institute, Amsterdam.
JAMA Oncology
|April 2, 2026
Summary
Pretreatment prostate MRI significantly predicts cancer recurrence, metastasis, and mortality after prostatectomy. MRI findings like extraprostatic extension and tumor size offer crucial prognostic information for men with prostate cancer.
Area of Science:
- Oncology
- Radiology
- Medical Imaging
Background:
- Accurate prostate cancer risk stratification is vital for balancing treatment benefits and harms.
- Established prognostic factors include clinical and pathological parameters, but the role of imaging is less clear.
Purpose of the Study:
- To evaluate the prognostic capability of pretreatment magnetic resonance imaging (MRI) parameters for oncological outcomes in patients undergoing radical prostatectomy.
Main Methods:
- A systematic literature search across MEDLINE, Embase, and Scopus was conducted.
- Included studies analyzed pretreatment prostate MRI in men undergoing radical prostatectomy, focusing on multivariable time-to-event analyses for recurrence, metastasis, and mortality.
- Random-effects meta-analysis synthesized hazard ratios (HRs) from 40 studies (24,941 patients).
Main Results:
- Extraprostatic extension (mrT3a) on MRI predicted biochemical recurrence (HR, 2.16), metastatic failure (HR, 3.18), and prostate cancer-specific mortality (HR, 10.93).
- Seminal vesicle invasion (mrT3b) on MRI predicted biochemical recurrence (HR, 2.74) and metastatic failure (HR, 5.58).
- Quantitative MRI features like high Prostate Imaging Reporting and Data System (PI-RADS) scores (≥4), large tumor size (≥20 mm), and low apparent diffusion coefficient (ADC) values (<0.9 × 10-3 mm2/s) prognosticated biochemical recurrence.
Conclusions:
- Pretreatment MRI offers significant independent prognostic value for biochemical recurrence, metastatic failure, and prostate cancer-specific mortality in men undergoing radical prostatectomy.
- These findings are robust even after adjustment for established clinicopathologic factors.
- MRI parameters enhance risk assessment, aiding in personalized treatment decisions for prostate cancer.
