Local staging of prostatic carcinoma: comparison of transrectal sonography and endorectal MR imaging

We compared the results of transrectal sonography and endorectal MR imaging in the local staging of prostatic carcinoma.

56 patients (mean age, 61.1 +/- 7.3 years) with the diagnosis of prostate cancer who by transrectal sonography had no evidence of gross extracapsular extension underwent endorectal coil MR imaging prior to radical prostatectomy. Imaging findings prospectively evaluated in each patient were cancer laterality, extracapsular extension, and seminal vesicle invasion. Twenty-one of 56 (38%) patients had extracapsular extension on final pathology. A total of 100 sides and five seminal vesicles were involved with cancer, and 27 sides (21 patients, six with bilateral extracapsular extension) demonstrated extracapsular extension. Imaging results were correlated with step-sectioned, radical prostatectomy pathologic data, and statistical analysis was expressed at a p = .05 level of significance. Retrospective readings of the images were used to construct receiver operating characteristic curves for the detection of extracapsular extension.

For tumor laterality, transrectal sonography was compared with endorectal coil MR imaging for sensitivity (70% versus 97%; p < .001), specificity (58% versus 58%), positive predictive value (93% versus 95%) and negative predictive value (18% versus 70%). For extracapsular extension, transrectal sonography was compared with endorectal coil MR imaging for the entire prostate and individually for each side of the prostate. The respective results for sensitivity (48% versus 91%, p < .01 and 37% versus 78%, p < .005), specificity (71% versus 49% and 87% versus 73%), positive predictive value (50% versus 51% and 48% versus 48%), and negative predictive value (69% versus 90% and 81% versus 91%). The receiver operating characteristic analysis of retrospective data demonstrated endorectal coil MR imaging to be superior to transrectal sonography in the detection of extracapsular extension. The small number of seminal vesicles involved by cancer (n = 5) precluded meaningful comparisons between the imaging techniques.

Endorectal coil MR imaging is more sensitive but less specific than transrectal sonography for detecting extracapsular extension of carcinoma of the prostate. Both procedures have low positive predictive values yet similarly high negative predictive values when each side of the prostate is assessed independently for extracapsular extension.