[Staging of prostate cancer: value of the combined information of endorectal MRI, biopsy Gleason score, and preoperative PSA level].

Abstract

PURPOSE:

To evaluate the predictive value of MR imaging criteria, the biopsy Gleason score, and preoperative PSA levels for differentiating between T2 and T3 prostate carcinomas.

MATERIALS AND METHODS:

Endorectal MR images of 81 patients (median age: 65 years, range: 48 to 81 years) who had biopsy-proven prostate cancer and underwent a radical prostatectomy were analyzed retrospectively. The existence of different imaging features were recorded for each patient. A radiological analysis comprising all used imaging criteria was also performed for every patient. Optimal cut-off levels for the biopsy Gleason score and preoperative PSA levels were obtained using ROC analyses. Subsequently, a logistic regression analysis was performed to identify features which make a significant contribution to the prediction of the tumor stage.

RESULTS:

Histological examination showed that 24 patients (29.6 %) had a T3 tumor and 57 patients (70.4 %) had a T2 tumor. The mean preoperative PSA level was 9.4 ng/ml (+/- 7 ng/ml), and the median Gleason score was 6 with a range of 4 to 8. The radiological judgment comprising all imaging criteria led to a sensitivity of 54.2 % and specificity of 79 % for the detection of a T3 tumor. The obliteration of the rectoprostatic angle (regression coefficient B = 2.30; standard error (se) = 0.80; p = 0.002) and the biopsy Gleason score (B = 1.16; se = 0.3; p = 0.001) were the parameters with the highest independent predictive value for the diagnosis of an extracapsular tumor spread. The other radiological criteria and the preoperative PSA level were not statistically significant. A combination of the parameters "obliteration of the rectoprostatic angle" and "biopsy Gleason score" led to a sensitivity and specificity of 75 % and 79 %, respectively (existence of one parameter sufficient). The optimal cut-off value was a Gleason score of 7 for the differentiation between T2 and T3 prostate carcinomas.

CONCLUSION:

In our study, only the criteria "obliteration of the rectoprostatic angle" and "biopsy Gleason score" were of predictive value for the diagnosis of a T3 prostate carcinoma. The other MR imaging criteria and the preoperative PSA levels had no additional benefit.

• Authors: A Wetter, A N Ajdukovic, K Fliessbach, T Lehnert, T Engl, V Jacobi, T J Vogl
• Journal: RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin (Rofo) Vol. 178 Issue 4 Pg. 385-90 (Apr 2006) ISSN: 1438-9029 [Print] Germany
• Vernacular Title: Staging des Prostatakarzinoms: Wertigkeit der kombinierten Information aus endorektaler MRT, bioptischem Gleason Score und präoperativem PSA-Wert.
• PMID: 16607587 (Publication Type: Comparative Study, English Abstract, Journal Article)

Chemical References

• Biomarkers, Tumor
• Prostate-Specific Antigen

Topics

• Aged
• Aged, 80 and over
• Biomarkers, Tumor (blood)
• Biopsy
• Diagnosis, Differential
• Humans
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Neoplasm Invasiveness
• Neoplasm Staging
• Proctoscopy (methods)
• Prognosis
• Prostate (pathology)
• Prostate-Specific Antigen (blood)
• Prostatic Neoplasms (diagnosis, pathology, surgery)
• Sensitivity and Specificity