Routine use of magnetic resonance imaging in the management of T(1c) carcinoma of the prostate: is it necessary?
OBJECTIVE
To assess the role and implications of MRI in the management of patients with stage T(1c) prostate cancer.


METHODS
Data were collected from our oncology database, where all new prostate cancers are recorded, for a period of 3 years ending December 2005. A total of 915 patients were found to have prostate cancer. Of the 204 patients with stage T(1c) disease, 144 were considered eligible for radical treatment and underwent cross-sectional imaging in the form of an MRI scan. Gleason grade, clinical stage, cross-sectional imaging results, and subsequent treatment were recorded. The results were analyzed to see whether the MRI findings altered the modality of treatment offered to the patient.


RESULTS
Of the 144 patients, 137 had scans that showed no extracapsular invasion, while five scans were equivocal. All five patients had further investigation, either by CT scanning or targeted biopsies, which confirmed the cancer to be localized. In the remaining two cases, the MRI findings upstaged T(1c) disease to T(3) disease, as there was evidence of extracapsular involvement. The imaging result therefore affected treatment choice in only two patients in that radical surgery was not offered because of the scan findings.


CONCLUSIONS
The role of MRI in the management of clinical stage T(1c) prostate cancer is limited, as it altered the management of only 1.3% of our patients. The cost v the value of this study should be discussed with the patient before MRI is prescribed.
Manikandan
Ramaswamy
R
Department of Urology, The Royal Liverpool University Hospital, Liverpool, U.K. armanikan2000@gmail.com
Qazi
Hasan A R
HA
Philip
Joe
J
Mistry
Rahul
R
Lamb
Gabby H
GH
Woolfenden
Kenneth A
KA
Cornford
Philip A
PA
Parsons
Keith F
KF
D006302:Health Services Research; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000000981:diagnostic imaging*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D011859:Radiography