Diagnostic accuracy of surface coil magnetic resonance imaging at 1.5 T for local staging of elevated risk prostate cancer.
BACKGROUND
Preoperative prostate cancer stage predicts prognosis and affects treatment decisions. The purpose of this study was to estimate the sensitivity and specificity of surface coil magnetic resonance imaging (MRI) for prostate cancer stage using surgical pathologic data as the reference standard.


METHODS
High-risk patients (>/=cT3 or PSA >/=20 ng/mL or Gleason >/=8) and selected intermediate-risk patients (clinically bulky disease on exam or biopsy, cT2b/c, or Gleason 7 with >/=3 of 5 biopsy cores positive in a lobe) routinely received a pelvic MRI at our institution. The images of identified patients were reviewed by one radiologist who was blinded to clinical information. The radiologist reported presence or absence of tumour within each lobe of the prostate. Extraprostatic extension (EPE), seminal vesicle (SV) invasion and pelvic lymph node (PLN) metastasis were also reported. Radiological findings were compared with prostatectomy pathology reports.


RESULTS
During the study period, about 320 radical prostatectomies were performed. Of these, 32 had a preoperative surface coil pelvic MRI adequate for analysis. Pathologically, 53 of 64 (82.8%) prostate lobes contained tumour, 17 (26.6%) lobes had associated EPE, 12 (18.8%) had SV involvement and 7 (10.9%) sets of PLNs contained cancer. Magnetic resonance imaging sensitivity and specificity were, respectively, 94.3% and 81.8% for tumour location, 82.4% and 87.2% for EPE, 83.3% and 92.3% for SV invasion and 71.4% and 94.7% for PLN involvement.


CONCLUSIONS
Surface coil MRI accurately stages many prostate cancer patients with elevated risk of extraprostatic disease. This mode of imaging may be reasonable at centres that do not have endorectal coil MRI.
Kim
Brian
B
Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON;
Breau
Rodney H
RH
Papadatos
Demetri
D
Fergusson
Dean
D
Doucette
Steve
S
Cagiannos
Ilias
I
Morash
Chris
C