title: Role of pelvic phased array magnetic resonance imaging in staging of prostate cancer specifically in patients diagnosed with clinically locally advanced tumours by digital rectal examination.
abstract: OBJECTIVE
  To assess the value of dynamic contrast-enhanced magnetic resonance imaging (MRI) for the prediction of extracapsular extension (ECE) in patients with clinical T3 (cT3) prostate cancer (PCa) compared to digital rectal examination (DRE).
  
  
  METHODS
  A retrospective review of data for patients treated by radical prostatectomy for cT3 PCa was performed. Patients who underwent MRI in the pre-operative work-up were included. The likelihoods of extracapsular extension (T3a) and seminal vesicle invasion (T3b) were scored on the basis of MR images. For data analysis, receiver operating characteristic (ROC) curves were generated.
  
  
  RESULTS
  Overall, 70 consecutive patients were included. Mean age was 63.8 (range 45-75) years, and the mean PSA level was 11.3 (range 2.9-26) ng/ml. Pathological analysis of the prostatic specimens confirmed 81.4% (n = 57) had pT3 disease. According to MRI, 57 (81.4%) patients were predicted correctly to have T3 disease. The overstaging (actual pT2) by either DRE or MRI or both was 18.6, 7 or 7%, respectively. The sensitivity, specificity and positive (PPV) and negative predictive values (NPV) of MRI were 94.7, 69, 93 and 75%. The kappa index of concordance between pre-operative MRI stage and pathological stage was 0.68 (P < 0.00001). The performance of MRI for T3 staging was AUC 0.87 (95% CI, 0.77-0.97).
  
  
  CONCLUSIONS
  Pre-prostatectomy MRI adds significant incremental value to the assessment of patients with cT3 disease. Its ability to accurately predict and characterize pathological T3 status and its superiority to standard clinical variables (e.g. DRE) confirm its usefulness in pre-operative work-up.
authors.affiliation: Department of Urology, Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris, 47-83 Boulevard de l'hopital, 75013, Paris, France.
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.forename: David R
authors.initials: DR
authors.lastname: Yates
authors.forename: Raphaële
authors.initials: R
authors.lastname: Renard-Penna
authors.forename: Elise
authors.initials: E
authors.lastname: Seringe
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Bousquet
authors.forename: Eva
authors.initials: E
authors.lastname: Comperat
authors.forename: Marc-Olivier
authors.initials: MO
authors.lastname: Bitker
authors.forename: Philippe
authors.initials: P
authors.lastname: Grenier
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D051517:Digital Rectal Examination; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen