title: Prediction of extracapsular disease with multiparametric magnetic resonance imaging in high risk localized prostate cancer patient.
abstract: OBJECTIVE
  To assess the usefulness of multiparametric magnetic resonance imaging (MRI) in the staging of patients with localized prostate cancer (PC) and high risk of extracapsular disease (ECD).
  
  
  METHODS
  Retrospective study including 30 patients with localized PC and high risk of ECD. Pathologist and radiologist established an ECD suspicion according to the evaluation of the prostatic biopsy specimens and the multiparametric MRI analysis, respectively. Radical prostatectomy (RP) specimen analysis was used as a definitive confirmatory reference. Kappa (k)test was used to assess the degree of consistency between the initial suspicion provided by both specialists and the reference RP specimen.
  
  
  RESULTS
  When the prostatic gland was analyzed as a single unit, the pathological evaluation of the biopsy specimens did not correctly detect the risk of ECD in 46.6% of the patients (14/30; 10 FN; k=-0.035, 95%CI [-0.29-0.36]), while multiparametric MRI did not do in 36% of the cases (11/30, 9 FP; k=0.27, 95%CI [-0.03-0.61]). Whereas, if each side of the prostate (i.e. right and left) was considered as an independent observation, the pathologist wrongly predicted the risk of ECD in 35% of the cases (21/60; 18 FN; k=0.19, 95%CI [-0.03-0.40]), while the radiologist erred only in 18.3% of the cases (11/60; 7 FN and 4 FP; k=0, 61, 95%CI [0.40-0.81]).
  
  
  CONCLUSIONS
  Data from our experience suggest an added value of multiparametric MRI in the clinical staging of localized PC in cases of high risk of ECD. Multiparametric MRI may be used as a helpful tool in the surgical planning and the decision-making process regarding the management of this entity.
authors.affiliation: Servicio de Urologia.HospitalNuestra Señora de Sonsoles. Avila.Radiology Department. Hospital Universitario de Getafe. Madrid.Anatomical Pathologic Department. Hospital Universitario de Getafe. Getafe. Madrid. Urology Department. Hospital Universitario de Getafe. Getafe. Madrid. Universidad Europea de Madrid. Madrid. Urology Department. Hospital Central de la Cruz Roja San José y Santa Adela. Madrid. Spain.
authors.forename: J E
authors.initials: JE
authors.lastname: Hernández-Sánchez
authors.forename: E
authors.initials: E
authors.lastname: Castillo
authors.forename: J M
authors.initials: JM
authors.lastname: Barbero
authors.forename: F
authors.initials: F
authors.lastname: Lista
authors.forename: J
authors.initials: J
authors.lastname: Gonzalez
mesh_terms: D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000601:surgery; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen