title: The Impact of Magnetic Resonance Imaging on Prediction of Extraprostatic Extension and Prostatectomy Outcome in Patients with Low-, Intermediate- and High-Risk Prostate Cancer: Try to Find a Standard.
abstract: OBJECTIVE
  To investigate the value of multiparametric magnetic resonance imaging (mpMRI) and to predict extracapsular extension (ECE), seminal vesicle (SV) infiltration, and a negative surgical margin (SM) status at radical prostatectomy (RP) for different prostate cancer (PC) risk groups.
  
  
  METHODS
  In the study, 805 men underwent 3 tesla mpMRI without endorectal coil before MRI/transrectal ultrasonography-fusion guided prostate biopsy. MRIs were analyzed using the prostate imaging reporting and data system. The cohort was classified into risk groups according to National Comprehensive Cancer Network (NCCN) criteria. Of 132 men who subsequently underwent RP, pathologic stage and SM status at RP were used as reference. Retrospectively, we investigated a European Society of Urogenital Radiology (ESUR) score for ECE and SV-infiltration. Statistical analyses included regression analyses, receiver operating characteristics (ROC), and Youden Index to assess an ESUR-score cutoff.
  
  
  RESULTS
  Area under the curve in ROC curve analyses was 0.82 for ESUR-ECE score to detect pT(3a)-disease and 0.77 for ESUR-SV score for pT(3b). Using a cutoff of 4 for ECE and of 2 for SV, the positive predictive value of the ECE-score for harboring pT(3) was 50.0%, 90.0%, and 88.8% for the low-, intermediate- and high-risk cohort. Retrospectively, the use of the ESUR-ECE score preoperatively would have changed the initial surgical plan, according to NCCN criteria, in 31.1% of patients. In the high-risk subgroup, 9/35 (25.7%) patients were correctly assessed as not harboring pT(3) by imaging (ECE score <4), and would have allowed secure robot-assisted radical prostatectomy and nerve-sparing surgery (NSS). When T3 suspicion on preoperative MRI would be taken into account, intraoperative frozen-sections (IFS) might avoid positive SM in 12/18 high-risk patients and an oncologic secure NSS in 8/20 intermediate-risk patients.
  
  
  CONCLUSIONS
  Prediction of pT(3) disease is crucial to plan NSS and to achieve negative SM in RP. Standardized ECE scoring on mpMRI is an independent predictor of pT(3) and may help to plan RP with oncologic security, even in high-risk patients. In addition, it allows more accurate selection of a subgroup of patients for systematic and MRI-guided IFS.
authors.affiliation: 1 Department of Urology, University Hospital Heidelberg , Heidelberg, Germany .|2 Department of Radiology, German Cancer Research Center (DKFZ) , Heidelberg, Germany .
authors.forename: Jan Philipp
authors.initials: JP
authors.lastname: Radtke
authors.affiliation: 1 Department of Urology, University Hospital Heidelberg , Heidelberg, Germany .
authors.forename: Boris A
authors.initials: BA
authors.lastname: Hadaschik
authors.affiliation: 2 Department of Radiology, German Cancer Research Center (DKFZ) , Heidelberg, Germany .
authors.forename: Maya B
authors.initials: MB
authors.lastname: Wolf
authors.affiliation: 2 Department of Radiology, German Cancer Research Center (DKFZ) , Heidelberg, Germany .
authors.forename: Martin T
authors.initials: MT
authors.lastname: Freitag
authors.affiliation: 1 Department of Urology, University Hospital Heidelberg , Heidelberg, Germany .
authors.forename: Constantin
authors.initials: C
authors.lastname: Schwab
authors.affiliation: 3 Hanseatic Radiology , Hamburg, Germany .
authors.forename: Celine
authors.initials: C
authors.lastname: Alt
authors.affiliation: 4 Institute of Pathology, University Hospital Heidelberg , Heidelberg, Germany .
authors.forename: Wilfried
authors.initials: W
authors.lastname: Roth
authors.affiliation: 1 Department of Urology, University Hospital Heidelberg , Heidelberg, Germany .
authors.forename: Stefan
authors.initials: S
authors.lastname: Duensing
authors.affiliation: 1 Department of Urology, University Hospital Heidelberg , Heidelberg, Germany .
authors.forename: Sascha A
authors.initials: SA
authors.lastname: Pahernik
authors.affiliation: 2 Department of Radiology, German Cancer Research Center (DKFZ) , Heidelberg, Germany .
authors.forename: Matthias C
authors.initials: MC
authors.lastname: Roethke
authors.affiliation: 2 Department of Radiology, German Cancer Research Center (DKFZ) , Heidelberg, Germany .
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schlemmer
authors.affiliation: 1 Department of Urology, University Hospital Heidelberg , Heidelberg, Germany .
authors.forename: Markus
authors.initials: M
authors.lastname: Hohenfellner
authors.affiliation: 1 Department of Urology, University Hospital Heidelberg , Heidelberg, Germany .
authors.forename: Dogu
authors.initials: D
authors.lastname: Teber
mesh_terms: D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D005629:Frozen Sections; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009929:Organ Size; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D012372:ROC Curve; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012669:Seminal Vesicles / Q000473:pathology*; D016896:Treatment Outcome