title: Accuracy of preoperative multiparametric magnetic resonance imaging for prediction of unfavorable pathology in patients with localized prostate cancer undergoing radical prostatectomy.
abstract: BACKGROUND
  We investigated the accuracy of multiparametric MRI (mpMRI) for preoperative staging and its influence on the determination of neurovascular bundle sparing and disease prognosis in patients with localized prostate cancer.
  
  
  METHODS
  We reviewed 1045 patients who underwent radical prostatectomy with preoperative mpMRI at a single institution. Clinical local stages determined from mpMRI were correlated with preoperative and postoperative pathological outcomes.
  
  
  RESULTS
  The sensitivity and specificity to diagnose seminal vesicle invasion (SVI) on mpMRI were 43.8 and 95.4 %, respectively. The negative predictive value was 78.9 %. The sensitivity and specificity to diagnose extracapsular extension (ECE) were 54.5 and 80.5 %, respectively. The overall sensitivity and specificity of diagnosing pathological T3 or higher were 52.6 and 82.1 %, respectively. Non-organ-confined disease determined by mpMRI was significantly associated with positive surgical margin and pathological T3 disease on multivariate analysis. Preoperative adverse findings on mpMRI were significantly associated with performance of the non-nerve-sparing technique.
  
  
  CONCLUSIONS
  mpMRI did not show outstanding diagnostic accuracy relative to our expectations in predicting SVI or ECE preoperatively. However, adverse findings on preoperative mpMRI were significantly related to worse postoperative pathological outcomes as well as postoperative biochemical recurrence.
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hakmin
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Chan Kyo
authors.initials: CK
authors.lastname: Kim
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Byung Kwan
authors.initials: BK
authors.lastname: Park
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hyun Hwan
authors.initials: HH
authors.lastname: Sung
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Deok Hyun
authors.initials: DH
authors.lastname: Han
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hwang Gyun
authors.initials: HG
authors.lastname: Jeon
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Byong Chang
authors.initials: BC
authors.lastname: Jeong
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Seong Il
authors.initials: SI
authors.lastname: Seo
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Seong Soo
authors.initials: SS
authors.lastname: Jeon
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Han Yong
authors.initials: HY
authors.lastname: Choi
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. hyunmoo.lee@samsung.com.
authors.forename: Hyun Moo
authors.initials: HM
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011468:Prostatectomy / Q000379:methods / Q000401:mortality*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Cancer; MRI; Magnetic Resonance Imaging; Prostate; Survival; mpMRI