Department of Urology, Korea University School of Medicine, Seoul, Korea.
Asian J Androl. 2011 May;13(3):487-93. doi: 10.1038/aja.2010.165. Epub 2011 Mar 7.
To obtain improved accuracy in predicting extracapsular extension (ECE) and seminal vesicle invasion (SVI), we evaluated the variables affecting the predictability of staging magnetic resonance imaging (MRI, phased-array coil) and estimated their impact on accuracy between preoperative MRI staging and histological outcome. A total of 121 patients with localized or locally advanced prostate cancer who underwent robotic radical prostatectomy (RALP) were included. Following transrectal biopsy, all enrolled patients had undergone MRI for staging work-up. After RALP, only 43.8% (53/121) of the patients were matched with the MRI predicted stage. Compared to the matched group in the prediction of ECE, the unmatched group had significantly higher initial prostate-specific antigen (PSA, 12.8 ng ml⁻¹ versus 8.1 ng ml⁻¹, P = 0.048). In the prediction of SVI, initial PSA (8.1 ng ml⁻¹ versus 17.3 ng ml⁻¹, P = 0.009) and biopsy Gleason score (6.5 versus 7.6, P = 0.035) were significantly higher in the unmatched group. When applying clinical cutoffs of initial PSA of 10 and 20 ng ml⁻¹, the accuracy of MRI in the prediction of ECE was decreased in the group with PSA over 20 ng ml⁻¹ (75.6, 64.5 and 37.5%, P = 0.01), and this group had significantly decreased accuracy of MRI in the prediction of SVI (91.5, 77.4 and 37.5%, P<0.01). Applying the clinical cutoff of a Gleason score of 7, the accuracy of MRI in the prediction of SVI was decreased in the higher Gleason score group (93.9, 82.1 and 62.9%, P = 0.01). Thus, for these patient groups, to obtain margin negativity during radical prostatectomy, operative findings, rather than post-biopsy MRI images, may provide substantial information, implying a clinical advantage in conducting MRI before prostate biopsy.
为了提高预测包膜外侵犯（ECE）和精囊侵犯（SVI）的准确性，我们评估了影响分期磁共振成像（MRI，相控阵线圈）预测能力的变量，并估计了术前 MRI 分期和组织学结果之间的准确性。共有 121 例局限性或局部进展性前列腺癌患者接受了机器人根治性前列腺切除术（RALP）。所有入组患者在经直肠活检后均行 MRI 分期检查。在 RALP 后，只有 43.8%（53/121）的患者与 MRI 预测的分期相匹配。与 ECE 预测的匹配组相比，不匹配组的初始前列腺特异性抗原（PSA）显著升高（12.8ng/ml 比 8.1ng/ml，P=0.048）。在 SVI 预测中，不匹配组的初始 PSA（8.1ng/ml 比 17.3ng/ml，P=0.009）和活检 Gleason 评分（6.5 比 7.6，P=0.035）显著升高。当应用初始 PSA 为 10 和 20ng/ml 的临床界值时，PSA 大于 20ng/ml 的患者 MRI 预测 ECE 的准确性降低（75.6%、64.5%和 37.5%，P=0.01），且该组 MRI 预测 SVI 的准确性显著降低（91.5%、77.4%和 37.5%，P<0.01）。当应用 Gleason 评分 7 的临床界值时，Gleason 评分较高组 MRI 预测 SVI 的准确性降低（93.9%、82.1%和 62.9%，P=0.01）。因此，对于这些患者群体，为了在根治性前列腺切除术中获得阴性切缘，手术发现而不是活检后的 MRI 图像可能提供重要信息，这意味着在前列腺活检前进行 MRI 具有临床优势。
