Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland.
Department of Urology, Medical University of Vienna, Vienna, Austria.
World J Urol. 2023 May;41(5):1275-1284. doi: 10.1007/s00345-023-04383-2. Epub 2023 Apr 5.
The reliability of magnetic resonance imaging (MRI) as a local and nodal staging tool in radio-recurrent prostate cancer (PCa) is still unclear. The present study aims at evaluating the predictive value of MRI in the detection of extracapsular extension (ECE), seminal vesical invasion (SVI) and nodal involvement (LNI) in patients after primary radio (EBRT) and/or brachytherapy (BT) before salvage radical prostatectomy (SRP).
This systematic review and meta-analysis were performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Pubmed, Scopus, and Web of Science databases were systemically reviewed to extract the data on diagnostic performance of MRI in radio-recurrent PCa.
Four studies comprising 94 radio-recurrent PCa patients were included. The pooled prevalence of ECE, SVI, and LNI was 61%, 41%, and 20%, respectively. The pooled sensitivity for ECE, SVI and LNI detection was 53% (CI 95% 19.8-83.6%), 53% (CI 95% 37.2-68%) and 33% (CI 95% 4.7-83.1%) respectively, whereas specificity was 75% (CI 95% 40.6-92.6%), 88% (CI 95% 71.7-95.9%) and 92% (CI 95% 79.6-96.8%). The sensitivity analysis revealed that a single outlying study using only T2-weighted imaging instead of multiparametric MRI reported significantly higher sensitivity with significantly lower specificity.
This is the first meta-analysis reporting reliability of staging MRI in a radio-recurrent setting. MRI provides poor sensitivity while maintaining high specificity for local and nodal staging before SRP. However, current evidence is limited to the low number of heterogenous studies at meaningful risk of bias.
磁共振成像（MRI）作为局部和淋巴结分期工具在放射性复发性前列腺癌（PCa）中的可靠性尚不清楚。本研究旨在评估 MRI 在检测原发性放射治疗（EBRT）和/或近距离放射治疗（BT）后挽救性根治性前列腺切除术前放射性复发性 PCa 患者的包膜外侵犯（ECE）、精囊侵犯（SVI）和淋巴结受累（LNI）中的预测价值。
本系统评价和荟萃分析符合系统评价和荟萃分析的首选报告项目（PRISMA）指南。通过系统检索 Pubmed、Scopus 和 Web of Science 数据库，提取 MRI 在放射性复发性 PCa 中的诊断性能数据。
共纳入 4 项研究，包括 94 例放射性复发性 PCa 患者。ECE、SVI 和 LNI 的总患病率分别为 61%、41%和 20%。ECE、SVI 和 LNI 检测的合并敏感性分别为 53%（95%CI 19.8-83.6%）、53%（95%CI 37.2-68%）和 33%（95%CI 4.7-83.1%），特异性分别为 75%（95%CI 40.6-92.6%）、88%（95%CI 71.7-95.9%）和 92%（95%CI 79.6-96.8%）。敏感性分析显示，一项仅使用 T2 加权成像而未使用多参数 MRI 的孤立研究报告的敏感性显著较高，特异性显著较低。
这是第一项报告在放射性复发性前列腺癌中进行分期 MRI 可靠性的荟萃分析。MRI 提供了较低的敏感性，同时保持了在挽救性根治性前列腺切除术前进行局部和淋巴结分期的高特异性。然而，目前的证据仅限于数量有限且存在显著偏倚风险的异质性研究。
