Value of 3 Tesla Endorectal Coil Magnetic Resonance Imaging in Local Staging of Prostate Cancer

Purpose To prospectively evaluate the accuracy of 3-T multiparametric endorectal coil magnetic resonance imaging (including T2-weighted, diffusion-weighted and dynamic contrast enhanced imaging) in staging prostate cancer in a clinical setting. Materials and methods From January 2007 until January 2010, 123 patients underwent radical prostatectomy in our institution because of prostate cancer. Of those patients, 83 were included in this study. Inclusion criterium was a pre-operative 3-T MRI scan with endorectal coil. Exclusion criteria were prior hormonal or radiation therapy. To determine MR tumor stage, reports made before surgery by 2 experienced radiologists were used. MR tumor stage was compared to pathologic tumor stage according to the TNM-classification. Accuracy rates were calculated of detection of extracapsular extension, detection of seminal vesicle invasion and detection of invasion of the neurovascular bundle. Results Accuracy, sensitivity and specificity of detection of extracapsular extension were respectively 74% (37/50), 67% (16/24) and 81% (21/26) for radiologist A and 71% (24/34), 52% (11/21) and 100% (13/13) for radiologist B. When also tumor localization (side and zone) was taken into account those rates were respectively 66% (33/50), 50% (12/24) and 81% (21/26) for radiologist A, and 62% (21/34), 38% (8/21) and 100% (13/13) for radiologist B. Accuracy, sensitivity and specificity of detection of extensive extracapsular extension (> 0.6 mm) were respectively 70% (35/50), 55% (12/22) and 82% (23/28) for radiologist A and 74% (25/34), 50% (9/18) and 100% (16/16) for radiologist B. Accuracy, sensitivity and specificity of detection of seminal vesicle invasion were respectively 88% (44/50), 20% (1/5) and 96% (43/45) for radiologist A and 88% (29/33), 43% (3/7) and 100% (26/26) for radiologist B. Accuracy, sensitivity and specificity of detection of invasion of the neurovascular bundle were respectively 76% (38/50), 65% (11/17) and 82% (27/33) for radiologist A and 76% (25/33), 46% (6/13) and 95% (19/20) for radiologist B. Conclusions MR imaging is accurate in staging prostate cancer and can become a useful tool in determining the site of extracapsular extension before surgery.

Accuracy of multiparametric MRI for prostate cancer detection: a meta-analysis

Item does not contain fulltextOBJECTIVE. The purpose of this diagnostic meta-analysis was to determine the diagnostic accuracy of multiparametric MRI for prostate cancer detection using anatomic T2-weighted imaging combined with two functional techniques: diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI). MATERIALS AND METHODS. We searched electronic databases, including MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to February 3, 2012. We included diagnostic accuracy studies using a combination of T2-weighted imaging, DWI, and DCE-MRI to detect prostate cancer with histopathologic data from prostatectomy or biopsy as the reference standard. The methodologic quality was assessed with version 2 of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool by two independent reviewers. Sensitivity and specificity of all studies were calculated from 2 x 2 tables, and the results were plotted in a hierarchic summary receiver operating characteristic plot. RESULTS. Seven studies that met the inclusion criteria (526 patients) could be analyzed. The pooled data showed a specificity of 0.88 (95% CI, 0.82-0.92) and sensitivity of 0.74 (95% CI, 0.66-0.81) for prostate cancer detection, with negative predictive values (NPVs) ranging from 0.65 to 0.94. Subgroup analyses showed no significant difference between the subgroups. CONCLUSION. The high specificity with variable but high NPVs and sensitivities implies a potential role for multiparametric MRI in detecting prostate cancer

Measuring health-related quality of life in men with prostate cancer: A systematic review of the most used questionnaires and their validity

Contains fulltext : 153358.pdf (publisher's version ) (Closed access)OBJECTIVES: To identify and study the psychometric properties of the most used health-related quality-of-life (HRQoL) instruments in men with prostate cancer. METHODS: We performed a literature search using PubMed and EMBASE to identify all studies on prostate cancer using a HRQoL instrument. The most often used HRQoL instruments were investigated in detail by 2 independent reviewers. Data were extracted regarding the characteristics and psychometric values of the instruments, i.e., content validity, internal consistency, criterion validity, construct validity, reproducibility, responsiveness, floor and ceiling effects, and interpretability. Good psychometric outcomes indicate a high methodological quality of the instrument. RESULTS: Our systematic search revealed 13,812 potential relevant articles, of which 2,258 appeared relevant after screening the titles and reading the abstracts. We studied the psychometric properties of the 20 most often used HRQoL instruments, the first 3 of which were the Expanded Prostate Index Composite, University of California-Los Angeles Prostate Cancer Index, and Short Form-36 (SF-36). Content validity, internal consistency (alpha>0.70), criterion validity, construct validity, and reproducibility were good in 60%, 90%, 10%, 35%, and 65% of the 20 instruments, respectively. Responsiveness was not reported for 12 of 20 instruments (60%). Floor and ceiling effects and the interpretability of the questionnaires were only reported in 3 (15%) and 6 (30%) instruments. CONCLUSIONS: Considering the psychometric properties, we advise to use the SF-12 as a generic instrument, the Cancer Rehabilitation Evaluation System-SF or the Functional Assessment of Cancer Therapy-General as cancer-specific HRQoL instruments, and the University of California-Los Angeles Prostate Cancer Index, the QUFW94, or the Functional Assessment of Cancer Therapy-Prostate as prostate cancer-specific instruments