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Prostate Cancer Staging: Should MR Imaging Be Used?-A Decision Analytic Approach¹

¹ From the Departments of Radiology (G.J.J., S.H.J.R., J.O.B.) and Urology (J.J.M.C.H.d.l.R.), University Hospital Nijmegen, Geert Grooteplein zuid 18, 6500 HB, Nijmegen, the Netherlands; the Department of Medical Technology Assessment, University of Nijmegen, the Netherlands (J.L.S.); and the Department of Radiology, University of Wisconsin-Madison (J.R.T.). From the 1998 RSNA scientific assembly. Received February 1, 1999; revision requested March 31; final revision received August 16; accepted August 26. Address reprint requests to G.J.J. (e-mail: G.Jager@rdiag.azn.nl).

PURPOSE: To determine the appropriate use of magnetic resonance (MR) imaging for preoperative staging of prostate cancer.

MATERIALS AND METHODS: Literature review was performed by using the principles of evidence-based medicine and medical technology assessment. A decision analytic model was used to compare (a) the strategy that radical prostatectomy is performed on the basis of clinical staging with (b) the strategy that extracapsular disease detected at MR imaging contraindicates radical prostatectomy in patients who were considered surgical candidates on the basis of clinical staging.

RESULTS: After review of the literature, expert panel opinion did not recommend MR staging. No studies in which therapeutic efficacy was addressed were found. The decision analytic model indicated that the strategy including MR staging decreased costs (MR imaging, $10,568; radical prostatectomy, $11,669) and resulted in almost equal life expectancy (MR imaging, 12.59 years; radical prostatectomy, 12.60 years) and quality-adjusted life-years ([QALYs] MR imaging, 12.53; radical prostatectomy, 12.52). Results of sensitivity analyses demonstrated that the MR strategy was both more effective and less costly if the prior probability of extracapsular disease was at least 39% when considering QALY and 50% when considering unadjusted life expectancy.

CONCLUSION: It is not yet conclusively determined whether preoperative MR staging is appropriate, but results of decision analysis suggest that MR staging is cost-effective for men with moderate or high prior probability of extracapsular disease.

Index terms: Cost-effectiveness, 844.1214 • Diagnostic radiology, observer performance, 844.1214 • Economics, medical, 844.1214 • Prostate neoplasms, 844.32 • Prostate neoplasms, MR, 844.1214, 844.32 • Prostate neoplasms, surgery, 844.1267 • Radiology and radiologists, outcome studies, 844.1214 • Radiology and radiologists, socioeconomic issues, 844.1214

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