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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).

View larger version (24K): [in a new window]   Figure 1. Flowchart of the decision analytic model shows two strategies: the MR strategy (MRI) with subsequent surgery (operation) in the case of a T2 tumor versus going directly to surgery. The square indicates a decision node. The nodes represented by circles are used if subsequent outcomes occur by chance. End nodes are indicated by triangles. The model starts at the left node, at which the patient is considered a candidate for radical prostatectomy on the basis of clinical staging. In the case of no surgery, or in the case of a T3 tumor for which surgery was performed, we assumed patients received palliative treatment (*). The benefits of the MR strategy include no cost, mortality, morbidity, or complications owing to surgery. The costs include the costs of MR imaging and, in the case of a false-positive T3 tumor, a decrease in life expectancy and an increase in cost owing to palliative treatment. ECD = extracapsular disease.