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Prostate Cancer: Incremental Value of Endorectal MR Imaging Findings for Prediction of Extracapsular Extension¹

¹ From the Departments of Radiology (L.W., H.N.C., S.C.E., H.H.) and Urology (M.M., M.W.K., P.T.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021. From the 2002 RSNA scientific assembly. Received July 10, 2003; revision requested September 16; revision received December 19; accepted January 13, 2004. Supported by National Institutes of Health grant R01 CA76423. Address correspondence to L.W. (e-mail: wang6@mskcc.org).

View larger version (38K): [in a new window]   Figure 1. Graph shows comparison of ROC curves of seven variables for prediction of ECE. Area under ROC curve for MR imaging findings is 0.743. Diagonal line indicates area under ROC curve of 0.500 (ie, no separation between patients with and patients without ECE). Predictor variables treated as continuous variables except for Gleason score (categorized as 3 + 2, 3 + 3, and 3 + 4 vs 3 + 5, 4 + 3, 4 + 4, 4 + 5, and 5 + 5) and clinical stage of cancer (categorized as T1c vs T2a, T2b, and T2c). % Ca = greatest percentage of cancer in all core biopsy specimens, % of Pos Cores = percentage of cancer-positive core specimens in all core biopsy specimens.

View larger version (145K): [in a new window]   Figure 2. Transverse T2-weighted fast spin-echo 3-mm-thick MR image (5,266/121) in 61-year-old man with clinical stage T1c cancer shows no ECE. PSA level was 13.67 ng/mL, sextant biopsy results indicated PNI in right middle area, and tumors with Gleason score of 4 + 5 involved 50% of submitted tissue in both sides (14% of cores). Findings at final histopathologic analysis of step section indicated that tumor invaded prostate capsule but did not extend beyond it.

View larger version (155K): [in a new window]   Figure 3. Transverse T2-weighted fast spin-echo 3-mm-thick MR image (5,933/121) in 61-year-old man with clinical stage T1c cancer and PSA level of 5.00 ng/mL shows ECE (arrow) at left posterior area. Sextant biopsy results were negative for PNI, and tumors with Gleason score of 4 + 4 involved 30% of submitted tissue in the left side (43% of cores). Findings at final histopathologic analysis of step section indicated focal ECE at left posterior area.

View larger version (36K): [in a new window]   Figure 4. Graph shows ROC curves for comparison of models with and without MR imaging for prediction of ECE. Base model included the following variables: PSA level, Gleason score, clinical stage of tumor, greatest percentage of cancer in all core biopsy specimens, percentage of cancer-positive core specimens in all core biopsy specimens, and presence of PNI. Base model with endorectal MR imaging findings included MR imaging findings with all other variables. Predicted probability of both logistic regression models was bias corrected with jackknife method. Base model with endorectal MR imaging findings has greater area under ROC curve of 0.838.