Multiparametric Magnetic Resonance Imaging Should Be Preferred Over Digital Rectal Examination for Prostate Cancer Local Staging and Disease Risk Classification

• Published in: Urology (Ridgewood, N.J.) Vol. 147; pp. 205 - 212
• Main Authors: Soeterik, Timo F.W., van Melick, Harm H.E, Dijksman, Lea M., Biesma, Douwe H., Witjes, J. Alfred, van Basten, Jean-Paul A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2021
• Subjects: Aged; Digital Rectal Examination; Humans; Male; Middle Aged; Multiparametric Magnetic Resonance Imaging; Neoplasm Staging; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Risk Assessment
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2020.08.089

To assess the impact of multiparametric magnetic resonance imaging (mp-MRI) local tumor staging on prostate cancer risk stratification and choice of treatment. Prostate cancer patients, newly diagnosed from 2017 to 2018 at 7 Dutch teaching hospitals were included. Risk group classification was done twice, using either digital rectal examination (DRE) or mp-MRI information. Risk group migration and rates of treatment intensification associated with mp-MRI upstaging were established. Diagnostic accuracy measures for the detection of nonorgan-confined disease (stage ≥T3a), for both DRE and mp-MRI, were assessed in patients undergoing robot-assisted radical prostatectomy. A total of 1683 patients were included. Upstaging due to mp-MRI staging occurred in 493 of 1683 (29%) patients and downstaging in 43 of 1683 (3%) patients. Upstaging was associated with significant higher odds for treatment intensification (odds ratio [OR]: 3.5 95% confidence interval [CI] 1.9-6.5). Stage ≥T3a on mp-MRI was the most common reason for risk group upstaging (77%). Sensitivity for the detection of stage ≥T3a was higher for mp-MRI compared to DRE (51% vs 12%, P <.001), whereas specificity was lower (82% vs 97%, P <.001). Mp-MRI resulted in a significantly higher cumulative rate of true positive and true negative stage ≥T3a predictions compared with DRE (67% vs 58%, P <.001). Use of mp-MRI tumor stage for prostate cancer risk classification leads to upstaging in 1 of 3 patients. Mp-MRI enables superior detection of nonorgan-confined disease compared with DRE, and should be the preferred tool for determining clinical tumor stage.