Presented by: Angela Estevez MD
Beth Israel Deaconess Medical Center

Introduction

Delineating extraprostatic extension (EPE) is crucial for the treatment of patients with prostate cancer. EPE is associated with increased risk of recurrence, positive surgical margins, and metastatic disease.  A preoperative assessment of presence and location of EPE can help guide surgical decision making as to the nerve-sparing approach. The MRI-based EPE grading system developed by Mehralivand et al (Table 1) has not been widely adopted. The purpose of the study is to examine the ability of MRI-based EPE scoring to accurately detect EPE on pathology. 

Materials

We conducted a retrospective review of adult male patients who underwent a prostate MRI with EPE scoring by a trained radiologist and subsequent robotic radical prostatectomy at our tertiary level center from September 2020 to December 2022. The associations between MRI EPE score (mEPE) and the presence of EPE on surgical pathology (pEPE) were examined using logistic regression. 

Results

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A total of 194 patients were identified with a median age of 63 years and median PSA of 7 ng/mL. The rates of pEPE across mEPE scores are presented in Table 2. Among those with mEPE score 3, 96% had pEPE (Table 2). On univariable regression, those patients who had an mEPE score >= 2 had an increased risk of pEPE compared to those with mEPE score of 0 (OR 10.2; 95% CI 4.7-22.1, p<0.05) Furthermore, those with an mEPE score 3 were significantly more likely to have pEPE compared to those with mEPE score 0,1 and 2 independently (Table 3).  

Conclusion

MRI EPE is an easily definable tool that strongly correlates with the presence of pEPE. Moving forward, mEPE status may assist in augmented patient and surgical counseling. 

Funding

None

Lead Authors

Utsav Bansal, MD
Beth Israel Deaconess Medical Center

Co-Authors

Joseph Black, MD PHD
Beth Israel Deaconess Medical Center

Tatum Williamson, MD
Beth Israel Deaconess Medical Center

Sumedh Kaul, MS
Beth Israel Deaconess Medical Center

Catrina Crociani, MPH
Beth Israel Deaconess Medical Center

Jeffrey Sun, BS
Beth Israel Deaconess Medical Center

Leo Tsai, MD
Beth Israel Deaconess Medical Center

Sara Babapour, MD
Beth Israel Deaconess Medical Center

Jodi Mechaber Di Fiori, NP
Beth Israel Deaconess Medical Center

Boris Gershman, MD
Beth Israel Deaconess Medical Center

Peter Chang, MD, MPH
Beth Israel Deaconess Medical Center

Andrew A. Wagner, MD
Beth Israel Deaconess Medical Center