Predictive Value of Multiparametric MRI in Risk Group Stratification of Prostate Adenocarcinoma

Objective To further assess the clinical utility of multiparametric magnetic resonance imaging (MP-MRI) in prostate cancer (PC) staging following 2023 clinical guideline changes both as independent predictor of high-stage (>T3a) or high-risk PC, as well as when combined with patient characteristics. Patients and Methods The present study is a retrospective review of 171 patients from 2008-2018 who underwent a MP-MRI prior to radical prostatectomy (RP) at a single institution. The accuracy of clinical staging was compared between conventional staging versus MP-MRI-based clinical staging. Sensitivity, specificity, positive predictive value, and negative predictive value were compared, and receiver-operator characteristic (ROC) curves were generated. Linear regression analyses were used to calculate concordance (C-statistic). Results Of the 171 patients, final pathology revealed 95 (55.6%) with T2 disease, 62 (36.3%) with T3a disease, and 14 (8.2%) with T3b disease. Compared to conventional staging, MP-MRI-based staging demonstrated significantly increased accuracy in identifying T3a disease, intermediate risk, and high / very high-risk PC. When combined with clinical characteristics, MP-MRI-based staging improved AUC from 0.753 to 0.808 (p=0.0175), compared to conventional staging. Conclusions MP-MRI improves the identification of T3a PC, intermediate risk, and high or very high-risk PC. Further, when combined with clinical characteristics, the use of MP-MRI-based staging significantly improves risk stratification compared to conventional staging. These findings represent further evidence to support the integration of MP-MRI into prostate adenocarcinoma clinical staging guidelines.