Masashi Tsujimoto

Objectives: To assess the validity of magnetic resonance imaging‐determined tumor contact area (MRI‐TCA) as a predictive factor for pathological extraprostatic extension (EPE) in cT2N0M0 prostate cancer patients. Methods: We retrospectively analyzed 72 cT2N0M0 prostate cancer patients who underwent multiparametric MRI (mpMRI) followed by robot‐assisted laparoscopic prostatectomy (RARP) between February 2014 and April 2021. Patients whose MRI‐based index lesion did not match the pathological specimens were excluded. MRI‐TCA was approximated using an elliptical shape and calculated by two different methods: MRI‐TCA1: Calculated using the tumor contact length (TCL) in the axial plane and the longer TCL in either the sagittal or coronal plane, capturing tumor dimensions across two planes. MRI‐TCA2: Calculated using the TCL in the axial plane and tumor thickness derived from MRI slice data, reflecting the tumor’s contact area within the MRI volume. We compared postoperative prostate‐specific antigen (PSA) recurrence‐free survival by stratifying patients based on the optimal thresholds of MRI‐TCL, MRI‐TCA1, MRI‐TCA2, pathological‐TCL, and pathological‐TCA. Results: Sixteen patients (22.2%) were pathologically positive for EPE. MRI‐TCL, MRI‐TCA1, and MRI‐TCA2 were significantly greater in patients with EPE‐positive (EPE+) tumors than in those with EPE‐negative (EPE−) tumors ( p < 0.0001, p < 0.0001, and p = 0.0026, respectively). No statistically significant differences were found between MRI‐TCL and MRI‐TCA1 ( p = 0.914) or between MRI‐TCL and MRI‐TCA2 ( p = 0.112) in predicting pathological EPE. A significant difference in postoperative PSA recurrence rate was observed in the stratified analysis based on pathological‐TCA ( p = 0.022). Conclusion: Both MRI‐TCA1 and MRI‐TCA2 are clinically accessible and effective parameters for predicting pathological EPE in cT2N0M0 prostate cancer patients. However, neither method demonstrated clear superiority over MRI‐TCL. Pathological‐TCA was shown to be a significant predictor of both pathological EPE and postoperative PSA recurrence.

Background Population-based prostate-specific antigen (PSA) screening is effective for reducing prostate cancer (PCa)-related mortality rates. In this study, we assessed biopsy-proven maximum cancer core length (MCCL) and maximum cancer diameter on magnetic resonance imaging (MRI; MCDM) in prostate biopsy and multiparametric MRI (mp-MRI) by PCa detection. Methods We retrospectively assessed 214 male PCa patients and 187 PCa patients with Prostate Imaging Reporting and Data System version 2 (PI-RADS) category 3–5 lesions in pre-biopsy mp-MRI and targeted biopsy characteristics. The mean biopsy-proven MCCL and MCDM were compared among three PSA screening groups, namely the population-based PSA screening (PBS), opportunistic PSA screening (OPS), and symptomatic outpatient PSA examination (SOP) groups. Results The median age and PSA value of the 214 participants were 75 years and 7.9 ng/mL, respectively. In the PBS, OPS, and SOP groups, the median ages were 73, 76, and 76 years, respectively (p = 0.046); PSA values were 7.2, 9.5, and 11.5 ng/mL, respectively (p < 0.001); and biopsy-proven MCCL and MCDM were significantly increased to 7, 10, and 14 mm (p < 0.001) and to 11, 15, and 17 mm (p < 0.001), respectively. In the 187 PCa patients with PI-RADS category 3–5 lesions on mp-MRI, MCDM were 11, 14, and 17 mm (p < 0.001), respectively. Conclusions The biopsy-proven MCCL and MCDM were significantly smaller in the PBS and OPS groups than in the SOP group, which suggests that PSA screening detected PCa earlier than in symptomatic patients. PSA screening with MRI could objectively lead to earlier diagnosis based on tumor size.