Download Stage Variation of Prostate Cancer between MRI Diagnosis and

Stage Variation of Prostate Cancer between MRI Diagnosis and Pathological Diagnosis
Introduction and Objective: We analyze the variation of clinical stage to pathological stage in
patients, who had prostate cancer and received radical prostatectomy. We also analyze the
predictors that may cause these variations.
Materials and Methods: Between January 2007 and March 2012, there were 538 patients with
prostate cancer, who underwent retropubic radical prostatectomy (RRP), laparoscopic radical
prostatectomy (LRP), and robot-assisted laparoscopic radical prostatectomy (RALP). Clinical
stages were recorded by digital rectal examination (DRE) and MRI study, respectively. Patients
were included only when the MRI diagnosis was reported in the radiology department of this
institute. Patients with incomplete pre-operative characteristics and operative parameters were
excluded. We analyze the stage variation of DRE and MRI study to final pathological diagnosis of
whole mount prostate specimens.
Results: There were 258 cases of prostate cancer included in this study in the 5-year follow-up.
Surgical intervention included RRP (n = 56), LRP (n = 62), and RALP (n = 140). Comparison of
clinical stage by DRE to pathological diagnosis, DRE overestimates in 3 cases (1.16%), but
underestimates in 181 (70.1%) cases and 74 cases (28.7%) were in accurate stage. As to clinical
stage by MRI study, MRI overestimates in 49 cases (19.0%), but underestimates in 73 cases
(28.3%). Finally, 136 cases (52.7%) were in accurate stage. With the Gleason’s sum of 5 to 6, the
possibility of stage upgrading is less than 30%, whatever the PSA level is. But with the higher
PSA level, there is higher risk of stage upgrading. With the Gleason’s sum of 7, and 8 to 10, the
possibilities of stage upgrading are more than 50% when PSA level is higher than 20 ng/mL.
Also, with the higher PSA level, there is higher risk of stage upgrading in these two groups.
Conclusion: The accuracy of clinical stage varies from different modalities of survey. However,
clinical stage may influence the strategy of treatment in prostate cancer. To know the accuracy of
different modalities of survey, and to know more predictors that make the result more accurate,
are the keys for patient’s benefits.