Systematic review and meta-analysis of pretreatment MRI as a prognostic factor after radical prostatectomy

Accurate pretreatment prostate cancer risk assessment is essential to balance long-term treatment benefits and harms. The role of imaging parameters in prognostication is unclear. Systematic review and meta-analysis of 40 studies, comprising 24 941 patients, assessed the prognostic value of pretreatment MRI parameters for oncological outcomes in men undergoing radical prostatectomy. MRI-detected extraprostaticextension (mrT3a disease) was independently associated with biochemical recurrence, metastatic failure, and prostate cancer-specific mortality. MRI-detected seminal vesicle invasion (mrT3b disease) was independently associated with biochemical recurrence and metastatic failure. In addition, quantitative MRI-derived parameters (such as the Prostate Imaging Reporting and Data System category score, tumor diameter, tumor volume, and apparent diffusion coefficient values) were independently associated with biochemical recurrence. The authors conclude that pretreatment prostate MRI provides independent prognostic information for biochemical recurrence, metastatic failure, and prostate cancer-specific mortality in men undergoing radical prostatectomy, even after accounting for tumor grade group and other clinicopathologic factors.