Multiparametric magnetic resonance imaging for pre-treatment local staging of prostate cancer: A Cancer Care Ontario clinical practice guideline

Authors

  • Jennifer Salerno McMaster University, Department of Oncology and Program in Evidence-Based Care, Cancer Care Ontario, Hamilton, ON
  • Antonio Finelli Princess Margaret Hospital, Toronto, ON
  • Chris Morash The Ottawa Hospital, Ottawa, ON
  • Scott C. Morgan The Ottawa Hospital, Ottawa, ON
  • Nicholas Power Western University, London, ON
  • Nichola Schieda Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON
  • Masoom A. Haider Sunnybrook Health Sciences Centre, University of Toronto, ON

DOI:

https://doi.org/10.5489/cuaj.3823

Abstract

Introduction: The utility of T2-weighted magnetic resonance imaging (MRI) in the local staging of prostate cancer is controversial. Due to the success of multiparametric MRI in cancer localization, there is renewed interested in MRI (± functional sequences) for local staging. Guidance on pre-treatment local staging of prostate cancer by MRI was developed using systematic review methodology and expert consultation.

Methods: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and other databases were searched to identify studies comparing: (1) MRI staging vs. radical prostatectomy staging on diagnostic accuracy outcomes; and (2) MRI staging vs. routine clinical staging on clinical and patient outcomes. Studies meeting inclusion criteria were synthesized by outcome and sensitivity/ specificity analysis by tumour location was performed. Evidence quality of included studies was assessed and considered in recommendation formulation.

Results: The literature search identified 2510 citations; 62 studies were included. Analysis of MRI ≥1.5 T plus endorectal coil (ER) (± functional sequences) in the detection of extraprostatic extension or seminal vesicle invasion showed modest sensitivities (≥50%) and excellent specificities (>85%) among patients scheduled for radical prostatectomy. MRI upstaging was shown in 20/21 studies, with large variation in correctness (11‒85%). Scarcity of clinical and patient outcomes among studies limited synthesis and evaluation. Quality assessment found non-trivial biases.

Conclusions: Modest imaging performance was shown for MRI (1.5 T + ER and 3 T ± ER) ± functional sequences in regards to sensitivity. Limitations in study design, reporting of clinical and patient outcomes, and the heterogeneous use of MRI tempered the strength of the recommendations.

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Published

2016-10-13

How to Cite

Salerno, J., Finelli, A., Morash, C., Morgan, S. C., Power, N., Schieda, N., & Haider, M. A. (2016). Multiparametric magnetic resonance imaging for pre-treatment local staging of prostate cancer: A Cancer Care Ontario clinical practice guideline. Canadian Urological Association Journal, 10(9-10), E332–9. https://doi.org/10.5489/cuaj.3823

Issue

Vol. 10 No. 9-10 (2016): CUAJ October

Section

Clinical Practice Guideline

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