Korean J Urol.  2013 Dec;54(12):824-829.

Preoperative Factors Predictive of Posterolateral Extracapsular Extension After Radical Prostatectomy

• Pak S
• Park S
• Ryu J
• Hong S
• Song SH
• You D
• Jeong IG
• Song C
• Hong JH
• Kim CS
• Ahn H

Abstract

PURPOSE
In radical prostatectomy (RP) procedures, sparing the neurovascular bundles adjacent to the posterolateral aspect of the prostatic fascia has often been suggested as a possible risk factor for positive surgical margins. Here we aimed to quantify the probability of extracapsular extension (ECE) at the posterolateral side of the prostate to aid in nerve-sparing decision making.
MATERIALS AND METHODS
We evaluated 472 patients who underwent RP between July 2007 and January 2012. All patients underwent preoperative magnetic resonance imaging (MRI) with diffusion-weighted imaging and apparent diffusion coefficient mapping. We analyzed 944 side-specific prostate lobes with preoperative variables. To quantify the risk of side-specific posterolateral ECE after RP, we developed a risk-stratification scoring system through logistic regression analysis.
RESULTS
Overall, 20.6% of 944 prostate lobes had ECE. In the multivariate analysis, prostate-specific antigen (PSA), biopsy Gleason score > or =7, percentage of side-specific cores with tumor, and posterolateral ECE on MRI were independent predictive factors of posterolateral ECE. On internal and external validation to calculate the predicted risk, the Hosmer-Lemeshow goodness-of-fit test showed good calibration (p=0.396).
CONCLUSIONS
PSA, biopsy Gleason score, percentage of side-specific cores with tumor, and posterolateral ECE on MRI are independent predictors of posterolateral ECE. The scoring system derived from this study will provide objective parameters for use when deciding if the neurovascular bundle can be safely spared.

Keyword

Magnetic resonance imaging; Prostatectomy; Prostatic neoplasms

MeSH Terms

Biopsy
Calibration
Diffusion
Fascia
Humans
Logistic Models
Magnetic Resonance Imaging
Multivariate Analysis
Neoplasm Grading
Prostate
Prostate-Specific Antigen
Prostatectomy*
Prostatic Neoplasms
Risk Factors
Prostate-Specific Antigen

Figure

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  FIG. 1 Receiver operating characteristic curves for the development set (AUC=0.810) and external validation set (AUC=0.830). AUC, area under the curve.

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  FIG. 2 Calibration curves for the development set.

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  FIG. 3 Calibration curves for the external validation set.

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