Diagnosing Extraprostatic Extension (EPE)

[Tall_Allen]

EPE is very hard to diagnose clinically. DRE is terrible at it, and mpMRI isn't much better. This article discusses a new system for scoring an mpMRI for EPE. However, it's only a small improvement. But I propose that an mpMRI-targeted transprostatic biopsy may be more useful. If anyone discusses this with his biopsy urologist, let me know what he says.

pcnrv.blogspot.com/2020/04/...

[timotur]

If there is hypervascularity of the tumor at the EPE, perhaps color-doppler ultrasound (CDUS) would be more specific than mpMRI alone--

In the present study, the ability of CDUS to detect prostate cancer was compared with that of grey‐scale TRUS and MRI. For each site, the rates of positive findings by CDUS were higher for high‐grade tumours than for low‐grade tumours. This correlation was also detected for grey‐scale TRUS and for MRI, but was strongest for CDUS. This result may have been obtained because hypervascularity is more significant in aggressive prostate cancer [11], and lesions with positive CDUS findings should thus be considered high‐grade tumours. On the other hand, of 12 patients with prostate cancer missed by all three imaging techniques, one had a pT3a tumour which extended bilaterally over the peripheral zone, and this tumour was mostly moderately and in part poorly differentiated (Gleason grade 8). Another two tumours with no hypervascularity were clinically stage C tumours. These findings should be considered when TRUS, CDUS and MRI detect no cancerous lesion in the prostate in a patients with an increased PSA level.

The PPV of CDUS for tumour detection was excellent compared with the other modalities tested, but its sensitivity was lower than that of grey‐scale TRUS and MRI. However, CDUS should be evaluated in combination with grey‐scale TRUS, as CDUS is not usually used alone and its colour information is shown on the display over the grey‐scale images. Although the improvement in sensitivity with the combination of grey‐scale TRUS and CDUS was less than that with grey‐scale TRUS and MRI, the changes in specificity and PPV were very small with the former. The specificity and PPV for the former remained above those for grey‐scale TRUS alone, but those for the latter decreased to below that value. A combination of the three imaging techniques yielded the highest sensitivity but a considerable decrease in specificity and PPV. CDUS appears to be more suitable than MRI for detecting prostate cancer; moreover, CDUS is more useful than MRI because of its low cost, simple operation and real‐time methods necessary for taking lesion‐directed biopsies. However, MRI is useful for the local staging of prostate cancer.

bjui-journals.onlinelibrary...

I had a CDUS-guided biopsy with Dr Bahn, and he clearly outlined SV involvement on the images and was staged 3b accordingly.