In a systematic review and meta-analysis reported in JAMA Oncology, Agrotis et al found that pretreatment MRI provided important prognostic information after radical prostatectomy in patients with prostate cancer.
Study Details
A literature review was conducted through March 2025. Studies were included if they evaluated pretreatment prostate MRI in men undergoing radical prostatectomy and reported multivariable, time-to-event analyses for the outcomes of biochemical recurrence (primary measure), metastatic failure, and prostate cancer–specific mortality.
Key Findings
A total of 40 studies were included in the analysis, including 24,941 patients.
Extraprostatic extension (mrT3a disease) detected on pretreatment MRI was independently associated with biochemical recurrence (pooled hazard ratio [HR] = 2.16, 95% confidence interval [CI] = 1.84–2.54), metastatic failure (HR = 3.18, 95% CI = 2.04–4.97), and prostate cancer–specific mortality (HR = 10.93, 95% CI = 5.05–23.65).
Seminal vesicle invasion (mrT3b disease) detected on MRI was also independently associated with biochemical recurrence (HR = 2.74, 95% CI = 2.06–3.65) and metastatic failure (HR = 5.58, 95% CI = 1.15–27.13).
Quantitative MRI features identified as prognostic for biochemical recurrence consisted of: Prostate Imaging Reporting and Data System score of 4 or 5 (HR = 2.15, 95% CI = 1.82–2.55), large tumor size (tumor diameter ≥ 20 mm; HR = 2.35, 95% CI = 1.71–3.24), and apparent diffusion coefficient value less than 0.9 × 10−3 mm2/s (HR = 2.39, 95% CI = 1.82–3.14).
The investigators concluded: “This systematic review and meta-analysis found that pretreatment MRI provides independent prognostic value for biochemical recurrence, metastatic failure, and prostate cancer–specific mortality in men undergoing radical prostatectomy, even when adjusted for established clinicopathologic factors.”
Georgios Agrotis, MD, PhD, of the Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands, is the corresponding author for the JAMA Oncology article.
DISCLOSURE: The investigators reported that there was no external funding for the study. For full disclosures of the study authors, visit jamanetwork.com.
