PCa is extremely important clinically, being the second most common tumor in men and causing high morbidity and mortality rates.
Local staging is responsible for risk stratification, which also includes free PSA, PSA density and Gleason score.
For local staging, it is necessary to assess the EEP, which can be characterized as focal ( 1mm).
Non-focal EEP characterizes a T3 tumour, which correlates with a high risk of positive surgical margins, metastatic disease, biochemical recurrence and low survival rates after radical prostatectomy.
The mpMRI is already a well-established and widely used method for the detection of clinically significant tumors (Gleason >= 7), localization and characterization of lesions, biopsy with image fusion, control in active surveillance, recurrence evaluation, as well as for the planning of focal therapy and radiation.
However, most of the current literature reports that mpMRI shows low sensitivity and only moderate specificity in assessing extraprostatic extension, especially when assessed by inexperienced radiologists.
More recent studies have shown that the application of a system for predicting extraprostatic extension, using more objective criteria, such as the extent of curvilinear contact, capsular irregularity and bulging, asymmetry of the vasculonervous bundles, even the frank invasion of the periprostatic fat and seminal vesicles, have proved to be more accurate than the use of binary terms as in the case of absent or present extraprostatic extension.
In our daily practice, we use the Mehralivand EEP prediction scale, which uses objective criteria and has four distinct categories: being grade 0 contact or = 1.5 cm or bulging/irregularity of the prostatic contour; grade 2 contact > or = 1.5 cm and bulging/irregularity of the external prostatic contour; and grade 3 frank measurable extension.
Methods: This was a single-center, cross-sectional study, with retrospective collection of objective data and EEP scale reported in the preoperative mpMRI report and data from the surgical specimen AP of 105 patients who underwent radical prostatectomy and had mpMRI available in a digital file between April 2021 and August 2022.
The mpMRI images and anatomopathological data for each patient were reviewed simultaneously.
In mpMRI, EEP was considered according to the classification previously provided in the study reports, according to the Mehralivand criteria.
The mpMRI scans were performed on 1.5 and 3.0 Tesla devices, following the PI- RADS v 2.1 protocol and interpreted by 07 abdominal radiologists with experience in mpMRI evaluation.
All surgical procedures were performed in a tertiary hospital, using laparoscopic or robotic surgery.
The AP was analyzed according to the report provided at the time of the examination, with absent extension, focal present and non-focal present.
The surgical specimens were evaluated by 02 pathologists with experience in PCa.
Chi-squared and ANOVA tests were used to detect differences among groups.
Agreement between mpMRI image and the histology findings in the same patient was assessed using the kappa coefficient and percentage of agreement.
The significance level adopted was 5%.