OPTIMIZATION OF PROSTATE CARCINOMA STAGING - COMPARISON OF IMAGING AND CLINICAL METHODS

Purpose: The diagnostic value of endorectal coil MRI, body coil MRI, t ransrectal ultrasound, digital rectal examination and PSA levels were prospectively analysed in order to define the most accurate preoperati ve staging method. Methods: 33 patients with prostate carcinoma, who u nderwent subsequent prostatectomy, were enrolled in the study and exam ined on a 1.5 T system using the body coil as well as the endorectal s urface coil before and after the administration of contrast material. The results were compared to digital rectal examination, prostate spec ific antigen levels and endorectal ultrasound. Results: Staging accura cy of endorectal coil MRI was 87.9% with a sensitivity of 88.9% and sp ecificity of 86.7%. For body coil MRI, the staging accuracy was 75.7%, the sensitivity 66.7% and the specificity 87.9%, for transrectal ultr asound 69.6%, 41.7% and 100% and for the digital rectal examination 56 .6%, 33.3% and 100%, respectively. Prediction was improved by combinin g results of endorectal coil MRI with PSA values. Conclusion: Endorect al ultrasound and digital rectal examination both had a tendency to un derestimate the extent of the lesion. Endorectal coil MRI proved to be the best preoperative staging method. In combination with PSA values, diagnostic accuracy could be further improved. Therefore, local stagi ng of prostate cancer could be based on these two parameters alone.