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(Sala et al. 2006)
Design: Retrospective case series (diagnosis, screening), evidence level: 3
Country: United States, setting: Tertiary care
Inclusion criteria 45 consecutive men who had salvage radical prostatectomy for prostate cancer at one institution between 1998 and 2004. The primary curative therapy was radiotherapy. None of the men had evidence of distant metastases.
Exclusion criteria -
Population number of patients = 45, age range 43 to 76 years, median age = 62 years.
Interventions All men were initially treated with radiotherapy (33 EBRT, 3 brachytherapy and 9 both). Following biochemical failure (not defined) all men had endorectal MRI (before or after prostate biopsy) and then salvage prostatectomy .32% had chemotherapy or hormonal therapy before salvage prostatectomy.
Outcomes Sensitivity and specificity of endorectal MRI for tumour localisation, the detection of extracapsular extension (ECE) and the detection of seminal vessel involvement (SVI). A 5 point scale was used to evaluate each feature from 1 - tumour definitely absent to 5-tumour definitely present. 2 radiologists interpreted the MR reports separately.
The reference standard diagnosis was pathologic assessment of the prostatectomy specimen.
Follow up The median time from radiation therapy to surgery was 54 months.
Results Pathologic assessment of the prostatectomy specimen showed all men had tumour in at least one quadrant of the prostate gland. 19/45 (42%) had ECE and 13/45 (29%) had SVI.
A sensitivity of 62% (eight of 13) (95% CI: 33%, 84%) and a specificity of 97% (31 of 32) (95% CI: 80%, 100%) for detection of SVI at the patient level and a sensitivity of 89% (17 of 19) (95% CI: 65%, 98%) and a specificity of 50% (13 of 26) (95% CI: 31%, 96%) for detection of ECE at the patient level were recorded for reader 1. A sensitivity of 38% (five of 13) (95% CI: 16%, 67%) and a specificity of 94% (30 of 32) (95% CI: 77%, 99%) for detection of SVI at the patient level and a sensitivity of 84% (16 of 19) (95% CI: 60%, 95%) and a specificity of 46% (12 of 26) (95% CI: 28%, 66%) for detection of ECE at the patient level were recorded for reader 2.
For tumour detection, the area under the ROC curve (AUC) value for reader 1 was 0.75 (95% confidence interval [CI]: 0.67, 0.84), whereas the AUC value for reader 2 was 0.61 (95% CI: 0.52, 0.71). The AUC values for prediction of ECE were 0.87 (95% CI: 0.80, 0.94) for reader 1 and 0.76 (95% CI: 0.67, 0.85) for reader 2. The AUC values for prediction of SVI were 0.76 (95% CI: 0.62, 0.90) for reader 1 and 0.70 (95% CI: 0.56, 0.85) for reader 2.
8/45 (18%) men had lymph node involvement, however only 3/8 (38%) of these cases were detected on MRI.
General comments There may have been patients excluded from salvage prostatectomy on the basis of MRI results but these would not be included in this study.

From: Chapter 5 –The Management of Relapse After Radical Treatment

Cover of Prostate Cancer
Prostate Cancer: Diagnosis and Treatment.
NICE Clinical Guidelines, No. 58.
National Collaborating Centre for Cancer (UK).
Copyright © 2008, National Collaborating Centre for Cancer.

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