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Journal Article Multicenter Study Comparative Study Epublish 1 citation

PubMed: 42455568 DOI: 10.1001/jamanetworkopen.2026.23288

Performance of MRI-Based vs Clinical T Staging in Localized Prostate Cancer.

JAMA Netw Open 9(7):e2623288

Authors: Arthur Peyrottes, Michael Baboudjian, Thibaut Long-Depaquit, Morgan RouprĂȘt, Thierry Roumeguere, Alexandre Peltier, Guillaume Ploussard, Romain Diamand

Affiliations

  • Department of Urology, HĂŽpital Saint-Louis, Assistance Publique-HĂŽpitaux de Paris, UniversitĂ© Paris CitĂ©, Paris, France.
  • Department of Urology, North Hospital, Assistance Publique-HĂŽpitaux de Marseille, Aix Marseille University, French National Centre for Scientific Research, Interdisciplinary Nanoscience Center of Marseille, ERL INSERM U 1326, European Center for Research in Medical Imaging, Marseille, France.
  • Department of Urology, Saint-Anne Instruction Hospital, Service de SantĂ© des ArmĂ©es, Toulon, France.
  • Groupe Recherche Clinique 5 Predictive Onco-Urology, Assistance Publique-HĂŽpitaux de Paris, PitiĂ©-SalpĂȘtriĂšre Hospital, Sorbonne University, Paris, France.
  • Department of Urology, Jules Bordet Institute-Erasme Hospital, Brussels University Hospital, Brussels, Belgium.
  • Department of Urology, La Croix du Sud HĂŽpital, Quint Fonsegrives, France.

Abstract

IMPORTANCE

Magnetic resonance imaging (MRI) is increasingly used for local staging in prostate cancer, yet its value relative to digital rectal examination (DRE) staging remains uncertain.

OBJECTIVES

To compare the performance of MRI-based vs DRE-based clinical T staging in men undergoing radical prostatectomy (RP) and to assess the outcome of substituting MRI staging in established prognostic classification systems.

DESIGN, SETTING, AND PARTICIPANTS

This multicenter, retrospective case-control study (iTNM Consortium) was conducted from January 1, 2015, to December 31, 2021, among consecutive men 18 years or older with clinically localized or locally advanced prostate cancer who underwent RP and preoperative multiparametric MRI and systematic biopsies with or without targeted biopsies at 31 referral centers across 6 European countries. Patients receiving prior prostate cancer treatment or missing key variables were excluded. Data analysis was performed from August to October 2025.

EXPOSURES

MRI-derived T stage (iT) vs DRE-derived T stage (cT) incorporated into D'Amico, European Association of Urology, National Comprehensive Cancer Network, and International Staging Collaboration for Prostate Cancer risk groups to generate MRI-adapted classification systems.

MAIN OUTCOMES AND MEASURES

Primary outcome was distant metastasis-free survival. Secondary outcomes were biochemical recurrence-free survival and overall survival. Discrimination was assessed using a C index and time-dependent area under the receiver operating characteristic curves.

RESULTS

A total of 4425 men were included (median [IQR] age, 66 [61-70] years; median [IQR] prostate-specific antigen, 7.4 [5.5-10.5] ng/mL). Median (95% CI) follow-up was 52 (51-53) months. MRI-based staging showed slightly higher discriminatory ability than DRE staging for biochemical recurrence-free survival (C index, 0.62 [95% CI, 0.61-0.64] vs 0.59 [95% CI, 0.57-0.61]) and distant metastasis-free survival (0.67 [95% CI, 0.64-0.70] vs 0.65 [95% CI, 0.62-0.68]). However, across all 4 risk classification systems, MRI-based and DRE-based versions demonstrated comparable discrimination with overlapping 95% CIs. Time-dependent area under the receiver operating characteristic curves showed no significant difference during follow-up. Subgroup analyses of patients with cT1 disease and those with PSA levels less than 10 ng/mL yielded similar results.

CONCLUSIONS AND RELEVANCE

In this case-control study of patients undergoing radical prostatectomy, MRI-based staging demonstrated discrimination similar to traditional DRE-based staging for biochemical recurrence, distant metastasis, and overall survival. These findings suggested that MRI-derived staging could be safely integrated into contemporary risk systems without compromising accuracy.

MeSH

Case-Control Studies, Neoplasms, Classification, Prostate, Biopsy, Neoplasm Metastasis, Prostatic Neoplasms, Prostatectomy