1171 JOURNAL OF ENDOUROLOGY Volume 21, Number 10, October 2007 © Mary Ann Liebert, Inc. DOI: 10.1089/end.2007.9912 Routine Use of Magnetic Resonance Imaging in the Management of T 1c Carcinoma of the Prostate: Is It Necessary? RAMASWAMY MANIKANDAN, M.S., M.Ch.(Uro), FRCS, 1 HASAN A.R. QAZI, MRCS, 1 JOE PHILIP, M.B.B.S., FRCS, 1 RAHUL MISTRY, 1 GABBY H. LAMB, FRCS, 2 KENNETH A. WOOLFENDEN, FRCS, 1 PHILIP A. CORNFORD, M.D., FRCS(Urol), 1 and KEITH F. PARSONS, FRCS 1 ABSTRACT Purpose: To assess the role and implications of MRI in the management of patients with stage T 1c prostate cancer. Patients and Methods: Data were collected from our oncology database, where all new prostate cancers are recorded, for a period of 3 years ending December 2005. A total of 915 patients were found to have prostate cancer. Of the 204 patients with stage T 1c disease, 144 were considered eligible for radical treatment and un- derwent cross-sectional imaging in the form of an MRI scan. Gleason grade, clinical stage, cross-sectional imaging results, and subsequent treatment were recorded. The results were analyzed to see whether the MRI findings altered the modality of treatment offered to the patient. Results: Of the 144 patients, 137 had scans that showed no extracapsular invasion, while five scans were equivocal. All five patients had further investigation, either by CT scanning or targeted biopsies, which con- firmed the cancer to be localized. In the remaining two cases, the MRI findings upstaged T 1c disease to T 3 disease, as there was evidence of extracapsular involvement. The imaging result therefore affected treatment choice in only two patients in that radical surgery was not offered because of the scan findings. Conclusions: The role of MRI in the management of clinical stage T 1c prostate cancer is limited, as it al- tered the management of only 1.3% of our patients. The cost v the value of this study should be discussed with the patient before MRI is prescribed. INTRODUCTION C LINICAL STAGING of prostate cancer attempts to deter- mine the anatomic extent of the disease. Because this in- formation, combined with other clinical data, determines the prognosis, it enables a rational treatment strategy to be formu- lated. 1 Accurate staging of early prostate cancer is mandatory if the radical treatment offered to the patient is to be curative. The most accurate method of staging remains to be determined. The limitations of the various modalities, which include digi- tal rectal examination (DRE), transrectal ultrasonography (TRUS), and targeted prostatic biopsy, have driven the explo- ration of MRI as an additional modality in the evaluation of lo- calized prostate cancer. 2 Even though MRI is widely used for staging, its role remains controversial. The mainstay of curative treatment for organ-confined prostate cancer is either radical prostatectomy or radiation ther- apy, either external beam or interstitial. In many institutions, including our own, the presence of extracapsular spread would preclude radical prostatectomy. Thus, the accuracy of identifi- cation of disease beyond the confines of the glandular capsule is crucial. We therefore sought to evaluate whether an MRI scan influenced the management in patients with clinical T 1c prostate cancer, as judged by DRE and TRUS, and whether it gave ad- ditional information that caused the treatment plan to be altered. PATIENTS AND METHODS Patient population A total of 915 patients were found to have prostate cancer in the 3-year period ending December 2005. To confirm the di- agnosis, all patients underwent 10-core TRUS-guided biopsy of the prostate, with specimens from each of the 10 cores analyzed Departments of 1 Urology and 2 Radiology, The Royal Liverpool University Hospital, Liverpool, U.K.