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Whole-body magnetic resonance imaging for staging patients with high-risk prostate cancer

Prostate Cancer and Prostatic Diseases volume 28, pages 761–766 (2025)Cite this article

Subjects

Abstract

Background

Staging patients with high-risk prostate cancer (HRPCa) with conventional imaging of computed tomography (CT) and bone scintigraphy (BS) is suboptimal. Therefore, we aimed to compare the accuracy of whole-body magnetic resonance imaging (WBMRI) with conventional imaging to stage patients with HRPCa.

Methods

We prospectively enrolled patients with newly diagnosed HRPCa (prostate‐specific antigen ≥20 ng/ml and/or Grade Group ≥4). Patients underwent BS, CT of the abdomen and pelvis, and WBMRI within 30 days of evaluation. The primary endpoint was the diagnostic performances of detecting metastatic disease to the lymph nodes and bone for WBMRI and conventional imaging. The reference standard was defined by histopathology or by all available clinical information at 6 months of follow-up. To compare diagnostic tests, Exact McNemar’s test and area under the curve (AUC) of the receiver operating characteristics curves were utilized.

Results

Among 92 patients enrolled, 15 (16.3%) and 8 (8.7%) patients were found to have lymphatic and bone metastases, respectively. The sensitivity, specificity, and accuracy of WBMRI in detecting lymphatic metastases were 0.60 (95% confidence interval 0.32–0.84), 0.84 (0.74–0.92), and 0.80 (0.71–0.88), respectively, while CT were 0.20 (0.04–0.48), 0.92 (0.84–0.97), and 0.80 (0.71–0.88). The sensitivity, specificity, and accuracy of WBMRI to detect bone metastases were 0.25 (0.03–0.65), 0.94 (0.87–0.98), and 0.88 (0.80–0.94), respectively, while CT and BS were 0.12 (0–0.53), 0.94 (0.87–0.98), and 0.87 (0.78–0.93). For evaluating lymphatic metastases, WBMRI demonstrated a higher sensitivity (p = 0.031) and discrimination compared to CT (0.72 versus 0.56, p = 0.019).

Conclusions

For staging patients with HRPCa, WBMRI outperforms CT in the detection of lymphatic metastases and performs as well as CT and BS in the detection of bone metastases. Further studies are needed to assess the cost effectiveness of WBMRI and the utility of combined PSMA PET and WBMRI.

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Fig. 1: MR images in a 65-year-old man with biopsy-proven prostate cancer (Grade Group 4).
Fig. 2: MR images in a 68-year-old man with biopsy-proven prostate cancer (Grade Group 5).
Fig. 3: Receiver operating curves (ROC) of whole-body MRI (WBRMI) versus computed tomography (CT) and bone scan (BS).

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Data availability

The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Andrew M. Fang & Brian F. Chapin

  2. Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Charles W. Shi & Tharakeswara K. Bathala

  3. Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jia Sun

  4. Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa Bay, FL, USA

    Aliya Qayyum

  5. Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Vikas Kundra

  6. Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Paul G. Corn

  7. Department of Genitourinary Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Deborah A. Kuban & Gregory C. Ravizzini

  8. Department of Nuclear Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Devaki Shilpa S. Surasi

  9. Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jingfei Ma

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Contributions

All authors made substantial contributions to all the following: AMF was involved with the design of the work, analysis and interpretation of the data, drafting the manuscript, reviewing the manuscript, and final approval. BFC was involved with the conception and design of the work, acquisition of data, reviewing the manuscript, and final approval. CWS was involved with the acquisition of the data, reviewing the manuscript, and final approval. JS was involved with the analysis and interpretation of the data, reviewing the manuscript, and final approval. AQ was involved with the acquisition of the data, reviewing the manuscript, and final approval. VK was involved with the acquisition of the data, reviewing the manuscript, and final approval. PGC was involved with the acquisition of the data, reviewing the manuscript, and final approval. DAK was involved with the acquisition of the data, reviewing the manuscript, and final approval. GCR was involved with the acquisition of the data, reviewing the manuscript, and final approval. DSS was involved with the acquisition of the data, reviewing the manuscript, and final approval. JM was involved with the acquisition of the data, reviewing the manuscript, and final approval. TKB was involved with the conception and design of the work, acquisition of the data, interpretation of the data, reviewing the manuscript, and final approval.

Corresponding author

Correspondence to Andrew M. Fang.

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Competing interests

JM reports IP licensing to GE Healthcare and Siemens Healthineers. The remaining authors do not report any relevant conflicts of interest.

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All procedures performed in studies involving human participants were approved by the University of Texas MD Anderson Cancer Center Institutional Review Board and with the 1964 Helsinski declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Fang, A.M., Chapin, B.F., Shi, C.W. et al. Whole-body magnetic resonance imaging for staging patients with high-risk prostate cancer. Prostate Cancer Prostatic Dis 28, 761–766 (2025). https://doi.org/10.1038/s41391-024-00893-1

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