We report the overall rate, locations and predictive factors of positive surgical margins （PSMs） in 271 patients with high-risk prostate cancer. Between April 2008 and October 2011, we prospectively collected data f...We report the overall rate, locations and predictive factors of positive surgical margins （PSMs） in 271 patients with high-risk prostate cancer. Between April 2008 and October 2011, we prospectively collected data from patients classified as D＇Amico high-risk who underwent robot-assisted laparoscopic radical prostatectomy. Overall rate and location of PSMs were reported. Stepwise logistic regression models were fitted to assess predictive factors of PSM. The overall rate of PSMs was 25.1% （68 of 271 patients）. Of these PSM, 38.2% （26 of 68） were posterolateral （PL）, 26.5% （18 of 68） multifocal, 16.2% （11 of 68） in the apex, 14.7% （10 of 68） in the bladder neck, and 4.4% （3/68） in other locations. The PSM rate of patients with pathological stage pT2 was 8.6% （12 of 140）, 26.6% （17 of 64） of pT3a, 53.3% （32/60） of pT3b, and 100% （7 of 7） of pT4. In a logistic regression model including pre-, intra-, and post-operative parameters, body mass index （odds ratio [OR]. 1.09; 95% confidence interval [CI]： 1.01-1.19, P = 0.029）, pathological stage （pT3b or higher vs pT2; OR： 5.14; 95% Ch 1.92-13.78; P = 0.001） and percentage of the tumor （OR： 46.71; 95% CI： 6.37-342.57; P 〈 0.001） were independent predictive factors for PSMs. The most common location of PSMs in patients at high-risk was the PL aspect, which reflects the reported tumor aggressiveness. The only significant predictive factors of PSMs were pathological outcomes, such as percentage of the tumor in the specimen and pathological stage.展开更多
Sedation may result in reduction in pain during transrectal ultrasound （TRUS）-guided prostate biopsies. We aimed to evaluate the efficacy and safety of a combination of propofol and remifentanil infusion during TRUS...Sedation may result in reduction in pain during transrectal ultrasound （TRUS）-guided prostate biopsies. We aimed to evaluate the efficacy and safety of a combination of propofol and remifentanil infusion during TRUS-guided prostate biopsy and the related increases in health care costs. From January to September 2010, 100 men undergoing a transrectal prostate biopsy were randomized into two groups. In Group 1, 50 patients received a combined infusion of propofol and remifentanil; in Group 2, 50 patients received lidocaine jelly. After TRUS-guided biopsies were performed, pain and patient satisfaction were evaluated by a lO-point visual analog scale （VAS）, and a cost-related patient satisfaction questionnaire was completed by all patients. Patients were also asked whether they would be willing to undergo repeat biopsy by the same method. Patients in Group I showed a significantly lower VAS score than those in Group 2 （mean VAS score： 0.9± 1.1 versus 6.3±2.5; P〈0.001）. In addition, the patient satisfaction scale was significantly higher in Group 1 （P=0.002）. Although the overall cost was significantly higher in Group 1 （P=0.006）, patient satisfaction scales considering cost were also higher in this group （P=0.009）. A combination of propofol and remifentanil is a safe and effective way to decrease patient pain and increase patient satisfaction during TRUS-guided prostate biopsy. Although the costs were higher in the group that received sedation, as expected, the patients exhibited heightened satisfaction and willingness to repeat biopsies by the same method.展开更多
To gain beneficial effects in the management of high-risk prostate cancer, an integrated approach that combines local therapy and androgen deprivation therapy （ADT） was used. We compared biochemical responses betwee...To gain beneficial effects in the management of high-risk prostate cancer, an integrated approach that combines local therapy and androgen deprivation therapy （ADT） was used. We compared biochemical responses between primary cryosurgical ablation of the prostate （CSAP） combined with prolonged ADT and radiation combined with ADT, which is the established modality in high-risk disease. A total of 33 high-risk patients received CSAP combined with ADT for 3 months before and up to 24 months after treatment. This patient group was matched with another 33 patients who had undergone three-dimensional conformal radiation therapy （3D-CRT） with the same protocol for ADT. Biochemical recurrence （BCR） was assessed by the American Society for Therapeutic Radiation Oncology （ASTRO） definition, the Phoenix definition and a prostate-specific antigen （PSA） cutoff of 0.5 ng mL^-1. Median follow-up was 61.0 ± 11.9 months for the CSAP ＋ ADT group and 86.0±15.8 months for the 3D-CRT ＋ ADT group. In the CSAP group, major complications including rectourethral fistula and incontinence were not noted. In the CSAP ＋ ADT group, 57.0% had BCR using the ASTRO definition, 21.2% using the Phoenix definition and 54.5% using a PSA cutoff of 0.5 ng mL^-1. In the 3D-CRT ＋ ADT group, 54.5%, 21.2% and 54.5% had BCR using the ASTRO, Phoenix and PSA definition, respectively. In the CSAP ＋ ADT group, the BCR-free survival （BRFS） was 54 ± 10 months using the ASTRO definition, 65 ± 5 months using the Phoenix definition and 51 ± 4 months using a PSA cutoff of 0.5 ng mL-1. In the 3D-CRT ＋ ADT group, the BRFS was 68 ± 12, 93 ± 19 and 70 ± 18 months using the ASTRO, Phoenix and PSA definition, respectively. By the log-rank test, the BRFS values for each group were not statistically different. This intermediate-term result indicated that primary CSAP combined with prolonged ADT offers a parallel biochemical response compared with radiotherapy in high-risk prostate cancer.展开更多
The goal of our study was to evaluate the impact of the interval between prostate biopsy and magnetic resonance imaging （MRI） on the accuracy of simple tumor localization, which is essential information that enables...The goal of our study was to evaluate the impact of the interval between prostate biopsy and magnetic resonance imaging （MRI） on the accuracy of simple tumor localization, which is essential information that enables nerve-sparing surgery. We also sought to determine the optimal timing of a post-biopsy MRI, A total of 184 patients who had undergone MRI before radical prostatectomy at an institution without a predetermined schedule for MRI after a prostate biopsy were enrolled. The mean interval from the biopsy to the MRI was 30.8 ± 18.6days. The accuracy of the MRI for simplified tumor location （right, left, bilateral and none） was 44.6%. In the group with discordant pathologic and MRI findings, the most common reason recorded was ＇MRI predicted a unilateral lesion, but pathology revealed bilateral lesions＇ （58.3%）, followed by ＇MRI predicted no lesion, but pathology revealed the presence of a lesion＇ （32.0%）. Multivariable analysis showed that the discordant group had a shorter interval （25.0 ± 14.3 vs 38.1 ± 20.6days, P 〈 0.01） preceding the MRI and a higher rate of hemorrhage as observed by MRI （80.4% vs 54.8%, P 〈 0.01） in comparison with the accordant group. In receiver operating characteristics analysis, the area under the curve of the MRI interval in accurate prediction of the tumor location was 0.707 （P 〈 0.001）. At the MRI interval＇s cutoff of 28.5days, the sensitivity was 73.2% and the specificity was 63.7%. When the MRI was performed within 28days, the accumulated accuracy was only 26.1% （23/88）; however, when it was performed after 28days, the reversely accumulated accuracy was 61.5% （59/96）. These data support a waiting period of at least 4weeks after a biopsy before performing an MRI for the purposes of surgical refinement.展开更多
MicroRNAs （miRs） are small noncoding RNAs that have been reported to be premising diagnostic tools. We used quantitative real-time reverse transcription PCR （RT-qPCR） to analyze differentially expressed miRNAs in ...MicroRNAs （miRs） are small noncoding RNAs that have been reported to be premising diagnostic tools. We used quantitative real-time reverse transcription PCR （RT-qPCR） to analyze differentially expressed miRNAs in prostate tumor samples to determine its prognostic value. From 2007 to 2009, tumor tissues were obtained from 73 radical prostatectomy specimens. Differentially expressed miR-96, -145 and -221 were validated by TaqMan RT-qPCR using all 73 tissues. The prognostic value was assessed in terms of biochemical recurrence using Kaplan-Meier and Cox regression analyses. For our patient cohort, the mean age was 64.7 years （50-76 years） and the mean prostate-specific antigen （PSA） was 7.5 ng m1-1. During the follow-up period （mean, 19.4 months）, 14 of 73 （19.2%） patients developed biochemical recurrence. Expression of miR-96, -145 and -221 correlated strongly with each other, but there were no correlations between miRNA expression and clinicopathologic parameters. Kaplan-Meier survival curves using the log-rank test showed a decreased biochemical recurrence-free interval with pathologic stage （P〈O.O01）. In addition, patients with Gleason scores over 8, compared with those with a Gleason score of 6, showed a decreased biochemical recurrence-free interval in Kaplan-Meier analysis （P=O.O01）. However, expression of miR-96, -145 and -221 did not correlate with the biochemical recurrence interval in Kaplan-Meier survival curves or by multivariate analysis using the Cox proportional hazard regression model, either. In conclusion, we did not observe a significant correlation between the expression of miR-96, -145 and -221 and clinicopathologic parameters. To utilize miRNA as a diagnostic tool in clinical practice, more research is needed to understand miRNA mechanisms, identify miRNA targets, and further characterize miRNA function.展开更多
We describe an unusual case of extragastrointestinal stromal tumor （EGIST） presenting as a scrotal mass. A 71- year-old man presented with a gradually enlarging scrotal mass with a 20-year duration. Physical examina...We describe an unusual case of extragastrointestinal stromal tumor （EGIST） presenting as a scrotal mass. A 71- year-old man presented with a gradually enlarging scrotal mass with a 20-year duration. Physical examination re vealed a huge （as large as volleyball）, round, nontender mass occupying the whole scrotum, which was resected completely. Clinical and radiological findings did not comply with any other primary site disease. Under histological examination, the tumor showed a spindle cell pattern with low cellularity, absence of necrotic and mitotic features. Immunohistochemical anlaysis revealed the tumor reactive for CD117 and CD34, while negative for smooth muscle actin, desmin and S-100 protein. To our knowledge, this is the first reported case of an EGIST involving the scrotum.展开更多
To estimate the short-term results of robot-assisted laparoscopic radical prostatectomy(RALRP)during the learning curve,in terms of surgical,oncological and functional outcomes,we conducted a prospective survey on RAL...To estimate the short-term results of robot-assisted laparoscopic radical prostatectomy(RALRP)during the learning curve,in terms of surgical,oncological and functional outcomes,we conducted a prospective survey on RALRP.From July 2007,a single surgeon performed 63 robotic prostatectomies using the same operative technique.Perioperative data,including pathological and early functional results of the patient,were collected prospectively and analyzed.Along with the accumulation of the cases,the total operative time,setup time,console time and blood loss were significantly decreased.No major complication was present in any patient.Transfusion was needed in six patients;all of them were within the initial 15 cases.The positive surgical margin rate was 9.8%(5/51)in pT2 disease.The most frequent location of positive margin in this stage was the lateral aspect(60%),but in pT3 disease multiple margins were the most frequent(41.7%).Overall,53(84.1%)patients had totally continent status and the median time to continence was 6.56 weeks.Among 17 patients who maintained preoperative sexual activity(Sexual Health Inventory for Men≥17),stage below pT2,followed up for>6 months with minimally one side of neurovascular bundle preservation procedure,12(70.6%)were capable of intercourse postoperatively,and the mean time for sexual intercourse after operation was 5.7 months.In this series,robotic prostatectomy was a feasible and reproducible technique,with a short learning curve and low perioperative complication rate.Even during the initial phase of the learning curve,satisfactory results were obtained with regard to functional and oncological outcome.展开更多
To obtain improved accuracy in predicting extracapsular extension （ECE） and seminal vesicle invasion （SVI）, we evaluated the variables affecting the predictability of staging magnetic resonance imaging （MRI, phas...To obtain improved accuracy in predicting extracapsular extension （ECE） and seminal vesicle invasion （SVI）, we evaluated the variables affecting the predictability of staging magnetic resonance imaging （MRI, phased-array coil） and estimated their impact on accuracy between preoperative MRI staging and histological outcome. A total of 121 patients with localized or locally advanced prostate cancer who underwent robotic radical prostatectomy （RALP） were included. Following transrectal biopsy, all enrolled patients had undergone MRI for staging work-up. After RALP, only 43.8% （53/121） of the patients were matched with the MRI predicted stage. Compared to the matched group in the prediction of ECE, the unmatched group had significantly higher initial prostate-specific antigen （PSA, 12.8 ng m1-1 versus 8.1 ng m1-1, P=0.048）. In the prediction of SVI, initial PSA （8.1 ng ml- 1 versus 17.3 ng ml- 1, P=0.009） and biopsy Gleason score （6.5 versus 7.6, P=0.035） were significantly higher in the unmatched group. When applying clinical cutoffs of initial PSA of 10 and 20 ng ml-1, the accuracy of MRI in the prediction of ECE was decreased in the group with PSA over 20 ng ml- 1 （75.6, 64.5 and 37.5%, P=0.01）, and this group had significantly decreased accuracy of MRI in the prediction of SVI （91.5, 77.4 and 37.5%, P〈0.01）. Applying the clinical cutoff of a Gleason score of 7, the accuracy of MRI in the prediction of SVI was decreased in the higher G leason score group （93.9, 82.1 and 62.9%, P= 0.01）. Thus, for these patient groups, to obtain margin negativity during radical prostatectomy, operative findings, rather than post-biopsy MRI images, may provide substantial information, implying a clinical advantage in conducting MRI before prostate biopsy.展开更多
文摘We report the overall rate, locations and predictive factors of positive surgical margins （PSMs） in 271 patients with high-risk prostate cancer. Between April 2008 and October 2011, we prospectively collected data from patients classified as D＇Amico high-risk who underwent robot-assisted laparoscopic radical prostatectomy. Overall rate and location of PSMs were reported. Stepwise logistic regression models were fitted to assess predictive factors of PSM. The overall rate of PSMs was 25.1% （68 of 271 patients）. Of these PSM, 38.2% （26 of 68） were posterolateral （PL）, 26.5% （18 of 68） multifocal, 16.2% （11 of 68） in the apex, 14.7% （10 of 68） in the bladder neck, and 4.4% （3/68） in other locations. The PSM rate of patients with pathological stage pT2 was 8.6% （12 of 140）, 26.6% （17 of 64） of pT3a, 53.3% （32/60） of pT3b, and 100% （7 of 7） of pT4. In a logistic regression model including pre-, intra-, and post-operative parameters, body mass index （odds ratio [OR]. 1.09; 95% confidence interval [CI]： 1.01-1.19, P = 0.029）, pathological stage （pT3b or higher vs pT2; OR： 5.14; 95% Ch 1.92-13.78; P = 0.001） and percentage of the tumor （OR： 46.71; 95% CI： 6.37-342.57; P 〈 0.001） were independent predictive factors for PSMs. The most common location of PSMs in patients at high-risk was the PL aspect, which reflects the reported tumor aggressiveness. The only significant predictive factors of PSMs were pathological outcomes, such as percentage of the tumor in the specimen and pathological stage.
文摘Sedation may result in reduction in pain during transrectal ultrasound （TRUS）-guided prostate biopsies. We aimed to evaluate the efficacy and safety of a combination of propofol and remifentanil infusion during TRUS-guided prostate biopsy and the related increases in health care costs. From January to September 2010, 100 men undergoing a transrectal prostate biopsy were randomized into two groups. In Group 1, 50 patients received a combined infusion of propofol and remifentanil; in Group 2, 50 patients received lidocaine jelly. After TRUS-guided biopsies were performed, pain and patient satisfaction were evaluated by a lO-point visual analog scale （VAS）, and a cost-related patient satisfaction questionnaire was completed by all patients. Patients were also asked whether they would be willing to undergo repeat biopsy by the same method. Patients in Group I showed a significantly lower VAS score than those in Group 2 （mean VAS score： 0.9± 1.1 versus 6.3±2.5; P〈0.001）. In addition, the patient satisfaction scale was significantly higher in Group 1 （P=0.002）. Although the overall cost was significantly higher in Group 1 （P=0.006）, patient satisfaction scales considering cost were also higher in this group （P=0.009）. A combination of propofol and remifentanil is a safe and effective way to decrease patient pain and increase patient satisfaction during TRUS-guided prostate biopsy. Although the costs were higher in the group that received sedation, as expected, the patients exhibited heightened satisfaction and willingness to repeat biopsies by the same method.
文摘To gain beneficial effects in the management of high-risk prostate cancer, an integrated approach that combines local therapy and androgen deprivation therapy （ADT） was used. We compared biochemical responses between primary cryosurgical ablation of the prostate （CSAP） combined with prolonged ADT and radiation combined with ADT, which is the established modality in high-risk disease. A total of 33 high-risk patients received CSAP combined with ADT for 3 months before and up to 24 months after treatment. This patient group was matched with another 33 patients who had undergone three-dimensional conformal radiation therapy （3D-CRT） with the same protocol for ADT. Biochemical recurrence （BCR） was assessed by the American Society for Therapeutic Radiation Oncology （ASTRO） definition, the Phoenix definition and a prostate-specific antigen （PSA） cutoff of 0.5 ng mL^-1. Median follow-up was 61.0 ± 11.9 months for the CSAP ＋ ADT group and 86.0±15.8 months for the 3D-CRT ＋ ADT group. In the CSAP group, major complications including rectourethral fistula and incontinence were not noted. In the CSAP ＋ ADT group, 57.0% had BCR using the ASTRO definition, 21.2% using the Phoenix definition and 54.5% using a PSA cutoff of 0.5 ng mL^-1. In the 3D-CRT ＋ ADT group, 54.5%, 21.2% and 54.5% had BCR using the ASTRO, Phoenix and PSA definition, respectively. In the CSAP ＋ ADT group, the BCR-free survival （BRFS） was 54 ± 10 months using the ASTRO definition, 65 ± 5 months using the Phoenix definition and 51 ± 4 months using a PSA cutoff of 0.5 ng mL-1. In the 3D-CRT ＋ ADT group, the BRFS was 68 ± 12, 93 ± 19 and 70 ± 18 months using the ASTRO, Phoenix and PSA definition, respectively. By the log-rank test, the BRFS values for each group were not statistically different. This intermediate-term result indicated that primary CSAP combined with prolonged ADT offers a parallel biochemical response compared with radiotherapy in high-risk prostate cancer.
文摘The goal of our study was to evaluate the impact of the interval between prostate biopsy and magnetic resonance imaging （MRI） on the accuracy of simple tumor localization, which is essential information that enables nerve-sparing surgery. We also sought to determine the optimal timing of a post-biopsy MRI, A total of 184 patients who had undergone MRI before radical prostatectomy at an institution without a predetermined schedule for MRI after a prostate biopsy were enrolled. The mean interval from the biopsy to the MRI was 30.8 ± 18.6days. The accuracy of the MRI for simplified tumor location （right, left, bilateral and none） was 44.6%. In the group with discordant pathologic and MRI findings, the most common reason recorded was ＇MRI predicted a unilateral lesion, but pathology revealed bilateral lesions＇ （58.3%）, followed by ＇MRI predicted no lesion, but pathology revealed the presence of a lesion＇ （32.0%）. Multivariable analysis showed that the discordant group had a shorter interval （25.0 ± 14.3 vs 38.1 ± 20.6days, P 〈 0.01） preceding the MRI and a higher rate of hemorrhage as observed by MRI （80.4% vs 54.8%, P 〈 0.01） in comparison with the accordant group. In receiver operating characteristics analysis, the area under the curve of the MRI interval in accurate prediction of the tumor location was 0.707 （P 〈 0.001）. At the MRI interval＇s cutoff of 28.5days, the sensitivity was 73.2% and the specificity was 63.7%. When the MRI was performed within 28days, the accumulated accuracy was only 26.1% （23/88）; however, when it was performed after 28days, the reversely accumulated accuracy was 61.5% （59/96）. These data support a waiting period of at least 4weeks after a biopsy before performing an MRI for the purposes of surgical refinement.
文摘MicroRNAs （miRs） are small noncoding RNAs that have been reported to be premising diagnostic tools. We used quantitative real-time reverse transcription PCR （RT-qPCR） to analyze differentially expressed miRNAs in prostate tumor samples to determine its prognostic value. From 2007 to 2009, tumor tissues were obtained from 73 radical prostatectomy specimens. Differentially expressed miR-96, -145 and -221 were validated by TaqMan RT-qPCR using all 73 tissues. The prognostic value was assessed in terms of biochemical recurrence using Kaplan-Meier and Cox regression analyses. For our patient cohort, the mean age was 64.7 years （50-76 years） and the mean prostate-specific antigen （PSA） was 7.5 ng m1-1. During the follow-up period （mean, 19.4 months）, 14 of 73 （19.2%） patients developed biochemical recurrence. Expression of miR-96, -145 and -221 correlated strongly with each other, but there were no correlations between miRNA expression and clinicopathologic parameters. Kaplan-Meier survival curves using the log-rank test showed a decreased biochemical recurrence-free interval with pathologic stage （P〈O.O01）. In addition, patients with Gleason scores over 8, compared with those with a Gleason score of 6, showed a decreased biochemical recurrence-free interval in Kaplan-Meier analysis （P=O.O01）. However, expression of miR-96, -145 and -221 did not correlate with the biochemical recurrence interval in Kaplan-Meier survival curves or by multivariate analysis using the Cox proportional hazard regression model, either. In conclusion, we did not observe a significant correlation between the expression of miR-96, -145 and -221 and clinicopathologic parameters. To utilize miRNA as a diagnostic tool in clinical practice, more research is needed to understand miRNA mechanisms, identify miRNA targets, and further characterize miRNA function.
文摘We describe an unusual case of extragastrointestinal stromal tumor （EGIST） presenting as a scrotal mass. A 71- year-old man presented with a gradually enlarging scrotal mass with a 20-year duration. Physical examination re vealed a huge （as large as volleyball）, round, nontender mass occupying the whole scrotum, which was resected completely. Clinical and radiological findings did not comply with any other primary site disease. Under histological examination, the tumor showed a spindle cell pattern with low cellularity, absence of necrotic and mitotic features. Immunohistochemical anlaysis revealed the tumor reactive for CD117 and CD34, while negative for smooth muscle actin, desmin and S-100 protein. To our knowledge, this is the first reported case of an EGIST involving the scrotum.
基金This study was carried out without any commercial sponsorship from equipment manufacturers.
文摘To estimate the short-term results of robot-assisted laparoscopic radical prostatectomy(RALRP)during the learning curve,in terms of surgical,oncological and functional outcomes,we conducted a prospective survey on RALRP.From July 2007,a single surgeon performed 63 robotic prostatectomies using the same operative technique.Perioperative data,including pathological and early functional results of the patient,were collected prospectively and analyzed.Along with the accumulation of the cases,the total operative time,setup time,console time and blood loss were significantly decreased.No major complication was present in any patient.Transfusion was needed in six patients;all of them were within the initial 15 cases.The positive surgical margin rate was 9.8%(5/51)in pT2 disease.The most frequent location of positive margin in this stage was the lateral aspect(60%),but in pT3 disease multiple margins were the most frequent(41.7%).Overall,53(84.1%)patients had totally continent status and the median time to continence was 6.56 weeks.Among 17 patients who maintained preoperative sexual activity(Sexual Health Inventory for Men≥17),stage below pT2,followed up for>6 months with minimally one side of neurovascular bundle preservation procedure,12(70.6%)were capable of intercourse postoperatively,and the mean time for sexual intercourse after operation was 5.7 months.In this series,robotic prostatectomy was a feasible and reproducible technique,with a short learning curve and low perioperative complication rate.Even during the initial phase of the learning curve,satisfactory results were obtained with regard to functional and oncological outcome.
文摘To obtain improved accuracy in predicting extracapsular extension （ECE） and seminal vesicle invasion （SVI）, we evaluated the variables affecting the predictability of staging magnetic resonance imaging （MRI, phased-array coil） and estimated their impact on accuracy between preoperative MRI staging and histological outcome. A total of 121 patients with localized or locally advanced prostate cancer who underwent robotic radical prostatectomy （RALP） were included. Following transrectal biopsy, all enrolled patients had undergone MRI for staging work-up. After RALP, only 43.8% （53/121） of the patients were matched with the MRI predicted stage. Compared to the matched group in the prediction of ECE, the unmatched group had significantly higher initial prostate-specific antigen （PSA, 12.8 ng m1-1 versus 8.1 ng m1-1, P=0.048）. In the prediction of SVI, initial PSA （8.1 ng ml- 1 versus 17.3 ng ml- 1, P=0.009） and biopsy Gleason score （6.5 versus 7.6, P=0.035） were significantly higher in the unmatched group. When applying clinical cutoffs of initial PSA of 10 and 20 ng ml-1, the accuracy of MRI in the prediction of ECE was decreased in the group with PSA over 20 ng ml- 1 （75.6, 64.5 and 37.5%, P=0.01）, and this group had significantly decreased accuracy of MRI in the prediction of SVI （91.5, 77.4 and 37.5%, P〈0.01）. Applying the clinical cutoff of a Gleason score of 7, the accuracy of MRI in the prediction of SVI was decreased in the higher G leason score group （93.9, 82.1 and 62.9%, P= 0.01）. Thus, for these patient groups, to obtain margin negativity during radical prostatectomy, operative findings, rather than post-biopsy MRI images, may provide substantial information, implying a clinical advantage in conducting MRI before prostate biopsy.
