MAGNETIC resonance imaging (MRI) T staging demonstrated comparable prognostic performance to digital rectal examination for patients with localised prostate cancer undergoing radical prostatectomy, suggesting that MRI based staging could be incorporated into contemporary risk classification systems without compromising predictive accuracy.
Magnetic resonance imaging is increasingly used for local staging in prostate cancer, although its value compared with traditional digital rectal examination has remained uncertain. To address this question, researchers conducted a multicentre retrospective case control study involving men aged 18 years or older with clinically localised or locally advanced prostate cancer who underwent radical prostatectomy between 2015–2021. All participants had preoperative multiparametric magnetic resonance imaging and systematic biopsies, with or without targeted biopsies, before surgery.
The analysis included 4,425 men treated at 31 referral centres across six European countries. The primary outcome was distant metastasis free survival, while biochemical recurrence free survival and overall survival were evaluated as secondary outcomes. Researchers also assessed whether magnetic resonance imaging derived T staging could replace digital rectal examination staging within four established prognostic classification systems.
During a median follow up of 52 months, magnetic resonance imaging based staging demonstrated slightly higher discriminatory ability than digital rectal examination staging for both biochemical recurrence free survival and distant metastasis free survival. The C index for biochemical recurrence free survival was 0.62 (95% CI: 0.61–0.64) for magnetic resonance imaging compared with 0.59 (95% CI: 0.57–0.61) for digital rectal examination. For distant metastasis free survival, the C index was 0.67 (95% CI: 0.64–0.70) and 0.65 (95% CI: 0.62–0.68), respectively.
Despite these numerical differences, incorporation of magnetic resonance imaging based staging into the D’Amico, European Association of Urology, National Comprehensive Cancer Network, and International Staging Collaboration for Prostate Cancer risk classification systems resulted in comparable discrimination, with overlapping 95% confidence intervals. Time dependent analyses also showed no significant differences between the two staging approaches throughout follow up.
Subgroup analyses of patients with clinical T1 disease and those with prostate specific antigen levels below 10 ng/mL produced similar findings.
The findings suggested that magnetic resonance imaging based T staging could replace digital rectal examination based staging within established prostate cancer risk models without reducing prognostic performance. Across all outcomes assessed, including biochemical recurrence, distant metastasis, and overall survival, magnetic resonance imaging maintained discrimination comparable with traditional clinical staging.
These results support the integration of magnetic resonance imaging derived staging into contemporary prostate cancer diagnostic pathways and risk classification systems for patients undergoing radical prostatectomy.
Reference
Peyrottes A et al. Performance of MRI-based vs clinical T staging in localized prostate cancer. JAMA Netw Open. 2026;9;(7):e2623288.
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