International Urology and Nephrology

, Volume 51, Issue 8, pp 1349–1355 | Cite as

Index tumor volume on MRI as a predictor of clinical and pathologic outcomes following radical prostatectomy

  • Dordaneh Sugano
  • Abhinav Sidana
  • Amit L. JainEmail author
  • Brian Calio
  • Sonia Gaur
  • Mahir Maruf
  • Maria Merino
  • Peter Choyke
  • Baris Turkbey
  • Bradford J. Wood
  • Peter A. Pinto
Urology - Original Paper



Index tumor volume (ITV) measured on radical prostatectomy (RP) specimens has been shown to be associated with adverse pathologic and oncologic outcomes. We evaluate the value of ITV calculated from prostate multiparametric MRI (mpMRI) in predicting adverse clinical and pathologic outcomes.

Materials and methods

Data from a prospectively maintained, single-institution database were analyzed for patients who underwent mpMRI prior to RP (2007–2016). Index tumor was defined as a T2-visible lesion with the longest diameter. Adverse pathologic outcomes were extraprostatic extension (EPE), lymph node invasion (LNI), seminal vesicle invasion (SVI), and positive margins (PM). Logistic and Cox proportional hazard regression were used to assess associations with adverse pathology and biochemical recurrence (BCR), respectively.


Of the 455 patients included, EPE, LNI, SVI and PM were present in 23.5%, 6.2%, 5.5% and 15.7% patients, respectively. Patients with adverse pathologic outcomes had larger median ITV. ITV was found to be an independent predictor of EPE (OR 1.22, p = 0.010), LNI (OR 1.39, p = 0.001), and SVI (OR 1.28, p = 0.009), but not PM (OR 1.03, p = 0.522). Combination of ITV and PSA was found to have predictive ability comparable to that of modified Partin tables (EPE:ITV + PSAAUC = 0.71 vs. PartinAUC = 0.71; LNI:ITV + PSAAUC = 0.92 vs. PartinAUC = 0.90, SVI:ITV + PSAAUC = 0.78 vs. PartinAUC = 0.82). 5 year BCR-free survival (median follow-up 24.9 months) was higher for patients with ITV < 2 cc (84.1% vs. 58.5%, p = 0.001). However, ITV was not found to be an independent predictor of BCR (HR 1.69, p = 0.130).


We demonstrate that ITV measured on mpMRI is a predictor of adverse pathologic and clinical outcomes and can aid in preoperative risk assessment.


Biomarkers Magnetic resonance imaging Prostatic neoplasms Tumor volume PSA 



Supported by the Intramural Research Program of National Institutes of Health, National Cancer Institute, Center for Cancer Research, Center for Interventional Oncology, and the National Institutes of Health Medical Research Scholars Program, a public–private partnership supported jointly by National Institutes of Health and contributions to the Foundation for National Institutes of Health from Pfizer Inc., The Doris Duke Charitable Foundation, The Alexandria Real Estate Equities Inc., Mr. and Mrs. Joel S. Marcus, the Howard Hughes Medical Institute and other private donors (

Compliance with ethical standards

Conflict of interest

The authors have no affiliation with any organization with a direct or indirect financial interest in the subject matter discussed in the manuscript. NIH, Philips Healthcare have a cooperative research, NIH and Philips share intellectual property in the field and development agreement.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Dordaneh Sugano
    • 1
  • Abhinav Sidana
    • 1
  • Amit L. Jain
    • 1
    Email author
  • Brian Calio
    • 1
  • Sonia Gaur
    • 2
  • Mahir Maruf
    • 1
  • Maria Merino
    • 3
  • Peter Choyke
    • 2
  • Baris Turkbey
    • 2
  • Bradford J. Wood
    • 4
  • Peter A. Pinto
    • 1
  1. 1.Urologic Oncology Branch, National Cancer InstituteNational Institutes of HealthBethesdaUSA
  2. 2.Molecular Imaging Program, National Cancer InstituteNational Institutes of HealthBethesdaUSA
  3. 3.Center for Cancer Research, National Cancer InstituteNational Institutes of HealthBethesdaUSA
  4. 4.National Cancer Institute and Clinical Center, Center for Interventional OncologyNational Institutes of HealthBethesdaUSA

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