Extraprostatic extension in prostate cancer: primer for radiologists

Alice C. Shieh, Ezgi Guler, Vijayanadh Ojili, Raj Mohan Paspulati, Robin Elliott, Nikhil H. Ramaiya, Sree Harsha Tirumani

Research output: Contribution to journalReview articlepeer-review

18 Scopus citations


The presence of extraprostatic extension (EPE) on multiparametric MRI (mpMRI) is an important factor in determining the management of prostate cancer. EPE is an established risk factor for biochemical recurrence of prostate cancer after radical prostatectomy (RP) and patients with EPE may be considered for wider resection margins, non-nerve-sparing surgery, adjuvant radiation therapy (RT), or androgen deprivation therapy (ADT). Several statistical nomograms and scoring systems have been developed to predict pathological stage at time of RP but with varying accuracies. Using the current PI-RADS v2 mpMRI staging guidelines results in high specificity but lacks in sensitivity. These findings reveal the need for more standardization and further refinement of existing MRI protocols and prostate cancer prediction tools. Current studies have looked into indirect additional imaging criteria such as index tumor volume, length of capsular contact, and apparent diffusion coefficient. Measuring for these features can improve the robustness of mpMRI in staging prostate cancer, as they have been shown to be independent predictors of EPE. MRI/ultrasound fusion-guided targeted biopsy can detect EPE not found on standard biopsy. Collectively, these measurements and imaging techniques can augment the detection of EPE and subsequent risk stratification.

Original languageEnglish (US)
Pages (from-to)4040-4051
Number of pages12
JournalAbdominal Radiology
Issue number12
StatePublished - Dec 2020


  • Extraprostatic extension
  • Multiparametric MRI
  • PI-RADS v2
  • Radical prostatectomy
  • Tumor capsule contact length

ASJC Scopus subject areas

  • Gastroenterology
  • Urology
  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging


Dive into the research topics of 'Extraprostatic extension in prostate cancer: primer for radiologists'. Together they form a unique fingerprint.

Cite this