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Objectives  To externally validate the extraprostatic extension (EPE) grade criteria on MRI and analyze the incremental value of EPE grade to clinical models of prostate cancer.    Methods  A consecutive 130 patients who underwent preoperative prostate MRI followed by radical prostatectomy between January 2015 to January 2020 in our institution were retrospectively enrolled. The EPE grade, Cancer of the Prostate Risk Assessment (CAPRA), and Memorial Sloan Kettering Cancer Center nomogram (MSKCCn) score for each patient were assigned. Significant clinicopathological factors in univariate and multivariate analyses were combined with EPE grade to build the Clinical + EPE grade model, and the CAPRA and MSKCCn score were also combined with EPE grade to build the CAPRA + EPE grade and MSKCCn + EPE grade model, respectively. The area under the curve (AUC), sensitivity and specificity of these models were calculated to evaluate their diagnostic performance. Calibration and decision curve analyses were used to analyze their calibration performance and clinical utility.    Results  The AUC for predicting EPE was 0.767–0.778 for EPE grade, 0.704 for CAPRA, and 0.723 for MSKCCn. After combination with EPE grade, the AUCs of these clinical models increased significantly than using clinical models along ( P  < 0.05), but was comparable with using EPE grade alone ( P  > 0.05). The calibration curves of EPE grade, clinical models and combined models showed that these models are well-calibrated for EPE. In the decision curve analysis, EPE grade showed slightly higher net benefit than MSKCCn and CAPRA.    Conclusion  The EPE grade showed good performance for evaluating EPE in our cohort and possessed well clinical utility. Further combinations with the EPE grade could improve the diagnostic performance of clinical models.

External Validation of the Extraprostatic Extension Grade on MRI and Its Incremental Value to Clinical Models for Assessing Extraprostatic Cancer