The Use of mpMRI for Preoperative Planning in High-Risk Prostate Cancer and the Impact on Surgical Planning, Cancer Control, and Quality of Life - Commentary

Multiparametric magnetic resonance imaging (mpMRI) is a robust staging modality for high-risk prostate cancer. Less clear is whether pre-operative mpMRI may potentially improve radical prostatectomy outcomes by providing actionable information for planning neurovascular bundle excision, bladder neck sparing, and extent of staging lymph node dissection.

To address this question, these investigators performed a novel, single-center survey study of six urologic oncologists. Study participants were given two surveys incorporating 41 case studies of patients with clinically localized prostate cancer who underwent pre-operative mpMRI prostate followed by robot-assisted laparoscopic prostatectomy and extended pelvic lymph node dissection.

The first survey included only clinical data. The second survey, administered two months later, included clinical data, mpMRI images, and a standardized mpMRI report. The case order was randomly shuffled for the second survey. For each survey, participants were asked to provide a surgical plan for nerve-sparing, bladder neck sparing, the extent of lymph node dissection, and robotic vs. open surgical approach. Survey results were compared to the final pathologic stage.  

These investigators observed that preoperative mpMRI favorably influenced surgical planning in 50% of the cases. Favorable changes occurred in 37%, 49%, and 51% of the bladder neck, right neurovascular bundle, and left neurovascular bundle components of these cases, respectively. They concluded that pre-operative mpMRI may potentially lead to improved outcomes for high-risk prostate cancer patients by informing surgical planning.

The take-home message is that, while these data require validation in other centers and cohorts, it is reasonable to consider mpMRI prior to radical prostatectomy in high-risk patients to inform the surgical plan—particularly if these patients require axial imaging for staging.     

Written by: J. Kellogg Parsons, MD, MHS, Urologist, Professor of Urology, University of California San Diego Health, San Diego, California

Read the Full-Text Article: Impact of Preoperative Prostate Magnetic Resonance Imaging on the Surgical Management of High-Risk Prostate Cancer

email news signup