Introduction & Objectives
Local staging of Prostate Cancer (PCa) has a crucial role in decision-making process about resection or preservation of Neurovascular Bundles (NVB) during radical prostatectomy. The clinical relevance of multiparametric Magnetic Resonance Imaging (mpMRI) in preoperative workup and its influence on planning of radical prostatectomy is still under investigation. The purpose of our study was to evaluate the diagnostic performance of 3-Tesla mpMRI in preoperative staging of PCa in men subjected to endoscopic radical prostatectomy (ERP). We investigated the influence of mpMRI on the extension of resection during ERP.
Material & Methods
The study was the retrospective analysis of prospectively collected data of 154 men with PCa in whom mpMRI was performed prior to ERP. Imaging results were compared with pathological reports to investigate diagnostic performance of mpMRI in detecting Extraprostatic Extension (EPE). Initial decision whether to perform NVB sparing surgery was based on EAU guidelines. mpMRI was reevaluated prior ERP to determine feasibility and extent of a NVB preservation.
The extent of NVB sparing surgery was changed in 69 (45%) men after reevaluation of mpMRI study. NVB preservation was made in 17 (11%) men, in whom NVB would have been resected, if mpMRI had not been available. The extension of resection was broadened at the expense of narrower NVB preservation in 52 (34%) men, in whom NVB would have been spared, if the decision had been made solely based on guidelines. The change in the extension of resection either to more preserving NVB sparing or more aggressive resection was not correlated with the higher risk of positive surgical margins (PSM). mpMRI had increased diagnostic performance in men with the high-risk cancer (sensitivity 49%, specificity 89%), than in man with low-risk and intermediate-risk cancer (sensitivity 27%, specificity 93%). Despite decreased diagnostic performance of mpMRI in the low-risk and intermediate-risk group, the extension of NVB preservation was narrowed in 17 (63%) and 19 (33%) men, respectively. mpMRI failed to detect or understaged the tumor in nearly half of PSM cases.
mpMRI influences decision-making about the extension of resection during ERP irrespective of the prostate cancer risk group. The changes of the extent of resection made basing on the mpMRI result are not related to the increased risk of PSM.