The use of preoperative magnetic resonance imaging (MRI) can help guide surgical decisions that may spare nerves in men with prostate cancer undergoing robotic-assisted laparoscopic prostatectomy (RALP), according to a study published online in Radiology.
Timothy D. McClure, MD, of the University of California in Los Angeles, and colleagues examined whether preoperative prostate MRI influenced the decision to preserve neurovascular bundles and the extent of surgical margins in 104 men with biopsy-proven prostate cancer who underwent RALP. One surgeon planned surgery before and after review of the MRI report, and the differences were determined and compared with the actual surgical and pathological results.
The researchers found that review of preoperative MRI results led to changes in the surgical plan in 27% of patients (28 men). The plan was modified to a nerve-sparing technique in 61% of these cases and to a non-nerve-sparing technique in the remaining 39% of cases. Surgical margins were positive in 6.7% of the 104 patients (seven men). There were no positive margins on the side of the prostate in patients whose surgical plan was changed to a nerve-sparing technique.
“To our knowledge, this is the first report demonstrating the value of MRI in planning RALP,” the authors wrote. “On the basis of our initial experience, prostate MRI may be useful for helping surgeons plan the extent and side of nerve sparing during RALP.”