Preoperative multiparametric magnetic resonance imaging (mpMRI) of the prostate is not routinely recommended as standard practice for men with high-risk prostate cancer, but new findings suggest that it could lead to changes in surgical planning that improve outcomes, according to investigators.
“Preoperative mpMRI may lead to improved decision making regarding nerve-sparing and bladder neck dissection with the potential for decreasing positive surgical margin rates when obtained prior to radical prostatectomy for high-risk prostate cancer,” Brian F. Chapin, MD, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues concluded in a paper published in Prostate Cancer and Prostatic Diseases.
Dr Chapin’s team explored how 6 fellowship-trained urologic oncologists would manage 41 high-risk prostate cancer cases. The investigators administered 2 surveys to the urologic oncologists. The first one included a case description with clinical data only (including physical exam, pathology, and patient history). The second survey, given to respondents 2 months later, included the case description with mpMRI images and a standardized mpMRI report. For the second survey, the case order was shuffled with a random number generator. For each survey, the urologic oncologists were asked for their surgical plan with regard to surgical approach (robotic vs open), degree of planned nerve sparing (none, partial, full) on each side, lymph node dissection (standard or extended), and bladder neck sparing (yes or no). Dr Chapin’s team compared respondents’ changes to the surgical plan with the findings on final pathology.
All cases had at least 1 change to surgical planning following mpMRI review, Dr Chapin and his collaborators reported. After mpMRI, 40 patients (98%) had a change in the degree of planned nerve sparing, with 32% of nerves excised when they originally were planned to be spared and 24% of nerves spared when they originally were planned for excision. After mpMRI, the correct surgical plan change was made in 49% and 51% of cases with respect to the right and left neurovascular bundles, respectively, decreasing the potential for positive surgical margins. Lymph node dissection was altered from standard to extended in 17% of cases. Bladder neck sparing was changed in 15% of cases.
“We found urologic oncologist surgical planning for high-risk prostate cancer to be heavily influenced by the findings of a preoperative mpMRI,” Dr Chapin’s team wrote.
Baack Kukreja J, Bathala TK, Reichard CA, et al. Impact of preoperative prostate magnetic resonance imaging on the surgical management of high-risk prostate cancer [published online September 9, 2019]. Prostate Cancer Prostatic Dis. doi: 10.1038/s41391-019-0171-0