eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
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SCImago Journal & Country Rank
6/2018
vol. 14
 
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abstract:
Clinical research

3.0-T multiparametric MRI modifies the template of endoscopic, conventional radical prostatectomy in all cancer risk categories

Mieszko Kozikowski
,
Jan Powroźnik
,
Wojciech Malewski
,
Szymon Kawecki
,
Sebastian Piotrowicz
,
Wojciech Michalak
,
Łukasz Nyk
,
Magdalena Gola
,
Jakub Dobruch

Arch Med Sci 2018; 14, 6: 1387–1393
Online publish date: 2018/07/17
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Introduction
We aimed to evaluate the diagnostic performance of 3.0-T multiparametric magnetic resonance imaging (mpMRI) in preoperative staging of prostate cancer (PCa) and its influence on the extent of resection during endoscopic radical prostatectomy (ERP) among cancer risk groups.

Material and methods
The data of 154 patients with PCa in whom mpMRI was performed prior to ERP between 2011 and 2015 were included. The initial decision whether to perform neurovascular bundle (NVB) sparing surgery was based on EAU guidelines. mpMRI images were reevaluated prior to prostatectomy to modify the surgical template. Imaging was compared with pathological reports to investigate the diagnostic performance of mpMRI.

Results
The surgical template was modified in 69 (44.8%) patients after reevaluation of mpMRI. More preserving NVB sparing was attempted in 17 (11.0%) men, in whom NVB would have been resected if mpMRI had not been available. More aggressive NVB resection was performed in 52 (33.8%) men, in whom innervation would have been spared if basing solely based on guidelines. Among all PCa risk groups mpMRI had an impact on the surgical template with more aggressive surgery in 63.0% and 33.3% of men in the low- and intermediate-risk group, respectively, and more preserving in 21.4% of the high-risk patients. The change in extent of resection was not correlated with a higher risk of positive surgical margins (p = 0.196).

Conclusions
Preoperative mpMRI exerts a significant impact on decision making concerning the extent of resection during ERP irrespective of the PCa risk group.

keywords:

prostate cancer, neurovascular bundle, multiparametric magnetic resonance imaging, extraprostatic extension, endoscopic radical prostatectomy

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