eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
Current issue Archive Manuscripts accepted About the journal Special issues Editorial board Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
vol. 14
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
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
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.

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).

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


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

Heidenreich A, Bastian PJ, Bellmunt J, et al. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 2014; 65: 124-37.
Bill-Axelson A, Holmberg L, Filen F, et al. Radical prostatectomy versus watchful waiting in localized prostate cancer: the Scandinavian prostate cancer group-4 randomized trial. J Natl Cancer Inst 2008; 100: 1144-54.
Quinlan DM, Epstein JI, Carter BS, Walsh PC. Sexual function following radical prostatectomy: influence of preservation of neurovascular bundles. J Urol 1991; 145: 998-1002.
Yossepowitch O, Briganti A, Eastham JA, et al. Positive surgical margins after radical prostatectomy: a systematic review and contemporary update. Eur Urol 2014; 65: 303-13.
Golabek T, Powroźnik J, Chłosta P, et al. The impact of nutrition in urogenital cancers. Arch Med Sci 2015; 11: 411-8.
Barentsz JO, Richenberg J, Clements R, et al. ESUR prostate MR guidelines 2012. Eur Radiol 2012; 22: 746-57.
Park BH, Jeon HG, Jeong BC, et al. Influence of magnetic resonance imaging in the decision to preserve or resect neurovascular bundles at robotic assisted laparoscopic radical prostatectomy. J Urol 2014; 192: 82-8.
Rud E, Baco E, Klotz D, et al. Does preoperative magnetic resonance imaging reduce the rate of positive surgical margins at radical prostatectomy in a randomised clinical trial? Eur Urol 2015; 68: 487-96.
Mottet N, Bellmunt J, et al. EAU guidelines on prostate cancer: 6.2.10 Indications for nerve-sparing surgery. European Association of Urology 2015. Available at: https://uroweb.org/guideline/prostate-cancer/.
Salonia A, Burnett AL, Graefen M, et al. Prevention and management of postprostatectomy sexual dysfunctions. Part 1: choosing the right patient at the right time for the right surgery. Eur Urol 2012; 62: 261-72.
Steineck G, Bjartell A, Hugosson J, et al. Degree of preservation of the neurovascular bundles during radical prostatectomy and urinary continence 1 year after surgery. Eur Urol 2015; 67: 559-68.
Michl U, Tennstedt P, Feldmeier L, et al. Nerve-sparing surgery technique, not the preservation of the neurovascular bundles, leads to improved long-term continence rates after radical prostatectomy. Eur Urol 2016; 69: 584-9.
Tan N, Margolis DJ, McClure TD, et al. Radical prostatectomy: value of prostate MRI in surgical planning. Abdom Imaging 2012; 37: 664-74.
Hricak H, Wang L, Wei DC, et al. The role of preoperative endorectal magnetic resonance imaging in the decision regarding whether to preserve or resect neurovascular bundles during radical retropubic prostatectomy. Cancer 2004; 100: 2655-63.
de Rooij M, Hamoen EH, Witjes JA, Barentsz JO, Rovers MM. Accuracy of magnetic resonance imaging for local staging of prostate cancer: a diagnostic meta-analysis. Eur Urol 2016; 70: 233-45.
Feng TS, Sharif-Afshar AR, Smith SC, et al. Multiparametric magnetic resonance imaging localizes established extracapsular extension of prostate cancer. Urol Oncol 2015; 33: 109 e15-22.
Roethke MC, Lichy MP, Kniess M, et al. Accuracy of preoperative endorectal MRI in predicting extracapsular extension and influence on neurovascular bundle sparing in radical prostatectomy. World J Urol 2013; 31: 1111-6.
Tanaka K, Shigemura K, Muramaki M, Takahashi S, Miyake H, Fujisawa M. Efficacy of using three-tesla magnetic resonance imaging diagnosis of capsule invasion for decision-making about neurovascular bundle preservation in robotic-assisted radical prostatectomy. Korean J Urol 2013; 54: 437-41.
Rud E, Klotz D, Rennesund K, et al. Preoperative magnetic resonance imaging for detecting uni- and bilateral extraprostatic disease in patients with prostate cancer. World J Urol 2015; 33: 1015-21.
McClure TD, Margolis DJ, Reiter RE, et al. Use of MR imaging to determine preservation of the neurovascular bundles at robotic-assisted laparoscopic prostatectomy. Radiology 2012; 262: 874-83.
Brown JA, Rodin DM, Harisinghani M, Dahl DM. Impact of preoperative endorectal MRI stage classification on neurovascular bundle sparing aggressiveness and the radical prostatectomy positive margin rate. Urol Oncol 2009; 27: 174-9.
Johnson MT, Ramsey ML, Ebel JJ, Abaza R, Zynger DL. Do robotic prostatectomy positive surgical margins occur in the same location as extraprostatic extension? World J Urol 2014; 32: 761-7.
Petralia G, Musi G, Padhani AR, et al. Robot-assisted radical prostatectomy: Multiparametric MR imaging-directed intraoperative frozen-section analysis to reduce the rate of positive surgical margins. Radiology 2015; 274: 434-44.
Quick links
© 2018 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe