Research and Reports in Urology (Apr 2017)

Prostate MRI prior to radical prostatectomy: effects on nerve sparing and pathological margin status

  • Druskin SC,
  • Liu JJ,
  • Young A,
  • Feng Z,
  • Dianat SS,
  • Ludwig WW,
  • Trock BJ,
  • Macura KJ,
  • Pavlovich CP

Journal volume & issue
Vol. Volume 9
pp. 55 – 63

Abstract

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Sasha C Druskin,1 Jen-Jane Liu,2 Allen Young,1 Zhaoyong Feng,1 Seyed S Dianat,3 Wesley W Ludwig,1 Bruce J Trock,1 Katarzyna J Macura,4 Christian P Pavlovich1 1The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, 2Department of Urology, Oregon Health and Science University, Portland, OR, 3Department of Radiology, University of Minnesota Twin Cities, Minneapolis, MN, 4Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA Objectives: The aim of this study was to assess the positive surgical margin (PSM) and nerve sparing (NS) rates in patients who underwent prostate MRI (pMRI) prior to radical prostatectomy (RP) and compare them with matched, nonimaged control RP patients. Methods: We identified 204 men who underwent preoperative pelvic MRI (pelMRI), of whom 176 (86.3%) underwent pMRIs, within 60 days of RP, and compared them (1:1) with a nonimaged control group matched by surgeon, age, race, body mass index (BMI), prostate-specific antigen (PSA), pathological Gleason score, prostate specimen weight, and RP year. Results: The rates of nonfocal extracapsular extension (nfECE) on RP pathology in the MRI and control groups were similar. PSM rates were lower in the MRI group (13.7% vs 19.3%; P=0.14), but the difference did not meet statistical significance; this was also the case in patients with nfECE on RP pathology (27.7% vs 39.5%; P=0.3). NS rates were similar between groups. In the MRI group, 54 (26.5%) patients had an MRI suspicious for nfECE; their PSM rate (20.4%) was higher than that of patients with an MRI not suspicious for nfECE (11.3%; P=0.11), but the difference lacked statistical significance; the former group had significantly lower rates of NS. Limitations of the study include sample power and nonuniform heeding of MRI results by each surgeon. Conclusion: MRI did not significantly decrease the rates of PSM, including in the subset of patients with nfECE on final pathology. Even wider resection may be necessary in patients with MRIs suggesting locally-advanced disease. Studies with greater power are needed. Keywords: MRI, positive surgical margins, nerve sparing, extracapsular extension, radical prostatectomy

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