MRI can guide nerve-sparing decision in prostate surgery

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The use of preoperative magnetic resonance imaging (MRI) can change the surgical plan for men undergoing surgery for prostate cancer, helping surgeons decide whether to preserve neurovascular bundles (nerve-sparing surgery) and determine the extent of surgical margins in robotic-assisted laparoscopic prostatectomy (RALP).

RALP does not provide the surgeon with tactile feedback, which can make it difficult to evaluate neurovascular bundles alongside the prostate. An aggressive surgical approach could unnecessarily damage the bundles and leave the patient with a loss of function, whereas an approach that is not aggressive enough could leave some cancer cells behind.

Daniel J. A. Margolis, MD, a radiologist at the David Geffen School of Medicine at the University of California, Los Angeles, and fellow researchers prospectively evaluated 104 men with prostate cancer who underwent preoperative endorectal coil MRI to investigate whether this method could improve assessment of the cancer and the involvement of the neurovascular bundles before surgery. The team determined the differences in the surgical plan before and after review of the MRI report and compared them with the actual surgical and pathologic results.

As Margolis and colleagues reported in the journal Radiology, after review of the MRI results the initial surgical plan was changed in 28 (27%) of the patients, from a nerve-sparing technique in 17 of these men (61%) and to a non-nerve-sparing technique in 11 men (39%). Seven of the 104 patients (6.7%) had positive surgical margins, but none of these were the men whose surgical plans were changed to a nerve-sparing technique.

In a separate statement, Dr. Margolis cautioned that the study participants had low-to-medium-grade cancer and that these results might not apply to all patients with prostate cancer.

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