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Preoperative mpMRI Possibly Beneficial in High-Risk Prostate Cancer

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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.

Reference

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

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