Role of Multiparametric Magnetic Resonance Imaging of the Prostate in Surgical Planning of Radical Prostatectomy

Parodi S1,2*, Tappero S1, O’Malley KJ2, Borghesi M1 and Terrone C1

1IRCCS San Martino Polyclinic Hospital in Genoa, Urology Complex Operational Unit, Italy
2Department of Urology, Mater Private Hospital Network, Dublin, Ireland

^*Correspondance to: Stefano Parodi 

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Abstract:

The nerve sparing technique offers better functional outcomes (urinary continence and erectile function) at cost of arguably higher risk of positive surgical margins. The EAU guidelines affirm there is no conclusive data to recommend for or against nerve sparing. Therefore, the preoperative available factors (e.g. digital-rectal-examination and bioptic findings, and multiparametric MRI) are discretionarily used by the urologist while counselling patients undergoing radical prostatectomy regarding a nerve sparing technique. Although the prostate multiparametric MRI is routine practice to guide nerve sparing nowadays, its accuracy performance for local staging is far from consistent among the literature, ranging 0% to 100%. Our study aims at assessing its role in surgical planning in a real-world workframe. 356 consecutive patients undergone radical prostatectomy were enrolled at two institutions. Their preoperative local staging was compared to their wholemount pathological findings to assess whether being confirmed as localized or locally advanced. Local staging was correct in only 37% of overall population, in 28% of patients with positive surgical margins, in 37% of those with multifocal positive surgical margins and in 33% of high-risk patients with positive surgical margins. We confirm an important role of multiparametric MRI of the prostate in surgical planning of radical prostatectomy; nevertheless, our results also demonstrate that a peripherally performed mpMRI is not reliable enough to guide nerve sparing as a stand-alone technique. Finally, we reiterate the importance of rectal-examination and bioptic findings in surgical planning. An individualized combination of multiparametric MRI, rectal examination and bioptic findings can accurately select patients for a safe nerve sparing technique, both in every-risk and high-risk subsets of patients.

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Cite the Article:

Parodi S, Tappero S, O’Malley KJ, Borghesi M, Terrone C. Role of Multiparametric Magnetic Resonance Imaging of the Prostate in Surgical Planning of Radical Prostatectomy. Ann Clin Case Rep. 2024; 9: 2641..