Preop MRI aids prostate cancer surgery
Surgeons are able to make more informed decisions about nerve-sparing procedures in men with prostate cancer if they use preoperative MRI, a study suggests.
Conducted by researchers at the School of Medicine at the University of California Los Angeles, the study found preoperative prostate MRI data changed the decision to use a nerve-sparing technique in treating sufferers.
Robotic-assisted laparoscopic prostatectomy (RALP) is a new treatment performed with the assistance of a surgical robot. RALP uses smaller incisions than those of open radical prostatectomy and offers improved cosmetic results, less blood loss and briefer postoperative convalescence.
It is common to remove the prostate in an attempt to treat the disease, but the procedure can lead to incontinence and impotence.
Dr Daniel Margolis, assistant professor of radiology at the university’s David Geffen School of Medicine, worked with colleagues to evaluate 104 prostate cancer patients who underwent preoperative endorectal coil MRI of the prostate and subsequent RALP.
The researchers 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.
Preoperative prostate MRI data changed the decision to use a nerve-sparing technique during RALP in 28 (27 percent) of the 104 patients. The surgical plan was changed to the nerve-sparing technique in 17 (61 percent) of the 28 patients and to a non-nerve-sparing technique in 11 patients (39 percent).
“I think preoperative MRI will be useful for surgeons who are uncertain whether to spare or resect the nerves,” said Dr Margolis.
He did, however, caution that the study group represented men with low to medium grade cancer, and warned the findings might not apply to all patients.
- McClure T, et al. Use of MR Imaging to Determine Preservation of the Neurovascular Bundles at Robotic-assisted Laparoscopic Prostatectomy. Radiology 2012; Advance online publication.