Prostate MRI prior to radical prostatectomy: effects on nerve sparing and pathological margin status
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, 2Dep...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2017-04-01
|
| Series: | Research and Reports in Urology |
| Subjects: | |
| Online Access: | https://www.dovepress.com/prostate-mri-prior-to-radical-prostatectomy-effects-on-nerve-sparing-a-peer-reviewed-article-RRU |
| _version_ | 1798043748884545536 |
|---|---|
| author | Druskin SC Liu JJ Young A Feng Z Dianat SS Ludwig WW Trock BJ Macura KJ Pavlovich CP |
| author_facet | Druskin SC Liu JJ Young A Feng Z Dianat SS Ludwig WW Trock BJ Macura KJ Pavlovich CP |
| author_sort | Druskin SC |
| collection | DOAJ |
| description | 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 |
| first_indexed | 2024-04-11T22:53:29Z |
| format | Article |
| id | doaj.art-44b98e3d2ec847229d0f5acd73c06c3e |
| institution | Directory Open Access Journal |
| issn | 2253-2447 |
| language | English |
| last_indexed | 2024-04-11T22:53:29Z |
| publishDate | 2017-04-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Research and Reports in Urology |
| spelling | doaj.art-44b98e3d2ec847229d0f5acd73c06c3e2022-12-22T03:58:30ZengDove Medical PressResearch and Reports in Urology2253-24472017-04-01Volume 9556332426Prostate MRI prior to radical prostatectomy: effects on nerve sparing and pathological margin statusDruskin SCLiu JJYoung AFeng ZDianat SSLudwig WWTrock BJMacura KJPavlovich CPSasha 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 prostatectomyhttps://www.dovepress.com/prostate-mri-prior-to-radical-prostatectomy-effects-on-nerve-sparing-a-peer-reviewed-article-RRUMRIpositive surgical marginsnerve sparingextra-capsular extensionradical prostatectomy |
| spellingShingle | Druskin SC Liu JJ Young A Feng Z Dianat SS Ludwig WW Trock BJ Macura KJ Pavlovich CP Prostate MRI prior to radical prostatectomy: effects on nerve sparing and pathological margin status Research and Reports in Urology MRI positive surgical margins nerve sparing extra-capsular extension radical prostatectomy |
| title | Prostate MRI prior to radical prostatectomy: effects on nerve sparing and pathological margin status |
| title_full | Prostate MRI prior to radical prostatectomy: effects on nerve sparing and pathological margin status |
| title_fullStr | Prostate MRI prior to radical prostatectomy: effects on nerve sparing and pathological margin status |
| title_full_unstemmed | Prostate MRI prior to radical prostatectomy: effects on nerve sparing and pathological margin status |
| title_short | Prostate MRI prior to radical prostatectomy: effects on nerve sparing and pathological margin status |
| title_sort | prostate mri prior to radical prostatectomy effects on nerve sparing and pathological margin status |
| topic | MRI positive surgical margins nerve sparing extra-capsular extension radical prostatectomy |
| url | https://www.dovepress.com/prostate-mri-prior-to-radical-prostatectomy-effects-on-nerve-sparing-a-peer-reviewed-article-RRU |
| work_keys_str_mv | AT druskinsc prostatemripriortoradicalprostatectomyeffectsonnervesparingandpathologicalmarginstatus AT liujj prostatemripriortoradicalprostatectomyeffectsonnervesparingandpathologicalmarginstatus AT younga prostatemripriortoradicalprostatectomyeffectsonnervesparingandpathologicalmarginstatus AT fengz prostatemripriortoradicalprostatectomyeffectsonnervesparingandpathologicalmarginstatus AT dianatss prostatemripriortoradicalprostatectomyeffectsonnervesparingandpathologicalmarginstatus AT ludwigww prostatemripriortoradicalprostatectomyeffectsonnervesparingandpathologicalmarginstatus AT trockbj prostatemripriortoradicalprostatectomyeffectsonnervesparingandpathologicalmarginstatus AT macurakj prostatemripriortoradicalprostatectomyeffectsonnervesparingandpathologicalmarginstatus AT pavlovichcp prostatemripriortoradicalprostatectomyeffectsonnervesparingandpathologicalmarginstatus |