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Radical prostatectomy: value of prostate MRI in surgical planning

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Abstract

The introduction of serum prostate-specific antigen to the prostate cancer screening algorithm has led to an increase in prostate cancer diagnosis as well as a migration toward lower-stage cancer at the time of diagnosis. This stage migration has coincided with changes in treatment options; these include active surveillance, new therapies, and advances in surgical techniques. Use of robot-assisted radical prostatectomy (RARP) as a surgical technique has seen a significant increase over the past several years: the number of patients undergoing RARP has risen from 1% to 40% of all prostatectomies from 2001–2006 to as many as 80% in 2010. The robotic interface provides a 3D magnified view of the surgical field, intuitive instrument manipulation, motion scaling, tremor filtration, and excellent dexterity and range of motion. However, in some cases, the lack of tactile (haptic) feedback may limit the surgeon’s decision making ability in assessing malignant involvement of the neurovascular bundles. Pre-operative planning relies on nomograms based on limited clinical and prostate biopsy information. The surgical decision to spare or resect the neurovascular bundles is based on clinical information which is not spatially or anatomically based. Advances in magnetic resonance imaging (MRI) may provide spatially localized information to fill this void and aid surgical planning, particularly for robotic surgeons. In this review, we discuss the potential role of pre-operative MRI in surgical planning for radical prostatectomy.

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Abbreviations

PSA:

Prostate-specific antigen

DRE:

Digital rectal exam

RP:

Radical prostatectomy

RRP:

Radical retropubic prostatectomy

RARP:

Robotic-assisted radical prostatectomy

eMRI:

Endorectal coil MRI

DCE MRI:

Dynamic contrast-enhanced MRI

MRSI:

MR spectroscopic imaging

ADC:

Apparent diffusion coefficient

DWI:

Diffusion weighted imaging

ROC:

Receiver operating characteristic

AUC:

Area under the curve

ECE:

Extracapsular extension

SVI:

Seminal vesicle invasion

NVB:

Neurovascular bundle

MUL:

Mid-urethral length

PSM:

Positive surgical margin

AA:

African-American

GU:

Genitourinary

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Authors and Affiliations

  1. Department of Radiology, University of California, Los Angeles, Los Angeles, CA, 90095, USA

    Nelly Tan, Daniel J. A. Margolis, Timothy D. McClure, Albert Thomas & Steven S. Raman

  2. Department of Urology, University of California, Los Angeles, Los Angeles, CA, 90095, USA

    David S. Finley & Robert E. Reiter

  3. Department of Pathology, University of California, Los Angeles, Los Angeles, CA, 90095, USA

    Jiaoti Huang

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  1. Nelly Tan
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  2. Daniel J. A. Margolis
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Correspondence to Nelly Tan.

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Tan, N., Margolis, D.J.A., McClure, T.D. et al. Radical prostatectomy: value of prostate MRI in surgical planning. Abdom Imaging 37, 664–674 (2012). https://doi.org/10.1007/s00261-011-9805-y

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