All investigators participated in study design and reviewed the final article.
The role of preoperative endorectal magnetic resonance imaging in the decision regarding whether to preserve or resect neurovascular bundles during radical retropubic prostatectomy
Article first published online: 11 MAY 2004
Copyright © 2004 American Cancer Society
Volume 100, Issue 12, pages 2655–2663, 15 June 2004
How to Cite
Hricak, H., Wang, L., Wei, D. C., Coakley, F. V., Akin, O., Reuter, V. E., Gonen, M., Kattan, M. W., Onyebuchi, C. N. and Scardino, P. T. (2004), The role of preoperative endorectal magnetic resonance imaging in the decision regarding whether to preserve or resect neurovascular bundles during radical retropubic prostatectomy. Cancer, 100: 2655–2663. doi: 10.1002/cncr.20319
- Issue published online: 2 JUN 2004
- Article first published online: 11 MAY 2004
- Manuscript Accepted: 31 MAR 2004
- Manuscript Revised: 26 MAR 2004
- Manuscript Received: 18 FEB 2004
- U.S. National Institutes of Health. Grant Number: R01 CA76423
- magnetic resonance imaging (MRI);
- endorectal magnetic resonance imaging (eMRI);
- prostate neoplasm;
- erectile dysfunction;
Because the recovery of erectile function and the avoidance of positive surgical margins are important but competing outcomes, the decision to preserve or resect a neurovascular bundle (NVB) during radical prostatectomy (RP) should be based on the most accurate information concerning the location and extent of the tumor. In the current study, the authors determined the incremental value of endorectal magnetic resonance imaging (eMRI) in making this decision.
eMRI was performed in 135 patients preoperatively. For each NVB, tumor extension to the NVB and the need for NVB resection was judged by a surgeon on a scale from 1 (definite preservation) to 5 (definite resection) before and after reviewing eMRI with a radiologist. Histopathologic findings were used as the standard of reference. The value of eMRI was assessed using binormal receiver operating characteristic (ROC) analysis adjusted for multiple observations per patient, and a mixed effects ordinal regression model was used for risk stratification.
Histopathologic examination determined that NVB resection was warranted in 44 of 270 NVBs (16%) because of posterolateral extracapsular extension (n = 29), positive surgical margins (n = 7), or both (n = 8). The areas under the ROC curves (AUC) were 0.741 for pre-MRI and 0.832 for post-MRI surgical planning (P < 0.01). MRI findings suggested altering the surgical plan in 39% of NVBs (106 of 270 NVBs). When the surgeon judged that the NVB resection was definitely not necessary (165 NVBs), MRI confirmed that decision in 138 NVBs (84%); the concordant decision was correct in 96% of the cases (133 of 138 NVBs). In 36 high-risk patients (≥ 75% probability of extracapsular extension), MRI findings changed the surgical plan for 28 NVBs (78%); the change was found to be appropriate in 26 cases (93%).
MRI was found to significantly improve the surgeon's decision to preserve or resect the NVB during radical prostatectomy. Cancer 2004. © 2004 American Cancer Society.