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Preoperative prostate magnetic resonance imaging does not impact surgical outcomes of radical prostatectomy
Christopher K Bozorgmehr1, Johnny Wang1, James T Gross1
1Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Objective:
We reviewed our institutional experience of radical prostatectomy with and without preoperative multiparametric magnetic resonance imaging (mpMRI) to assess the impact of preoperative prostate mpMRI on surgical outcomes of radical prostatectomy.
Methods:
We identified patients at our institution who underwent radical prostatectomy for prostate cancer (PCa) between January 2012 and December 2017 (n = 1044). Using propensity scoring analysis, patients who underwent preoperative mpMRI (n = 285) were matched 1:1 to patients who did not receive preoperative mpMRI (n = 285). Multivariable regression analysis was performed to identify factors predictive of operative time, estimated blood loss (EBL), lymph node yield, rates of complications within 30 days, and positive surgical margin (PSM).
Results:
There were no significant differences in operative time, EBL, PSM, lymph node yield, or complication rates between the two cohorts. Multivariable analysis demonstrated that preoperative mpMRI was not predictive of the measured perioperative outcomes. Significant comorbidity (Charlson Comorbidity Index ≥3) was the sole predictor of perioperative complications (P = 0.015). Increasing biopsy Gleason score predicted increased lymph node yield (P < 0.001). The probability of PSM was associated with increasing preoperative prostate-specific antigen (odds ratio 1.036, P = 0.009). Body mass index was a predictor of operative time (P = 0.016) and EBL (P = 0.001).
Conclusions:
Although preoperative mpMRI has an important role in the diagnosis and staging of PCa, it does not impact perioperative radical prostatectomy outcomes. Our findings do not support the routine use of preoperative mpMRI for surgical planning in patients already diagnosed with clinically localized PCa.
Insights
Preoperative multiparametric magnetic resonance imaging (mpMRI) does not improve surgical outcomes for radical prostatectomy in prostate cancer patients. Routine use of mpMRI for surgical planning in localized prostate cancer is not supported by these findings.
Area of Science:
- Urology
- Oncology
- Radiology
Background:
- Radical prostatectomy is a primary treatment for localized prostate cancer.
- Preoperative multiparametric magnetic resonance imaging (mpMRI) is increasingly used for prostate cancer diagnosis and staging.
- The impact of mpMRI on radical prostatectomy surgical outcomes remains under investigation.
Purpose of the Study:
- To assess the impact of preoperative prostate mpMRI on surgical outcomes of radical prostatectomy.
- To compare perioperative outcomes between patients who underwent radical prostatectomy with and without preoperative mpMRI.
Main Methods:
- Retrospective review of 1044 patients undergoing radical prostatectomy between 2012 and 2017.
- Propensity score matching (1:1) of 285 patients with preoperative mpMRI to 285 patients without.
- Multivariable regression analysis to identify predictors of operative time, estimated blood loss (EBL), lymph node yield, 30-day complications, and positive surgical margin (PSM).
Main Results:
- No significant differences were observed in operative time, EBL, PSM, lymph node yield, or complication rates between the mpMRI and no-mpMRI cohorts.
- Preoperative mpMRI was not a significant predictor of the measured perioperative outcomes.
- Significant comorbidity (Charlson Comorbidity Index ≥3) predicted complications; biopsy Gleason score predicted lymph node yield; PSA predicted PSM; BMI predicted operative time and EBL.
Conclusions:
- Preoperative mpMRI does not significantly impact perioperative outcomes in radical prostatectomy for prostate cancer.
- Findings do not support the routine use of preoperative mpMRI for surgical planning in patients with clinically localized prostate cancer.
- Further research may explore specific subgroups or advanced imaging techniques.
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