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Published on: October 10, 2019
Association of surgical margin positivity with preoperative mpMRI-identified index lesions in radical prostatectomy A
Ahmet Halis1, Mucahit Gelmis2, Ufuk Caglar1
1Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey.
Introduction:
Prostate cancer remains the second most common malignancy in men worldwide. Positive surgical margins (PSMs) following radical prostatectomy are associated with an increased risk of biochemical recurrence. This study investigated the relationship between preoperative multiparametric magnetic resonance imaging (mpMRI)-detected index lesions and PSMs, aiming to assess whether specific lesion locations correlate with margin involvement.
Methods:
A retrospective cohort study was conducted at Health Sciences University Haseki Training and Research Hospital, analyzing 148 patients who underwent radical prostatectomy between 2017 and 2023. Patients were stratified based on surgical margin status, with comparisons made between mpMRI features, pathologic outcomes, and the anatomical distribution of PSMs. Binary logistic regression was used to identify independent predictors of PSMs.
Results:
Of the 148 patients, 49 had PSMs. Higher preoperative prostate-specific antigen levels, prostate-specific antigen density, and Prostate Imaging-Reporting and Data System (PI-RADS) scores were significantly associated with PSMs. Multivariate analysis revealed that PI-RADS 5, International Society of Urological Pathology grade 4 or above, and extraprostatic extension were independent predictors of PSMs. Although lesions in the apical and posterior regions showed higher rates of PSMs, the regional differences were not statistically significant.
Conclusions:
Our findings suggest that mpMRI plays a critical role in preoperative risk stratification and may guide surgical planning to reduce PSMs; however, further prospective studies are needed to validate these results and explore the potential benefits of targeted resections in high-risk regions for improving oncologic outcomes.
Insights
Multiparametric MRI (mpMRI) can help predict positive surgical margins in prostate cancer. Higher PI-RADS scores and specific tumor features indicate increased risk, guiding surgical planning to improve outcomes.
Area of Science:
- Urology
- Oncology
- Radiology
Background:
- Prostate cancer is a leading malignancy in men globally.
- Positive surgical margins (PSMs) after radical prostatectomy correlate with higher recurrence risk.
- Preoperative assessment is crucial for optimizing surgical outcomes.
Purpose of the Study:
- To investigate the association between preoperative multiparametric MRI (mpMRI)-detected index lesions and PSMs.
- To determine if specific lesion locations correlate with margin involvement during prostatectomy.
- To assess mpMRI's role in predicting PSMs and guiding surgical planning.
Main Methods:
- Retrospective cohort study of 148 patients undergoing radical prostatectomy (2017-2023).
- Analysis of mpMRI features, including PI-RADS scores, and their correlation with PSMs.
- Binary logistic regression used to identify independent predictors of PSMs.
Main Results:
- 49 out of 148 patients had PSMs.
- Higher preoperative PSA, PSA density, and PI-RADS scores were significantly associated with PSMs.
- PI-RADS 5, high-grade tumors (ISUP 4+), and extraprostatic extension independently predicted PSMs; regional differences were not significant.
Conclusions:
- mpMRI is valuable for preoperative risk stratification in prostate cancer.
- mpMRI findings can potentially guide surgical planning to minimize PSMs.
- Further prospective studies are warranted to validate findings and explore targeted resection benefits.
