Impact of MRI-to-surgery interval on pathological upstaging after robot-assisted radical prostatectomy: a real-world cohort study

Multiparametric MRI (mpMRI) is widely used for preoperative staging and surgical planning in prostate cancer. However, discrepancies between radiological and pathological staging are common. We evaluated staging concordance and investigated whether the interval between mpMRI and surgery is associated with pathological upstaging.

We conducted a retrospective single-center cohort study involving 151 men who underwent robot-assisted radical prostatectomy between 2017 and 2020 and had preoperative mpMRI. Radiological T-stage was compared with final pathological staging. Associations between MRI-to-surgery interval, upstaging, and surgical margin status were analysed.

The average time between mpMRI and surgery was 144 days. mpMRI classified 83% of patients as T2 and 17% as T3; however, the final pathology revealed 35.8% with pT2 and 64.2% with pT3 disease. In total, 62.2% of patients were upstaged. Positive surgical margins were observed in 24.5% of cases, primarily among patients with pT3 disease (81%). Upstaging was correlated significantly with the time interval between mpMRI and surgery (p = 0.048). This association likely reflects confounding by indication, whereby patients with more aggressive disease were prioritised for earlier surgery.

mpMRI frequently underestimated pathological stage, particularly in detecting extracapsular extension. The observed association between shorter MRI-to-surgery interval and upstaging likely reflects clinical prioritisation of higher-risk disease rather than a causal effect of surgical delay. These findings highlight the importance of cautious interpretation of mpMRI in surgical planning and patient counselling.