According to a new study, preoperative MRI scans can guide surgeons to avoid damaging nerves while operating on prostate cancer patients. The study is highlighted online in the journal Radiology.
Prostate cancer is one of the main forms of the disease in the United States. Surgical removal of the prostate gland, also known as open radical prostatectomy, is among the main treatment options of prostate cancer. However, the procedure is accompanied with risks of damaging prostate nerves, causing incontinence and impotence.
Daniel J. A. Margolis, M.D., assistant professor of radiology at the David Geffen School of Medicine at the University of California Los Angeles, said "I think preoperative MRI will be useful for surgeons who are uncertain whether to spare or resect the nerves," He added "Our surgeons feel that, compared with clinical information alone, MRI is worthwhile for all patients, because it identifies important information leading to a change in the surgical plan in almost a third of patients."
A recently designed procedure, robotic-assisted laparoscopic prostatectomy (RALP), uses a surgical robot to make incisions smaller than those made during open radical prostatectomy. RALP is preferred because it has better cosmetic results, less blood loss, and less time needed for postoperative convalescence. Yet, some surgeons performing RALP lake enough details that would help them avoid damaging neurovascular bundles. The latter are collections of blood vessels and nerves that extend next to the prostate.
During the study, Dr. Margolis and his team evaluated the use of endorectal coil MR imaging in enhancing preoperative assessment of prostate cancer. 104 prostate cancer patients were involved in the study. All of them had preoperative endorectal coil MRI on the prostate and they went RALP later. The research team reviewed the differences in the surgical plan before and after studying MRI. The results were compared to the actual surgical and pathologic results.
It was reported that preoperative prostate MRI scans helped in deciding to go for a nerve-sparing technique while performing RALP in 27% of the involved patients (28 of 104). Of the 28 patients, 17 had their surgical plan changed to the nerve-sparing technique. The remaining 11 underwent non-nerve-sparing technique.
Dr. Margolis, however, said that the study was carried out on a small number of patients. He added that they mainly had low and medium grades of prostate cancer and the findings of the study may not apply to all patients. He explained "There is a learning curve for prostate MRI. What we and others have found is that one has to select patients where there is likely to be a benefit from the imaging."
