2039 PERI-OPERATIVE OUTCOME OF RADICAL PROSTATECTOMY FOR INTERMEDIATE AND HIGH-RISK PROSTATE CANCER AFTER PRE-OPERATIVE MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGING (2010)

You have accessJournal of UrologyProstate Cancer: Localized X1 Apr 20102039 PERI-OPERATIVE OUTCOME OF RADICAL PROSTATECTOMY FOR INTERMEDIATE AND HIGH-RISK PROSTATE CANCER AFTER PRE-OPERATIVE MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGING Jennifer Robles, Tung-chin Hsieh, Gopal Gupta, Gennady Bratslavsky, Baris Turkbey, Peter Choyke, W. Marston Linehan, and Peter Pinto Jennifer RoblesJennifer Robles Bethesda, MD More articles by this author , Tung-chin HsiehTung-chin Hsieh Washington, DC More articles by this author , Gopal GuptaGopal Gupta Bethesda, MD More articles by this author , Gennady BratslavskyGennady Bratslavsky Bethesda, MD More articles by this author , Baris TurkbeyBaris Turkbey Bethesda, MD More articles by this author , Peter ChoykePeter Choyke Bethesda, MD More articles by this author , W. Marston LinehanW. Marston Linehan Bethesda, MD More articles by this author , and Peter PintoPeter Pinto Bethesda, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2085AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intermediate and high-risk prostate cancer (PCa) is associated with worse oncologic outcomes with published positive margin rates as high as 50%. Our goal is to assess the impact of multi-parametric magnetic resonance imaging (MP-MRI), incorporating T2-weighted, dynamic contrast enhanced, spectroscopic, and diffusion weighted magnetic imaging, on the surgical outcomes of intermediate and high-risk patients undergoing radical prostatectomy. METHODS We retrospectively analyzed 182 radical prostatectomies from 1/2004 to 8/2009. All patients had biopsy confirmed PCa with localized disease on pre-operative 3 Tesla MP-MRI. Modifications of surgical procedure based on imaging were identified and correlated with MP-MRI status. Functional outcomes were analyzed by Sexual Health Inventory for Men (SHIM) and International Prostate Symptom Score (IPSS). Both were administered anonymously via mail. RESULTS MP-MRI abnormalities suspicious for PCa were found in 172 patients (95%). Final pathology placed 83% of the entire cohort in the intermediate to high-risk category based on established risk stratification. The overall positive margin rate was 23% (T2: 20.1%, T3: 27%). 141 surgeries were altered by frozen section analysis of the lateral margins or by resection of the neurovascular bundle (NVB) due to suspicion of locally advanced disease on MP-MRI. At 1 year post-prostatectomy, a change from baseline SHIM score correlated with nerve sparing status and IPSS scores improved. CONCLUSIONS MP-MRI status appears to alter the surgical management of intermediate to high-risk patients by increasing the frequency of NVB resection and decreasing the positive margin rate. In addition, SHIM scores were impacted favorably by pre-operative MP-MRI guided sparing of the unaffected NVB. Further studies may determine if MP-MRI should be incorporated into pre-surgical planning for these patients. Table 2. No ED (SHIM: >22) Nerve Sparing Pre-Op SHIM 12 Mo. Post-Op SHIM % Change Pre-Op IPSS 12 Mo. Post-Op IPSS % Change B/L 24.1 15.2 -37% 7.2 4.2 -41% Uni 24.2 12.8 -47% 8.0 8.3 3% No 23.0 7.0 -70% 7.0 2.0 -71% Total 24.1 14.7 -39% 7.3 4.6 -36% Mild ED (SHIM: 17-21) Nerve Sparing Pre-Op SHIM 12 Mo. Post-Op SHIM % Change Pre-Op IPSS 12 Mo. Post-Op IPSS % Change B/L 19.3 8.1 -58% 8.9 2.7 -69% Uni 19.8 2.7 -86% 7.0 4.7 -33% No Total 19.6 6.6 -66% 8.5 3.3 -62% © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e791-e792 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer Robles Bethesda, MD More articles by this author Tung-chin Hsieh Washington, DC More articles by this author Gopal Gupta Bethesda, MD More articles by this author Gennady Bratslavsky Bethesda, MD More articles by this author Baris Turkbey Bethesda, MD More articles by this author Peter Choyke Bethesda, MD More articles by this author W. Marston Linehan Bethesda, MD More articles by this author Peter Pinto Bethesda, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...