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Abdominal Imaging

, Volume 37, Issue 4, pp 664–674 | Cite as

Radical prostatectomy: value of prostate MRI in surgical planning

  • Nelly TanEmail author
  • Daniel J. A. Margolis
  • Timothy D. McClure
  • Albert Thomas
  • David S. Finley
  • Robert E. Reiter
  • Jiaoti Huang
  • Steven S. Raman
Article

Abstract

The introduction of serum prostate-specific antigen to the prostate cancer screening algorithm has led to an increase in prostate cancer diagnosis as well as a migration toward lower-stage cancer at the time of diagnosis. This stage migration has coincided with changes in treatment options; these include active surveillance, new therapies, and advances in surgical techniques. Use of robot-assisted radical prostatectomy (RARP) as a surgical technique has seen a significant increase over the past several years: the number of patients undergoing RARP has risen from 1% to 40% of all prostatectomies from 2001–2006 to as many as 80% in 2010. The robotic interface provides a 3D magnified view of the surgical field, intuitive instrument manipulation, motion scaling, tremor filtration, and excellent dexterity and range of motion. However, in some cases, the lack of tactile (haptic) feedback may limit the surgeon’s decision making ability in assessing malignant involvement of the neurovascular bundles. Pre-operative planning relies on nomograms based on limited clinical and prostate biopsy information. The surgical decision to spare or resect the neurovascular bundles is based on clinical information which is not spatially or anatomically based. Advances in magnetic resonance imaging (MRI) may provide spatially localized information to fill this void and aid surgical planning, particularly for robotic surgeons. In this review, we discuss the potential role of pre-operative MRI in surgical planning for radical prostatectomy.

Keywords

Prostate MRI Surgical planning Multiparametric prostate imaging 

Abbreviations

PSA

Prostate-specific antigen

DRE

Digital rectal exam

RP

Radical prostatectomy

RRP

Radical retropubic prostatectomy

RARP

Robotic-assisted radical prostatectomy

eMRI

Endorectal coil MRI

DCE MRI

Dynamic contrast-enhanced MRI

MRSI

MR spectroscopic imaging

ADC

Apparent diffusion coefficient

DWI

Diffusion weighted imaging

ROC

Receiver operating characteristic

AUC

Area under the curve

ECE

Extracapsular extension

SVI

Seminal vesicle invasion

NVB

Neurovascular bundle

MUL

Mid-urethral length

PSM

Positive surgical margin

AA

African-American

GU

Genitourinary

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Nelly Tan
    • 1
    Email author
  • Daniel J. A. Margolis
    • 1
  • Timothy D. McClure
    • 1
  • Albert Thomas
    • 1
  • David S. Finley
    • 2
  • Robert E. Reiter
    • 2
  • Jiaoti Huang
    • 3
  • Steven S. Raman
    • 1
  1. 1.Department of RadiologyUniversity of California, Los AngelesLos AngelesUSA
  2. 2.Department of UrologyUniversity of California, Los AngelesLos AngelesUSA
  3. 3.Department of PathologyUniversity of California, Los AngelesLos AngelesUSA

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