Role of MRI in planning radical prostatectomy: what is the added value?

  • Jose MarencoEmail author
  • Clement Orczyk
  • Tom Collins
  • Caroline Moore
  • Mark Emberton
Topic Paper



The goal of radical prostatectomy is to eradicate oncological disease while achieving the best possible functional outcomes. In this regard, nerve sparing offers a greater chance of recovering potency after surgery. Accurately locating prostate cancer foci is instrumental for identifying good candidates for this approach whilst maintaining safe oncological margins. In addition to this, the length of membranous urethra is an independent predictor of time to, and extent of, continence recovery. The introduction of Mp-MRI allows visualising malignant tissue within the prostate gland, which could lead to image-directed surgery planning as with other solid-organ cancers such as kidney, pancreas, breast or testes.


A narrative review of the available literature was performed.


Mp-MRI demonstrated moderate sensitivity and high specificity to detect extra-capsular extension, seminal vesicle involvement or T3 stage. Measurements of membranous urethral length have shown to be useful in predicting probability of achieving continence after surgery. Furthermore, image-guided surgery has shown to be accurate to determine surgical planes to safely preserve neurovascular bundles.


The use of Mp-MRI for pre-surgical planning introduces a new scenario where the previously homogeneous radical prostatectomy can be tailored to suit patient and tumour features. This has the potential to improve functional outcomes whilst not compromising on surgical margins. Moreover, the introduction of Mp-MRI increases the ability to predict functional outcomes after surgery and allows for a more accurate local staging. This in turn provides more information to both patients and clinicians in the decision-making process regarding treatment.


Prostate cancer MRI Radical prostatectomy 


Author contributions

JM: data collection and manuscript writing. CO: data collection and manuscript editing. TC and CM: manuscript editing. ME: manuscript editing and supervision.


The authors confirm that all the funded sources were the following: none.

Compliance with ethical standards

Conflict of interest

Mark Emberton receives research support from the United Kingdom’s National Institute of Health Research (NIHR) UCLH/UCL Biomedical Research Centre. He has been an NIHR Senior Investigator since 2013. The remaining authors declare that they have no conflict of interest.

Ethical statement

Ethical standard was locally reviewed for this trial.


  1. 1.
    Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N et al (2012) Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol 61(3):480–487CrossRefGoogle Scholar
  2. 2.
    Feng T, Sharif-Afshar A, Wu J, Li Q, Luthringer D, Saouaf R et al (2015) Multiparametric MRI improves accuracy of clinical nomograms for predicting extracapsular extension of prostate cancer. Urology 86(2):332–337CrossRefGoogle Scholar
  3. 3.
    Ahmed H, El-Shater Bosaily A, Brown L, Gabe R, Kaplan R, Parmar M et al (2017) Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 389(10071):815–822CrossRefGoogle Scholar
  4. 4.
    Kasivisvanathan V, Rannikko A, Borghi M, Panebianco V, Mynderse L, Vaarala M et al (2018) MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 378(19):1767–1777CrossRefGoogle Scholar
  5. 5.
    Dell’Oglio P, Stabile A, Dias B, Gandaglia G, Mazzone E, Fossati N et al (2018) Impact of multiparametric MRI and MRI-targeted biopsy on pre-therapeutic risk assessment in prostate cancer patients candidate for radical prostatectomy. World J Urol 37:221–234CrossRefGoogle Scholar
  6. 6.
    Faria R, Soares M, Spackman E, Ahmed H, Brown L, Kaplan R et al (2018) Optimising the diagnosis of prostate cancer in the era of multiparametric magnetic resonance imaging: a cost-effectiveness analysis based on the prostate mr imaging study (PROMIS). Eur Urol 73(1):23–30CrossRefGoogle Scholar
  7. 7.
    Mungovan S, Sandhu J, Akin O, Smart N, Graham P, Patel M (2017) Preoperative membranous urethral length measurement and continence recovery following radical prostatectomy: a systematic review and meta-analysis. Eur Urol 71(3):368–378CrossRefGoogle Scholar
  8. 8.
    Spigelman S, McNeal J, Freiha F, Stamey T (1986) Rectal Examination in volume determination of carcinoma of the prostate: clinical and anatomical correlations. J Urol 136(6):1228–1230CrossRefGoogle Scholar
  9. 9.
    Weiner A, Matulewicz R, Schaeffer E, Liauw S, Feinglass J, Eggener S (2017) Contemporary management of men with high-risk localized prostate cancer in the United States. Prost Cancer Prost Dis 20(4):442–442CrossRefGoogle Scholar
  10. 10.
    Rayn KN, Bloom JB, Gold SA, Hale GR, Baiocco JA, Mehralivand S et al (2018) Added value of multiparametric magnetic resonance imaging to clinical nomograms in predicting adverse pathology in prostate cancer. J Urol 200:1041–1047CrossRefGoogle Scholar
  11. 11.
    de Rooij M, Hamoen E, Witjes J, Barentsz J, Rovers M (2016) Accuracy of magnetic resonance imaging for local staging of prostate cancer: a diagnostic meta-analysis. Eur Urol 70(2):233–245CrossRefGoogle Scholar
  12. 12.
    Yuh B, Artibani W, Heidenreich A, Kimm S, Menon M, Novara G et al (2014) The role of robot-assisted radical prostatectomy and pelvic lymph node dissection in the management of high-risk prostate cancer: a systematic review. Eur Urol 65(5):918–927CrossRefGoogle Scholar
  13. 13.
    Hövels A, Heesakkers R, Adang E, Jager G, Strum S, Hoogeveen Y et al (2008) The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol 63(4):387–395CrossRefGoogle Scholar
  14. 14.
    Brembilla G, Dell’Oglio P, Stabile A, Ambrosi A, Cristel G, Brunetti L et al (2017) Preoperative multiparametric MRI of the prostate for the prediction of lymph node metastases in prostate cancer patients treated with extended pelvic lymph node dissection. Eur Radiol 28(5):1969–1976CrossRefGoogle Scholar
  15. 15.
    Suardi N, Moschini M, Gallina A, Gandaglia G, Abdollah F, Capitanio U et al (2012) Nerve-sparing approach during radical prostatectomy is strongly associated with the rate of postoperative urinary continence recovery. BJU Int 111(5):717–722CrossRefGoogle Scholar
  16. 16.
    Kiyoshima K, Yokomizo A, Yoshida T, Tomita K, Yonemasu H, Nakamura M et al (2004) Anatomical features of periprostatic tissue and its surroundings: a histological analysis of 79 radical retropubic prostatectomy specimens. Jpn J Clin Oncol 34(8):463–468CrossRefGoogle Scholar
  17. 17.
    Schiavina R, Bianchi L, Borghesi M, Dababneh H, Chessa F, Pultrone C et al (2018) MRI displays the prostatic cancer anatomy and improves the bundles management before robot-assisted radical prostatectomy. J Endourol 32(4):315–321CrossRefGoogle Scholar
  18. 18.
    Panebianco V, Salciccia S, Cattarino S, Minisola F, Gentilucci A, Alfarone A et al (2012) Use of multiparametric MR with neurovascular bundle evaluation to optimize the oncological and functional management of patients considered for nerve-sparing radical prostatectomy. J Sex Med 9(8):2157–2166CrossRefGoogle Scholar
  19. 19.
    Ficarra V, Novara G, Rosen R, Artibani W, Carroll P, Costello A et al (2012) Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 62(3):405–417CrossRefGoogle Scholar
  20. 20.
    Coakley F, Eberhardt S, Kattan M, Wei D, Scardino P, Hricak H (2002) Urinary Continence after radical retropubic prostatectomy: relationship with membranous urethral length on preoperative endorectal magnetic resonance imaging. J Urol 168(3):1032–1035CrossRefGoogle Scholar
  21. 21.
    Paparel P, Akin O, Sandhu J, Otero J, Serio A, Scardino P et al (2009) Recovery of urinary continence after radical prostatectomy: association with urethral length and urethral fibrosis measured by preoperative and postoperative endorectal magnetic resonance imaging. Eur Urol 55(3):629–639CrossRefGoogle Scholar
  22. 22.
    Rassweiler M, Klein J, Mueller M, Meinzer H, Rassweiler J (2016) 578 IPad assisted PCNL—clinical study to compare to the standard puncturing technique. Eur Urol Suppl 15(3):e578–e578aCrossRefGoogle Scholar
  23. 23.
    Furukawa J, Miyake H, Tanaka K, Sugimoto M, Fujisawa M (2014) Console-integrated real-time three-dimensional image overlay navigation for robot-assisted partial nephrectomy with selective arterial clamping: early single-centre experience with 17 cases. Int J Med Robot Comput Assist Surg 10(4):385–390CrossRefGoogle Scholar
  24. 24.
    Mohareri O, Ischia J, Black P, Schneider C, Lobo J, Goldenberg L et al (2015) Intraoperative registered transrectal ultrasound guidance for robot-assisted laparoscopic radical prostatectomy. J Urol 193(1):302–312CrossRefGoogle Scholar
  25. 25.
    Ukimura O, Gill IS (2008) Imaging-assisted endoscopic surgery: Cleveland Clinic experience. J Endourol 22:803–810CrossRefGoogle Scholar
  26. 26.
    Simpfendörfer T, Baumhauer M, Müller M, Gutt C, Meinzer H, Rassweiler J et al (2011) Augmented reality visualization during laparoscopic radical prostatectomy. J Endourol 25(12):1841–1845CrossRefGoogle Scholar
  27. 27.
    Porpiglia F, Fiori C, Checcucci E, Amparore D, Bertolo R (2018) Augmented reality robot-assisted radical prostatectomy: preliminary experience. Urology 115:184CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.University College London Hospital, NHS Foundation TrustLondonUK
  2. 2.Division of Surgery and Interventional ScienceUniversity College of LondonLondonUK

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