Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

How can mpMRI help surgical planning in high risk prostate cancer?

Prostate Cancer and Prostatic Diseases volume 23, pages 364–365 (2020)Cite this article

Subjects

Multiparametric magnetic resonance imaging (mpMRI) represents nowadays an essential tool to guide radical prostatectomy (RP). Despite nerve sparing (NS) approach was traditionally precluded in high risk prostate cancer (HRPC) patients, Kumar et al. [1] suggested that a selective NS could be feasible even in HRPC patients with acceptable positive surgical margins (PSMs) rates. Of note, accurate preoperative selection of ideal candidates to NS surgery, especially in HRPC [2], is key. For this reason, we read with interest the article by Baack et al. [3], thought the innovative way of retrospective survey, the authors evaluated the impact of mpMRI on surgical plan in HRPC both considering NS approach, pelvic lymph node dissection (PLND) template, bladder neck approach and surgical technique. They found that all patients had at least one change to their surgical plan by urologists. Interestingly, considering the NS technique, the authors found that NS approach was changed in 58% of cases with overall appropriateness of 72%, which is consistent with our previous data with overall change in roughly 50% of cases, resulting an overall appropriateness of 75% [4]. This paper confirms the important role of mpMRI even in HRPC in which NS approach is usually not considered for higher risk of extracapsular extension, suggesting that in selective cases of HRPC an incremental NS approach could be oncologically safe only with a preoperative mpMRI.

However, one important limitation is the lack of comparison between the intended approach from the survey and the real surgical plan performed during surgery. As we know, the preoperative intended surgical plan (even after revision of mpMRI) could go through some modifications during surgery. Moreover, the definition of appropriateness of the surgical plan change (defined as presence of extra-prostatic extension at pathologic specimen) is not ideal, since it considers only the first surgical outcomes of robotic RP (moreover it does not consider the presence of PSMs) rather than a real oncologic outcome (i.e. biochemical recurrence) or the postoperative erectile function.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Kumar A, Samavedi S, Bates AS, Mouraviev V, Coelho RF, Rocco B, et al. Safety of selective nerve sparing in high risk prostate cancer during robot-assisted radical prostatectomy. J Robot Surg. 2016;11:129–38.

    Article  Google Scholar 

  2. Schiavina R, Bianchi L, Mineo Bianchi F, Borghesi M, Pultrone CV, Dababneh H, et al. Preoperative staging with 11C-choline PET/CT is adequately accurate in patients with very high-risk prostate cancer. Clin Genitourin Cancer. 2018;16:305–12.

    Article  Google Scholar 

  3. Baack KJ, Bathala TK, Reichard CA, Troncoso P, Delacroix S, Davies B, et al. Impact of preoperative prostate magnetic resonance imaging on the surgical management of high-risk prostate cancer. Prostate Cancer Prostatic Dis. 2019.

  4. Schiavina R, Bianchi L, Borghesi M, Dababneh H, Chessa F, Pultrone CV, et al. MRI displays the prostatic cancer anatomy and improves the bundles management before robot-assisted radical prostatectomy. J Endourol. 2018;32:315–21.

    Article  Google Scholar 

  5. Gandaglia G, Ploussard G, Valerio M, Mattei A, Fiori C, Fossati N, et al. A novel nomogram to identify candidates for extended pelvic lymph node dissection among patients with clinically localized prostate cancer diagnosed with magnetic resonance imaging-targeted and systematic biopsies. Eur Urol. 2018;75:506–14.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Via Palagi 9, 40138, Bologna, Italy

    Lorenzo Bianchi, Riccardo Schiavina & Eugenio Brunocilla

  2. Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy

    Lorenzo Bianchi, Riccardo Schiavina & Eugenio Brunocilla

Authors
  1. Lorenzo Bianchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Riccardo Schiavina
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eugenio Brunocilla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lorenzo Bianchi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bianchi, L., Schiavina, R. & Brunocilla, E. How can mpMRI help surgical planning in high risk prostate cancer?. Prostate Cancer Prostatic Dis 23, 364–365 (2020). https://doi.org/10.1038/s41391-019-0192-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41391-019-0192-8

Search

Advanced search

Quick links