Better prostate cancer surgery outcomes linked to MRI technique
October 1, 2010
Multi-parametric magnetic resonance imaging (MP-MRI) in patients with intermediate or advanced prostate cancer offers additional information sufficient enough to allow surgeons to alter management plans to the benefit of the patient.
Bethesda, MD-Multi-parametric magnetic resonance imaging (MP-MRI) in patients with intermediate or advanced prostate cancer offers additional information sufficient enough to allow surgeons to alter management plans to the benefit of the patient, results from a recent study indicate.
The application of the four individual imaging technologies incorporated in MP-MRI, rather than one, tends to reduce the incidence of positive margins and increase the frequency of surgical intervention and preservation of neurovascular bundles in moderate- and high-risk patients who might otherwise be scheduled for radiation therapy, according to the study's authors.
"We believe that multi-parametric MRI is a promising technology that significantly improves overall visualization of prostate cancer and specifically those cancers that have spread beyond the capsules," said first author Jennifer Robles, a clinical research fellow for senior author Peter Pinto, MD, at the National Institutes of Health's Urologic Oncology Branch, Bethesda, MD. "The technology can improve decision-making and, importantly, it appears to be able to improve surgical outcomes."
To assess the impact of the combined imaging approach, the research team retrospectively analyzed 185 patients who had biopsy-confirmed localized prostate cancer. MP-MRI suggested the presence of prostate cancer in 180 patients (97%). Final pathology placed 83% of the 182 patients into intermediate- or high-risk categories. MP-MRI identified 75% of the patients as intermediate or high risk, compared to 53% by National Comprehensive Cancer Network clinical staging alone.
"As with all imaging studies of this nature, the idea is that good preoperative imaging should lead to better outcomes than are seen with clinical staging without such imaging," Robles told Urology Times.
Images may alter surgeon approach
Surgeons altered their approach to the disease often in the overall cohort, allowing for high rates of neurovascular bundle sparing even in pT3 disease (45% bilateral, 20% unilateral nerve sparing), without increasing positive margin rates. With the prostate tumor location obtained from the MP-MRI in these high-risk cases, the overall positive margin rate was 27% in the patients with T3 disease.
"Our radiologists are now working with others to develop a staging system derived from MP-MRI findings," Robles said. "It is hoped that levels of risk-low, intermediate, or high-can be established based on findings in each of the MP-MRI's modalities. Continued research in this field is necessary to determine its role in patient care."