To evaluate the effect of adding multiparametric magnetic resonance imaging (mpMRI) to pre-surgical planning on surgical decision making for the management of high-risk prostate cancer (HRPC).

A survey was designed to query multiple centers on surgical decisions of 41 consecutive HRPC cases seen from 2012 to 2015. HRPC was defined by the National Comprehensive Cancer Center Network guidelines. Six fellowship-trained urologic oncologists were asked for their surgical plan in regards to the degree of planned nerve-sparing and lymph node dissection. Two rounds of surveys were administered to six external urologic oncologists. The first survey included the case description only and the second included case description with mpMRI images and report. The correct surgical plan was analyzed by correlation of the degree of planned surgical excision and consistency with the final pathologic evaluation. A priori, an effect size of 20% change was used to determine statistical significance, at p < 0.05.

All cases had at least one change to surgical planning after mpMRI review. Forty (98%) patients had a change in the degree of planned nerve sparing: wider excision in 32% and increased nerve sparing in 24%. After mpMRI the correct surgical plan change was made in 49% for the right and left 51%, decreasing the potential for positive margins. Lymph node dissection was altered from standard to extended lymph node dissection in 17%.

Although mpMRI is not integrated in guidelines for preoperative planning in HRPC, its use may impact surgical planning, cancer control, and quality of life.

Prostate cancer and prostatic diseases. 2019 Sep 09 [Epub ahead of print]

Janet Baack Kukreja, Tharakeswara K Bathala, Chad A Reichard, Patricia Troncoso, Scott Delacroix, Benjamin Davies, Scott Eggener, Marc Smaldone, Mohummad Minhaj Siddiqui, Matthew Tollefson, Brian F Chapin

University of Texas MD Anderson Cancer Center, Houston, TX, USA., Louisiana State University Health Science Center, New Orleans, LA, USA., University of Pittsburgh, Pittsburgh, PA, USA., University of Chicago, Chicago, IL, USA., Fox Chase Cancer Center, Philadelphia, PA, USA., University of Maryland, Baltimore, MD, USA., Mayo Clinic, Rochester, MN, USA., University of Texas MD Anderson Cancer Center, Houston, TX, USA. .