The role of multiparametric magnetic resonance imaging to detect the extracapsular extension in robot-assisted radical prostatectomy

Abstract

Objective: this study aimed to evaluate the effectiveness of multiparametric prostate magnetic resonance imaging (mpMRI) in detecting extracapsular extension (ECE) and its impact on our preoperative surgical plan. Materials and methods: overall, 150 patients who had undergone preoperative mpMRI and robot-assisted laparoscopic radical prostatectomy (RALRP) between June 2016 and March 2018 were enrolled. The preoperative International index of Erectile Function (IIEF) score of the patients was 22 or higher. On initial assessment, the patients' prostate specific antigen levels and digital rectal examination and pathology results of prostate biopsy specimens were evaluated to determine whether neurovascular bundle (NVB)-sparing surgery is feasible and appropriate. On the second evaluation, mpMRI results were considered in addition to the parameters included during the first evaluation to decide whether NVB-sparing surgery should be performed. Results: the mean age of the patients was 65.2 years. The sensitivity, specificity, positive predictive value and negative predictive value of mpMRI were 89.6%, 90.2%, 81.1% and 94.8%, respectively. According to mpMRI findings, the surgical plan at the initial evaluation changed in 35 (23.3%) of the cases. Conclusion: the high rate of detection of ECE with mpMRI prior to RALRP may guide the surgeon to decide for NVB-sparing surgery.