Concordance between Preoperative mpMRI and Pathological Stage and Its Influence on Nerve-Sparing Surgery in Patients with High-Risk Prostate Cancer

• Published in: Current oncology (Toronto) 2022-03, Vol.29 (4), p.2385-2394
• Main Authors: Humke, Clara, Hoeh, Benedikt, Preisser, Felix, Wenzel, Mike, Welte, Maria N, Theissen, Lena, Bodelle, Boris, Koellermann, Jens, Steuber, Thomas, Haese, Alexander, Roos, Frederik, Kluth, Luis Alex, Becker, Andreas, Chun, Felix K H, Mandel, Philipp
• Format: Article
• Language: English
• Subjects: Humans; Male; Margins of Excision; Multiparametric Magnetic Resonance Imaging; nerve-sparing surgery; Predictive Value of Tests; prostate cancer; Prostatectomy - methods; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; radical prostatectomy
• ISSN: 1718-7729; 1198-0052; 1718-7729
• DOI: 10.3390/curroncol29040193

We aimed to determine the concordance between the radiologic stage (rT), using multiparametric magnetic resonance imaging (mpMRI), and pathologic stage (pT) in patients with high-risk prostate cancer and its influence on nerve-sparing surgery compared to the use of the intraoperative frozen section technique (IFST). The concordance between rT and pT and the rates of nerve-sparing surgery and positive surgical margin were assessed for patients with high-risk prostate cancer who underwent radical prostatectomy. The concordance between the rT and pT stages was shown in 66.4% ( = 77) of patients with clinical high-risk prostate cancer. The detection of patients with extraprostatic disease (≥pT3) by preoperative mpMRI showed a sensitivity, negative predictive value and accuracy of 65.1%, 51.7% and 67.5%. In addition to the suspicion of extraprostatic disease in mpMRI (≥rT3), 84.5% ( = 56) of patients with ≥rT3 underwent primary nerve-sparing surgery with IFST, resulting in 94.7% ( = 54) of men with at least unilateral nerve-sparing surgery after secondary resection with a positive surgical margin rate related to an IFST of 1.8% ( = 1). Patients with rT3 should not be immediately excluded from nerve-sparing surgery, as by using IFST some of these patients can safely undergo nerve-sparing surgery.