The following is a summary of “MRI versus non-MRI diagnostic pathways before radical prostatectomy: Impact on nerve-sparing, positive surgical margins, and biochemical recurrence” published in the February 2023 issue of Urologic Oncology by Patel, et al.

Although Magnetic resonance imaging (MRI) has been shown to increase the diagnosis of clinically significant prostate cancer (CaP) prior to biopsy, its effect on surgical outcomes is less certain. Researchers analyzed the effects of diagnostic paths involving MRI and those not involving MRI on surgical outcomes in patients undergoing radical prostatectomy (RP). At Loyola University Medical Center (2014-2021), men were separated into MRI and non-MRI diagnostic paths based on whether or not they had received an MRI prior to prostate biopsy after being diagnosed with CaP and undergoing RP. Positive surgical margin (PSM) rates, the success of bilateral nerve-sparing, and biochemical recurrence (BCR) were the primary endpoints of study. 

Cox proportional hazards regression, Kaplan-Meier curves, and multivariable logistic regression models were used in this research. Out of a total of 609 patients, 281 (46.1%) were assigned to the MRI group and 328 (53.9%) were assigned to the non-MRI group. Both MRI and non-MRI patients showed comparable PSA, biopsy grade group (GG) distribution, RP GG, pT stage, and RP CaP volume. There was no significant difference in the prevalence of PSM between the MRI and non-MRI groups (22.8% vs. 26.8%, P = 0.25). The odds ratio for bilateral nerve sparing was significantly greater in the MRI group than in the non-MRI group  (OR 1.95 (95% CI 1.32–2.88), P = 0.001) 

After accounting for age, PSA, RP GG, pT, pN, and PSM status, the MRI group showed better BCR (HR 0.64 (95% CI 0.41-0.99, P = 0.04). Overall, the use of nerve-sparing was associated with a reduction of PSM by 5.2% in the meta-analysis, but there was considerable variation between studies. The results of the study in brief; Even after accounting for known prognostic variables, an MRI-based diagnostic approach selected patients for RP with a slight reduction in PSM rates, more utilization of bilateral nerve-sparing, and enhanced cancer control by BCR.

Source: sciencedirect.com/science/article/abs/pii/S1078143922003921