Fredrik Jäderling1,2, Olof Akre3,4, Markus Aly3,4,5, Johan Björklund3,4, Mats Olsson4, Christofer Adding3,4, Michael Öberg6, Lennart Blomqvist3,4,7, Tommy Nyberg8,9, Peter Wiklund3,4, Stefan Carlsson3,4. 1. Department of Diagnostic Radiology, Karolinska University Hospital, Solna, Sweden. fredrik.jaderling@sll.se. 2. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. fredrik.jaderling@sll.se. 3. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. 4. Department of Urology, Karolinska University Hospital, Solna, Sweden. 5. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 6. Department of Diagnostic Radiology, Karolinska University Hospital, Solna, Sweden. 7. Department of Radiation Sciences, Umeå University, Umeå, Sweden. 8. Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden. 9. Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom.
Abstract
BACKGROUND: It is unclear whether preoperative staging using Magnetic Resonance Imaging (MRI) reduces the risk of positive margins in prostate cancer. We aimed to assess the effect on surgical margins and degree of nerve sparing of a pelvic MRI presented at a preoperative MRI conference. METHODS: Single institution, observational cohort study including 1037 men that underwent robot assisted radical prostatectomy between October 2013 and June 2015. Of these, 557 underwent a preoperative MRI combined with a preoperative MRI conference and 410 did not. With whole-mount prostate specimen histopathology as gold standard we assessed the ability of MRI in finding the index tumor and the sensitivity and specificity for extra prostatic extension. We calculated relative risks for positive surgical margins and non-nerve sparing procedure, adjusting for preoperative risk factors using stabilized inverse-probability weighting. RESULTS: MRI detected the index tumor in 80% of the cases. Non-organ confined disease (pT3) at histology was present in the MRI and the non-MRI group in 42% and 24%, respectively. Rate of positive surgical margins comparing the MRI and non-MRI groups was 26.7% and 33.7%, respectively, relative risk 0.79 [95% CI 0.65-0.96], weighted relative risk (wRR) 0.69 [95% CI 0.55-0.86]. The wRR of extensive positive surgical margins was 0.45 [95% CI 0.31-0.67]. Undergoing MRI was also associated with an increased risk of being operated with a non-nerve sparing technique (wRR, 1.84 [95% CI 1.11-3.03]). CONCLUSIONS: Our study suggests that preoperative prostate MRI in combination with a preoperative MRI conference affects the degree of nerve-sparing surgery and reduces positive surgical margins.
BACKGROUND: It is unclear whether preoperative staging using Magnetic Resonance Imaging (MRI) reduces the risk of positive margins in prostate cancer. We aimed to assess the effect on surgical margins and degree of nerve sparing of a pelvic MRI presented at a preoperative MRI conference. METHODS: Single institution, observational cohort study including 1037 men that underwent robot assisted radical prostatectomy between October 2013 and June 2015. Of these, 557 underwent a preoperative MRI combined with a preoperative MRI conference and 410 did not. With whole-mount prostate specimen histopathology as gold standard we assessed the ability of MRI in finding the index tumor and the sensitivity and specificity for extra prostatic extension. We calculated relative risks for positive surgical margins and non-nerve sparing procedure, adjusting for preoperative risk factors using stabilized inverse-probability weighting. RESULTS: MRI detected the index tumor in 80% of the cases. Non-organ confined disease (pT3) at histology was present in the MRI and the non-MRI group in 42% and 24%, respectively. Rate of positive surgical margins comparing the MRI and non-MRI groups was 26.7% and 33.7%, respectively, relative risk 0.79 [95% CI 0.65-0.96], weighted relative risk (wRR) 0.69 [95% CI 0.55-0.86]. The wRR of extensive positive surgical margins was 0.45 [95% CI 0.31-0.67]. Undergoing MRI was also associated with an increased risk of being operated with a non-nerve sparing technique (wRR, 1.84 [95% CI 1.11-3.03]). CONCLUSIONS: Our study suggests that preoperative prostate MRI in combination with a preoperative MRI conference affects the degree of nerve-sparing surgery and reduces positive surgical margins.
Authors: André N Vis; Roderick C N van den Bergh; Henk G van der Poel; Alexander Mottrie; Philip D Stricker; Marcus Graefen; Vipul Patel; Bernardo Rocco; Birgit Lissenberg-Witte; Pim J van Leeuwen Journal: BJUI Compass Date: 2021-11-09
Authors: Clara Humke; Benedikt Hoeh; Felix Preisser; Mike Wenzel; Maria N Welte; Lena Theissen; Boris Bodelle; Jens Koellermann; Thomas Steuber; Alexander Haese; Frederik Roos; Luis Alex Kluth; Andreas Becker; Felix K H Chun; Philipp Mandel Journal: Curr Oncol Date: 2022-03-28 Impact factor: 3.109
Authors: Erik Ronmark; Ralf Hoffmann; Viktor Skokic; Maud de Klerk-Starmans; Fredrik Jaderling; Pieter Vos; Maudy C W Gayet; Hans Hofstraat; Marco Janssen; Olof Akre; Per Henrik Vincent Journal: BMJ Health Care Inform Date: 2022-08
Authors: William John Yaxley; François-Xavier Nouhaud; Sheliyan Raveenthiran; Anthony Franklin; Peter Donato; Geoff Coughlin; Boon Kua; Troy Gianduzzo; David Wong; Robert Parkinson; Nicholas Brown; Hemamali Samaratunga; Brett Delahunt; Lars Egevad; Matthew Roberts; John William Yaxley Journal: Prostate Cancer Prostatic Dis Date: 2020-09-30 Impact factor: 5.554