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Asian Journal of Urology, 2023, 10(4): 494-501    doi: 10.1016/j.ajur.2022.05.012
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Role of preoperative magnetic resonance imaging on the surgical outcomes of radical prostatectomy: Does preoperative tumor recognition reduce the positive surgical margin in a specific location? Experience from a Thailand prostate cancer specialized center
Thitipat Hansomwonga*(),Pat Saksirisampantb,Sudhir Isharwalc,Pubordee Aussavavirojekula,Varat Woranisarakula,Siros Jitpraphaia,Sunai Leewansangtonga,Tawatchai Taweemonkongsapa,Sittiporn Srinualnada
aDivision of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
bDivision of Urology, Department of Surgery, Somdech Phra Pinklao Hospital, Naval Medical Department, Royal Thai Navy, Bangkok, Thailand
cDepartment of Urology, Oregon Health and Science University, Portland, OR, United States
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Abstract: 

Objective: Multiparametric magnetic resonance imaging (MRI) has become the standard of care for the diagnosis of prostate cancer patients. This study aimed to evaluate the influence of preoperative MRI on the positive surgical margin (PSM) rates.

Methods: We retrospectively reviewed 1070 prostate cancer patients treated with radical prostatectomy (RP) at Siriraj Hospital between January 2013 and September 2019. PSM rates were compared between those with and without preoperative MRI. PSM locations were analyzed.

Results: In total, 322 (30.1%) patients underwent MRI before RP. PSM most frequently occurred at the apex (33.2%), followed by posterior (13.5%), bladder neck (12.7%), anterior (10.7%), posterolateral (9.9%), and lateral (2.3%) positions. In preoperative MRI, PSM was significantly lowered at the posterior surface (9.0% vs. 15.4%, p=0.01) and in the subgroup of urologists with less than 100 RP experiences (32% vs. 51%, odds ratio=0.51, p<0.05). Blood loss was also significantly decreased when a preoperative image was obtained (200 mL vs. 250 mL, p=0.02). Multivariate analysis revealed that only preoperative MRI status was associated with overall PSM and PSM at the prostatic apex. Neither the surgical approach, the neurovascular bundle sparing technique, nor the perioperative blood loss was associated with PSM.

Conclusion: MRI is associated with less overall PSM, PSM at apex, and blood loss during RP. Additionally, preoperative MRI has shown promise in lowering the PSM rate among urologists who are in the early stages of performing RP.
Key words:  Preoperative magnetic resonance imaging    Prostate cancer    Positive surgical margin    Radical prostatectomy    Apex    Apical positive surgical margin
收稿日期:  2022-01-21      修回日期:  2022-04-22      接受日期:  2022-05-18      出版日期:  2023-10-20      发布日期:  2023-11-13      整期出版日期:  2023-10-20
引用本文:    
. [J]. Asian Journal of Urology, 2023, 10(4): 494-501.
Thitipat Hansomwong, Pat Saksirisampant, Sudhir Isharwal, Pubordee Aussavavirojekul, Varat Woranisarakul, Siros Jitpraphai, Sunai Leewansangtong, Tawatchai Taweemonkongsap, Sittiporn Srinualnad. Role of preoperative magnetic resonance imaging on the surgical outcomes of radical prostatectomy: Does preoperative tumor recognition reduce the positive surgical margin in a specific location? Experience from a Thailand prostate cancer specialized center. Asian Journal of Urology, 2023, 10(4): 494-501.
链接本文:  
http://www.ajurology.com/CN/10.1016/j.ajur.2022.05.012  或          http://www.ajurology.com/CN/Y2023/V10/I4/494
Characteristic Preoperative MRI (n=322) Non-MRI (n=748) p-Value
Agea, year 68.29±6.62 67.59±6.37 0.20
Op-timea, min 182.51±73.11 187.64±77.08 0.36
Blood lossb, mL 200 (20-400) 250 (50-450) 0.02
BMIb, kg/m2 24.61 (22.49-26.89) 24.34 (22.41-26.54) 0.30
iPSAb, ng/mL 10.1 (7.18-18.00) 10.0 (6.70-16.30) 0.41
Tumor involvementb, % 12.0 (5.0-22.0) 15.0 (5.0-25.0) 0.10
Prostate sizea, mL 44.07±22.97 42.77±21.19 0.40
pTc 0.50
2 182 (56.5) 365 (48.8)
3a 102 (31.7) 243 (32.5)
3b 35 (10.9) 130 (17.4)
4 3 (0.9) 10 (1.3)
ISUP groupc 0.07
1 28 (8.7) 91 (12.2)
2 109 (33.9) 261 (34.9)
3 74 (23.0) 136 (18.2)
4 34 (10.6) 61 (8.2)
5 58 (18.0) 106 (14.2)
ADT effect 19 (5.9) 93 (12.4)
Surgical approachc <0.05
ORP 27 (8.4) 98 (13.1)
LRP 61 (18.9) 231 (30.9)
RARP 234 (72.7) 419 (56.0)
Surgeon's experiencec 0.70
1-100 73 (22.7) 178 (23.8)
>100 249 (77.3) 570 (76.2)
NVB sparing techniquec 0.20
None 201 (62.4) 508 (67.9)
Unilateral 28 (8.7) 46 (6.1)
Bilateral 93 (28.9) 194 (25.9)
  
PSM location Total Preoperative MRI Non-MRI p-Value
Apex 355 (33.2) 96 (29.8) 259 (34.6) 0.30
Posterior 144 (13.5) 29 (9.0) 115 (15.4) 0.01
Bladder neck 136 (12.7) 34 (10.6) 102 (13.6) 0.20
Anterior 115 (10.7) 36 (11.2) 79 (10.6) 0.80
Posterolateral 106 (9.9) 32 (9.9) 74 (9.9) 0.70
Lateral 25 (2.3) 6 (1.9) 19 (2.5) 0.50
Overall 532 (49.7) 149 (46.3) 383 (51.2) 0.14
sPSM 271 (25.3) 89 (27.6) 182 (24.3) 0.25
mPSM 261 (24.2) 60 (18.6) 201 (26.9) <0.05
  
Clinical and pathological characteristics Empty Cell PSM, n (%) Empty Cell
Preoperative MRI Non-MRI p-Value
Surgical approach
ORP 11 (41) 53 (54) 0.20
LRP 33 (54) 118 (51) 0.70
RARP 105 (45) 212 (51) 0.20
NVB sparing
None 99 (49) 257 (51) 0.90
Unilateral 10 (36) 25 (54) 0.10
Bilateral 37 (40) 100 (52) 0.06
pT
2 62 (34) 141 (39) 0.40
3a 61 (60) 148 (61) 0.80
3b 25 (71) 94 (72) 0.40
Surgeon experience
1-100 23 (32) 91 (51) <0.05
>100 126 (51) 292 (51) 0.90
  
Clinical and pathological characteristics Univariate analysis Multivariate analysis
OR (95% CI) p-Value Adjusted OR (95% CI) p-Value
Preoperative MRI
No 1 (ref) 1 (ref)
Yes 0.62 (0.45, 0.86) <0.05 0.59 (0.42, 0.85) <0.05
ISUP group
1 1 (ref) 1 (ref)
2 3.1 (1.6, 6.1) <0.05 3.0 (1.5, 6.0) <0.05
3 3.0 (1.5, 6.0) <0.05 2.2 (1.0, 4.7) <0.05
4 4.6 (2.1, 10.0) <0.05 3.5 (1.5, 8.2) <0.05
5 8.3 (3.8, 18.0) <0.05 3.7 (1.6, 8.8) <0.05
ADT effect 5.3 (2.2, 13.0) <0.05 4.1 (1.6, 10.0) <0.05
Surgeon's experience
>100 1 (ref) 1 (ref)
1-100 0.57 (0.38, 0.83) <0.05 0.51 (0.32, 0.79) <0.05
NVB sparing
None 1 (ref)
Unilateral 0.76 (0.42, 1.40) 0.40
Bilateral 1.20 (0.82, 1.70) 0.30
pT
2 1 (ref) 1 (ref)
3a 2.8 (1.9, 4.1) <0.05 2.3 (1.5, 3.5) <0.05
3b 4.7 (2.6, 8.5) <0.05 2.7 (1.3, 5.5) <0.05
Tumor involvement percentage
<50% 1 (ref) 1 (ref)
≥50% 5.4 (2.2, 13.0) <0.05 2.4 (0.9, 6.3) <0.05
iPSA, ng/mL
<10 1 (ref) 1 (ref)
10 to 20 2.0 (1.3, 2.9) <0.05 1.8 (1.2, 2.7) <0.05
≥20 2.9 (1.8, 4.4) <0.05 1.7 (1.0, 2.7) 0.05
Op-time, min
<120 1 (ref) 1 (ref)
120 to 180 0.60 (0.35, 1.0) 0.07 0.79 (0.44, 1.4) 0.40
180 to 240 0.53 (0.30, 0.94) <0.05 0.60 (0.32, 1.1) 0.10
≥240 0.62 (0.34, 1.10) 0.10 0.84 (0.43, 1.7) 0.60
Blood loss, mL
<600 1 (ref)
600 to 1200 0.89 (0.50, 1.60) 0.70
≥1200 1.10 (0.50, 2.40) 0.80
  
Clinical and pathological characteristics Univariate analysis Multivariate analysis
OR (95% CI) p-Value Adjusted OR (95% CI) p-Value
Preoperative MRI
No 1 (ref) 1 (ref)
Yes 0.69 (0.49, 0.96) <0.05 0.69 (0.48, 0.98) <0.05
ISUP group
1 1 (ref) 1 (ref)
2 2.5 (1.1, 5.7) <0.05 2.5 (1.1, 5.8) <0.05
3 2.2 (1.0, 5.2) 0.06 2.1 (0.9, 5.1) 0.09
4 2.4 (1.0, 6.1) 0.06 2.1 (0.8, 5.4) 0.10
5 4.4 (1.9, 10) <0.05 3.2 (1.3, 8.2) <0.05
ADT effect 3.5 (1.3, 9.0) <0.05 3.1 (1.2, 8.4) <0.05
Surgeon experience
>100 1 (ref)
1-100 0.69 (0.45, 1.10) 0.08
NVB sparing
None 1 (ref) 1 (ref)
Unilateral 0.42 (0.20, 0.87) <0.05 0.58 (0.27, 1.2) 0.20
Bilateral 0.79 (0.54, 1.2) 0.20 0.96 (0.63, 1.5) 0.80
pT
2 1 (ref) 1 (ref)
3a 1.2 (0.9, 1.8) 0.30 0.90 (0.59, 1.40) 0.60
3b 1.8 (1.1, 3.0) <0.05 0.81 (0.42, 1.60) 0.50
Tumor involvement percentage
<50% 1 (ref) 1 (ref)
≥50% 2.9 (1.6, 5.3) <0.05 2.0 (1.0, 4.1) 0.05
iPSA, ng/mL
<10 1 (ref) 1 (ref)
10 to 20 1.6 (1.1, 2.4) <0.05 1.6 (1.0, 2.4) <0.05
≥20 2.6 (1.7, 3.9) <0.05 2.1 (1.3, 3.5) <0.05
Op-time, min
<120 1 (ref) 1 (ref)
120 to 180 0.65 (0.39, 1.10) 0.10 0.78 (0.45, 1.30) 0.40
180 to 240 0.51 (0.29, 0.90) <0.05 0.54 (0.29, 0.98) <0.05
≥240 0.89 (0.50, 1.60) 0.70 0.97 (0.53, 1.80) 0.90
Blood loss, mL
<600 1 (ref)
600 to 1200 1.10 (0.59, 1.90) 0.80
≥1200 0.93 (0.41, 2.10) 0.90
  
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