(RxWiki News) Erectile dysfunction and incontinence are the most serious and disheartening side effects of surgery to treat prostate cancer. A new study finds imaging studies before a prostatectomy could make a difference.
A special type of MRI imaging prior to a prostatectomy - surgical removal of the prostate - can be useful in helping surgeons decide whether to spare or remove nerves near the prostate. These nerves play a critical role in sexual function.
"Ask your surgeon about having an MRI prior to a prostatectomy."
Researchers at the David Geffen School of Medicine at the University of California Los Angeles (UCLA) designed the study.
Daniel J. A. Margolis, M.D., assistant professor of radiology at UCLA led the study to see if endorectal coil MRI imaging prior to robotic-assisted laparoscopic prostatectomy (RALP) could help surgeons make better surgical decisions.
Endorectal coil MRI imaging is performed by placing a coil into the rectum to obtain high quality images of the area - including the nerves near the prostate.
As background, RALP involves smaller incisions than those in an open - or traditional - radical prostatectomy and uses the assistance of a surgical robot. The advantages of this technique include better cosmetic results, less blood loss and quicker recovery.
There are some drawbacks to this method, though - namely that the surgeon can't feel and evaluate the two neurovascular bundles—the blood vessels and nerves that run alongside prostate.
One type of prostatectomy does not remove one or both these bundles. This so-called "nerve-sparing" surgery doesn't affect cure rates and helps to preserve both sexual and urinary function. However, sometimes to get at all the cancer, these nerve bundles have to be removed, along with the prostate. This is called "non-nerve-sparing" surgery and commonly leaves men both impotent and incontinent.
Researchers evaluated 104 men who underwent preoperative endorectal coil MRI of the prostate, followed by robotic assisted surgery.
The prostate MRI data changed the surgical plan for 28 of the 104 men. This plan was changed to the nerve-sparing technique for 17 and to a non-nerve-sparing technique in 11 patients.
The decision regarding the nerve-sparing surgery did not affect the cancer outcome.
"I think preoperative MRI will be useful for surgeons who are uncertain whether to spare or resect the nerves," said Dr. Margolis. "Our surgeons feel that, compared with clinical information alone, MRI is worthwhile for all patients, because it identifies important information leading to a change in the surgical plan in almost a third of patients."
He adds this type of imaging isn't yet common and two things have to happen before it is - the ability select patients who could benefit from the imaging, and a standardized means of interpreting the results.
"The former is something we are investigating now," Dr. Margolis said. "The latter is something that a number of leading experts in prostate MRI are working toward. However, most centers already have this technology, so this may become widespread relatively soon."
This published online January 24, 2012 in the journal Radiology.
