One of the traits of highly successful people is their ability to stay grounded in the present moment yet anticipate the future. Although no one can predict the future with 100% accuracy, knowing the odds are favorable is a definite advantage.

For prostate cancer patients, the most common treatment recommendation is radical robotic prostatectomy (RRP). In fact, the majority of low-to-intermediate risk patients who decide to get treated following their initial diagnosis choose RRP. Most of them do so because they are told, “We can get all the cancer out and you’ll never have to worry about it again.”

However, the more certainty that no cancer has been left behind, the greater the odds that any prostatectomy is truly successful. At 5 years after surgery, biochemical failure (rising PSA) rates range from 75-91.6%.^[ii] The chief factor in predicting failure is the presence of positive surgical margins seen during the post-surgery pathology examination of the gland specimen. Positive margins mean that some cancer has been left behind, and its growth or spread is signaled by a rising PSA further down the line.

So why would a prostate cancer patient considering surgery want to take any chances, when the ability to predict positive surgical margins exists? Multiparametric MRI (mpMRI) can provide crucial information regarding whether surgery is an appropriate choice, and if so, what the best surgical strategy will be. A 2016 study demonstrated that pre-surgical imaging had significant success in identifying the risk of positive surgical margins.[iii] In fact, the authors found that tumor extension was correlated with certain areas of the gland, particularly at the apex, and that such tumors had specific characteristics on the imaging results.

This means that the probable success or failure of prostatectomy can be known before surgery is scheduled. If you are a prostate cancer patient leaning toward surgery, talk with your urologist about the importance of first having a multiparametric MRI done on a 3T magnet, and make sure that in addition to the radiologist’s report, you have at least one of your image CDs sent to an expert prostate radiologist for a second opinion.

For a successful prostatectomy, it’s essential to keep an eye on the future. Or, in this case, keep an MRI on the future.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Barocas DA, Al Hussein Al Awamlh B, Koyama T. Outcomes Following Localized Prostate Cancer Treatment—Reply. JAMA. Published online April 29, 2024.
[ii] Finkelstein J, Eckersberger E, Sadri H, Taneja S et al. Open versus laparoscopic versus robot-assisted laparoscopic prostatectomy: the European and US experience. Rev Urol. 2010 Winter;12(1):35-43.
[iii] Tamada T, Sone T, Kanomata N, Miyaji Y et al. Value of preoperative 3T multiparametric MRI for surgical margin status in patients with prostate cancer.  J. Magn. Reson. Imaging 2016. [Epub ahead of print]

About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.