PREOPERATIVE multiparametric magnetic resonance imaging (mpMRI) was associated with significantly lower positive surgical margin rates following robot assisted laparoscopic prostatectomy, according to new retrospective cohort data spanning 2007–2019.
Preoperative mpMRI and Surgical Precision
The study evaluated 844 men who underwent robot assisted laparoscopic prostatectomy for cT1–cT2 N0 M0 prostate adenocarcinoma at a single centre. Patients were divided into two calendar periods, a pre-mpMRI era from 2007–2012 and a mpMRI era from 2014–2019, with 2013 excluded as a transition year. From 2014, standardised 3T mpMRI interpreted by a single uroradiologist was integrated into side specific surgical planning, including nerve sparing decisions.
Of the total cohort, 393 procedures were performed in 2007–2012 and 451 in 2014–2019. Patients in the later era were older and had larger tumour volumes and less favourable Gleason and D’Amico risk profiles, while pathological stage distribution was similar between groups.
Margin status was available for 802 patients. Positive surgical margins fell from 25 percent in the earlier era to 15 percent following implementation of preoperative mpMRI, representing an absolute reduction of approximately 10 percentage points. Surgery in the mpMRIera was associated with lower odds of a positive surgical margin overall: (odds ratio [OR]: 0.51; 95% CI: 0.34–0.74; p<0.001).
Impact On Pathological Stage
When stratified by pathological stage, the benefit of preoperative mpMRI appeared most pronounced in patients with pathological T3 tumours: (OR: 0.35; 95% CI: 0.19–0.63; p<0.001). In pathological T2 disease, the association was directionally favourable but did not reach statistical significance: (OR: 0.71; 95% CI: 0.42–1.17; p=0.20).
These findings suggest that systematic imaging may enhance surgical precision particularly in more locally advanced disease.
Biochemical Recurrence Outcomes
Among 807 patients with prostate specific antigen follow up, 24-month biochemical recurrence free survival was 0.896 in 2007–2012 and 0.846 in 2014–2019, with a log rank p=0.0377. The unadjusted hazard ratio for biochemical recurrence was 1.55 (hazard ratio: 1.55; 95% CI: 1.02–2.35), but this association attenuated after adjustment for age and D’Amico risk group: (hazard ratio: 1.10; p=0.656).
While early biochemical recurrence free survival did not differ significantly after adjustment, the temporal association between preoperative mpMRI and reduced positive surgical margins supports a potential role for imaging guided surgical planning in experienced robotic programmes. Residual temporal confounding cannot be excluded.
Reference
Henry Rochat C et al. Preoperative mpMRI reduced positive surgical margins after prostatectomy, particularly in pT3 disease, without significant change in adjusted recurrence risk. Therapeutic Advances in Urology. 2026; DOI:10.1177/175628722614527
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