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Pre-op MRI May Prevent ED After Prostate Surgery

Imaging Helps Surgeons Decide If Nerves Can Be Safely Spared During Surgery for Prostate Cancer
WebMD Health News
Reviewed by Laura J. Martin, MD

May 7, 2010 -- Doing a preoperative MRI of the prostate may help surgeons better decide when they can safely spare the nerve bundle that controls a man's erections and continence, according to a new study.

''The use of imaging can help a surgeon make a better clinical decision about what he or she does during surgery," says Robert Reiter, MD, Bing Professor of Urology and director of the prostate cancer program at the University of California Los Angeles' David Geffen School of Medicine.

The research was presented Thursday at the annual meeting of the American Roentgen Ray Society in San Diego.

But the study is too small and the results not yet convincing enough to change practice, says J. Brantley Thrasher, MD, chair of the department of urology at the University of Kansas Medical Center in Kansas City, Kan. He reviewed the study results for WebMD.

Prostate Surgery Concerns

In the U.S., the most popular surgery to remove the cancerous prostate gland is robotic assisted laparoscopic prostatectomy or RALP, with about 70% of the procedures performed in this way, Reiter tells WebMD.

Surgeons must decide, when doing the prostate removal, whether to spare the neurovascular bundle, which lies below and to the side of the prostate gland and controls erections and continence.

The surgeon must strike a delicate balance, Reiter says, between sparing the nerve bundle and preserving the ability to get erections and getting all the cancer. Currently, a surgeon decides whether to spare those nerves (totally or partially) based on the biopsy and the level of PSA, or prostate specific antigen, in the blood.

Reiter and his team wanted to see if adding MRI, already suggested to help in other research, could make a difference in guiding the surgical decision.

"Our ability to determine the extent of prostate cancer is limited," he says.

Pre-op MRI: Study Details

The UCLA researchers evaluated 104 men who had biopsy-diagnosed prostate cancer. Reiter was the surgeon for all.

Based on the biopsy and other information, "I would say whether the plan was nerve-sparing or non-nerve-sparing surgery," he says.

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