MULTYPARAMETRIC PROSTATE MRI BEFORE RADICAL PROSTATECTOMY: CAN PREVENT PATHOLOGY, POSTOPERATIVE FUNCTIONAL RESULTS AND DISEASE RECURRENCE?

Background and Aim: Multiparametric Prostate MRI (MpMRI) has become increasingly important in the diagnosis and staging of prostate cancer, with increasing experience and device quality. In our study, we aimed to investigate the relationship between the histopathological correlation of the suspected malignancy detected in MpMRI and the postoperative functional results and biochemical recurrence. Materials and Methods: The data of 93 patients between January 2012 and June 2018 who underwent radical prostatectomy in the Urology Department of Ege University Medical Faculty and had preoperative MPMRG and met other inclusion criteria were examined. Age, pre-operative Prostate-Specific Antigen (PSA) value, type of operation, postoperative urinary incontinence status, erectile dysfunction and PSA values were retrospectively collected from patient files. The pathology specimen was examined again and post-operative gleason score, ISUP grade group, other pathological findings (lymph node involvement and extraprostatic extension), pre-operative MPMRI were re-examined and PIRADS score, extracapsular extension, seminal vesicle invasion, neurovascular bundle invasion, lymph node involvement and ADC values were recorded. SPSS for Windows 22.0 package program was used for statistical analysis. Results: 151 (92,07%) of 164 lesions detected in MpMRG were histopathologically correlated. Of the 248 lesions identified by the pathologist, 151 (60.88%) were confirmed by the radiologist. 80% of patients with seminal vesicle invasion, 28.8% of patients with extracapsular extension and 42.9% of patients with lymph node involvement in MpMRI were histopathologically correlated. A significant relationship was found between PIRADS scores and ISUP grade groups. There was a negative correlation between ADC values and ISUP grade groups. There was no relationship between postoperative urinary incontinence and any MRI findings. There was a significant relationship between extracapsular extension and ED in MpMRI. A significant relationship was found between biochemical recurrence and PIRADS scores, seminal vesicle invasion, ISUP grade group, Gleason score, preoperative PSA, extracapsular extension and neurovascular bundle invasion. Peroperative and postoperative complications were associated with significant relationship between seminal vesicle invasion and operation type (more in patients with RRP). Conclusions: Our study showed that the lesions detected by MpMRI showed a high histopathological correlation. However, the lesion was underestimated by MpMRI. Based on the MpMRI findings, the decision of definitive treatment may be changed or if the operation is decided, the type of operation and the decision of nerve sparing may be changed. Based on the MpMRI findings, patients can be informed preoperatively about the problems that may develop in the follow-up and the need for additional treatment.