Mittul Gulati MD, Presenter: Nothing to Disclose

Steven Satish Raman MD, Abstract Co-Author: Nothing to Disclose

Nagarajan Rajakumar PhD, Abstract Co-Author: Nothing to Disclose

Michael Albert Thomas PhD, Abstract Co-Author: Nothing to Disclose

Robert E. Reiter MD, Abstract Co-Author: Nothing to Disclose

David Shin-Kuo Lu MD, Abstract Co-Author: Consultant, Siemens AG Consultant, EZM Incorporated Consultant, Vital Images, Inc Consultant, General Electric Company Speaker, General Electric Company Consultant, RITA Medical Systems, Inc Speaker, RITA Medical Systems, Inc Consultant, Boston Scientific Corporation Speaker, Boston Scientific Corporation Consultant, Endocare, Inc Research funded, Endocare, Inc Consultant, Tyco Healthcare (Valleylab) Speaker, Tyco Healthcare (Valleylab) Research funded, Tyco Healthcare (Valleylab)

1. Review utility MRI/MRSI in prostate cancer staging. 2. Explain how MRI/MRSI allows clinicians to plan when to resect a neurovascular bundle (NVB) during prostatectomy. 3. Explain the use of MRI/MRSI in the increasingly prevalent setting of laparoscopic radical prostatectomy, in which the surgeon lacks tactile feedback to gauge tumor extent

1. Overview prostate cancer (CaP) staging -traditionally based on PSA and digital rectal exam 2. MRI/MRSI technique -first staging tool to spatially localize CaP, show extracapsular extension (ECE) 3. Prostate anatomy -NVBs run on posterior surface prostate, mediate potency 4. LRP overview -no tactile feedback, imaging more crucial than in open surgery 5. Case illustrations -where MRI/MRSI showed ECE of CaP, led LRP surgeon to resect NVBs resulting in negative surgical margins

Major teaching points: 1. MRI/MRSI can add unique information to the clinical staging of prostate cancer by differentiating T2 (organ-confined) from T3 (extracapsular, or ECE) cancer. 2. This staging distinction is crucial in helping surgeons plan whether to resect or spare the neurovascular bundles, structures responsible for potency. 3. Knowledge about local ECE of cancer is especially valuable for laparoscopic RRP, as the surgeon lacks the tactile feedback of open surgery.

Gulati, M, Raman, S, Rajakumar, N, Thomas, M, Reiter, R, Lu, D, MR Imaging (MRI) and MR Spectroscopic Imaging (MRSI) of Prostate Cancer: Review of Technique and Emerging Relevance in Planning Laparoscopic Radical Prostatectomy (LRP).  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5009847.html