Can the chance of nerve sparing be assessed from MRI images?

Yes, a prostate MRI can help surgeons determine whether nerves can be spared during a prostatectomy, and it is a crucial tool for surgical planning. The decision is based on whether the cancer appears to have spread beyond the prostatic capsule (extracapsular extension) and into the nearby neurovascular bundles (NVBs), which are critical for erectile function.

This article discusses it
https://ajronline.org/doi/full/10.2214/AJR.17.18757#:~:text=Although%20there%20are%20conflicting%20data,rates%20of%20PSM%20%5B20%5D.

Hi Jeff, thank you for your response. My MRI interpretation report does state that there are no signs of extracapsular extension. Besides this very relevant information, as you indicate, would the MRI images serve the Urologist to understand if the locations of the identified tumors are close to the nerves or not?

I assume that if these tumors or lesions are right next to the nerves then there is less likelihood of sparing but if they are located away from the nerves then it is more likely that the nerves could be spared. If this is correct, should I request to my Urologist that we review these MRI images in detail to understand the location of the tumors and how close or far they are from the nerves?

I didn't ask my surgeon to go through the MRI video nor the MRI reports (I had a 2nd independent report written from the MRI) with me, but rather I asked if he thought I'd be a good patient for surgery, if he'd be able to do nerve sparing, and what he thought my odds were of being continent, not having ED after surgery, and (since it was a teaching hospital) if he'd be doing the surgery. I also told him I knew that things could change based on what he found when he got in there, but I wanted to know how things looked based on the MRI report, biopsy, and my overall physical condition at 70 years old. Based on all that, he told me that while he would be teaching during the surgery he would be the person performing the surgery. He also told me he was "highly confident" (based on all the test results) he'd be able to spare the nerves, he thought I was a good candidate for surgery, and that he thought I had a 90% chance of being continent at 1 year and a 70% change of being able to perform sexually at 1 year (assuming I could perform before surgery). After surgery he told my wife everything went as expected, no complications, and he was able to spare the nerves. I'm now 14 months from NS RALP, currently 71 years old, and I'm continent and 95% back to my pre-surgery sexual capability. I was fortunate to have a highly qualified and experienced surgeon at a CCOE so I had a lot confidence in what he told me. Best wishes.

Yes, they should be able to look at the MRI and see if the tumors are near. I do know at least a couple of people that after surgery found out that they had to remove the nerves on one side, but they were able to keep them on the other.

Definitely ask your doctor to review the MRI and maybe have the radiation oncologist involved to see if they can detect if there are any problems.

The only problem is that there is more than one level of MRI sharpness. Hopefully your MRI is sharp enough to show what you need. If they have a machine with the stronger magnets, then they should be able to get a sharper image.

My Doc. ordered a PMSA petscan to get a clearer view of cancer location and spread possibilities.
NO nerve bundle involvement...but CAD and a kidney stone were identified. Oy vey!
The surgeon said that sparing the nerves is like removing a wall while leaving the wallpaper intact.
I'm happy and grateful for his skills and dedication!

Have you had a PSMA PET scan? That will provide you more information as to the location and aggressiveness of your prostate cancer.

FYI: I had 2 MRIs over the course of 6 years. Both negative. After the 2nd one in 2022, I decided for another biopsy. It showed 2 cores of cancer. From my personal experience, the MRIs were incorrect! Good luck.

Hi,
I am scheduled for a PSMA PET this week. My understanding was that the MRI provides more detailed image information than the PET scan, but from your comment I assume that they both complement each other to get a better full picture. I will ask my Doctor to review both the MRI and the PET scan with me, so that he can explain what he sees and what the odds are of nerve sparing and also about possible damage to the muscles that control continence.
Thank you.

It's my understanding that MRI can be used to initially assess whether nerve bundles can be salvaged. But the best detection is when they're inside with scope and the robo device and they can actually eyeball the situation. My prostatectemy was in 2018 so maybe the wizz bang stuff they have now allows for me certitude a priori. I got a "hopefully" from my surgeon and he managed to save the left one. Erection was up and running in a month and the weirdest thing orgasms are far more intense and longer lasting.
Docs don't have an answer on that. My layman's guess is that since it's no longer attached it kinda flops around and triggers off more. Not complaining mind you. Especially as a 77 year old

Actually, the technology today is so much improved these days. MRI, bone, and CT scans are called “conventional imaging” while PSMA PET scans are called “next generation imaging.”

Dr. Johnson (of Mayo Clinic) talks about the value of all these in his presentation, starting with the scans we’ve all heard about (MRI, bone, & CT scans), and then going into detail about PSMA PET scans at: https://youtu.be/JoJomACA5UM