Use of Multiparametric MR with Neurovascular Bundle Evaluation to Optimize the Oncological and Functional Management of Patients Considered for Nerve-Sparing Radical Prostatectomy Valeria Panebianco, PhD,* Stefano Salciccia, PhD, † Susanna Cattarino, PhD, † Francesco Minisola, PhD, † Alessandro Gentilucci, PhD, † Andrea Alfarone, PhD, † Gian Piero Ricciuti, PhD, † Andrea Marcantonio, PhD,* Danilo Lisi, PhD,* Vincenzo Gentile, PhD, † Roberto Passariello, PhD,* and Alessandro Sciarra, PhD † *Department of Radiology, University “Sapienza”, Rome, Italy; † Department of Urology, University “Sapienza”, Rome, Italy DOI: 10.1111/j.1743-6109.2012.02794.x ABSTRACT Introduction. To obtain the best results with radical prostatectomy, either from an oncological or a functional point of view, a correct selection of cases and planning of surgery are crucial. Multiparametric magnetic resonance imaging (MRI) promises to make it a successful imaging tool for improving many aspects of prostate cancer management. Aim. The aim of this study is to evaluate whether a modern multiparametric MRI can help either to better select prostate cancer cases for a nerve-sparing radical prostatectomy or to improve the functional evaluation related to neurovascular bundles preservation. Main Outcome Measures. The effect of preoperative MRI on neurovascular bundle management was examined for the frequency and the appropriateness of changes of the surgical plane on the basis of MRI indications. Methods. In a prospective study, 125 consecutive patients with biopsy proven prostate cancer who were scheduled to undergo bilateral nerve-sparing surgery. All patients included into the study were submitted to a preoperative multiparametric MRI. On the basis of MRI evaluation, patients were divided into two groups. Patients in group A were then submitted to a bilateral nerve-sparing (NS) radical prostatectomy (RP), whereas patients in group B were submitted to unilateral NS or non-NS RP. Results. In group A, the confirmation from the MRI study to perform a bilateral NS procedure was appropriate in 70 of 73 cases (95.9%), whereas in group B, the surgical plan was appropriate in 28 of 32 cases (87.5%). On the contrary, MRI findings suggested a change in the initial surgical plan (group B) for 32 of 105 cases (30.5%). Of these 32 cases in group B, MRI suggested to perform a unilateral NS procedure in 21 of 32 cases (65.6%) and a non-NS procedure in 11 of 32 cases (34.4%). Conclusions. Multiparametric MRI analysis can significantly improve the standard selection and management of prostate carcinoma cases considered for an NS RP. Panebianco V, Salciccia S, Cattarino S, Minisola F, Gentilucci A, Alfarone A, Ricciuti GP, Marcantonio A, Lisi D, Gentile V, Passariello R, and Sciarra A. Use of multiparametric MR with neurovascular bundle evaluation to optimize the oncological and functional management of patients considered for nerve-sparing radical prostatectomy. J Sex Med 2012;9:2157–2166. Key Words. Prostate Cancer; Multiparametric MRI; Erctile Dysfunction; Nerve-Sparing Prostatectomy Introduction R adical prostatectomy (RP) provides excellent long-term disease control for patients with clinically localized prostate carcinoma (PC). The unique challenge of RP is to eliminate the cancer while preserving urinary and sexual function. Recovery of erectile function after RP is related to the preservation of the neurovascular bundles (NVBs). It has been suggested that anatomic varia- tions exist regarding the course of NVBs [1,2]. From a pathological analysis of non-nerve-sparing 2157 © 2012 International Society for Sexual Medicine J Sex Med 2012;9:2157–2166