Concordance between Preoperative mpMRI and Pathological Stage and Its Influence on Nerve-Sparing Surgery in Patients with High-Risk Prostate Cancer
Round 1
Reviewer 1 Report
The work is overall well written and leads to shareable conclusions.
Although the mpMRI still has wide margins of uncertainty for the local staging of prostate cancer it remains an essential tool, from reading the work its role comes out a little too reduced.
I would like to point out that the message that must pass is not so much that in real life an mpMRI must be done just to do it but that in patients with high-risk disease it is essential.
It is right to specify that the mpMRIs were not reviewed centrally but it is equally important to assert that, especially for patients with high-risk disease, it is right to manage the cases in a multidisciplinary context, possibly with revision of the radiological examinations by dedicated radiologists.
It should also be noted that for patients with high-risk disease the surgical choice must be shared with the patient, specifying that it probably represents the stage of a multimodal path that will probably also include radiotherapy.
All this in the premises of the work does not seem well clarified.
I would add to the references also this one that reaches some conclusions a little different from those mentioned in the work:
Jäderling, F., Akre, O., Aly, M. et al. Preoperative staging using magnetic resonance imaging and risk of positive surgical margins after prostate-cancer surgery. Prostate Cancer Prostatic Dis 22, 391–398 (2019). https://doi.org/10.1038/s41391-018-0116-z
Overall, with the necessary clarifications, the work deserves publication as it addresses an important topic of study regarding the possibility of limiting the side effects of surgery even in patients with high-risk disease.
Author Response
Please see the attachment.
Reviewer 2 Report
This study presents some important findings regarding the use of mpMRI preoperatively to detect patients who are suitable for NSS vs those who are note.
The results are interesting and reasonable according to clinical reasoning, since depending only on mpMRI to support NSS or not is not a common practice. However, results are presented with many numbers which may be too frustrating for the average reader. Therefore I believe that a graph showing the main findings of the study would be a very useful addition.
Author Response
Please see the attachment.
Author Response File: 
Author Response.docx
