AUA 2017: The Effect Of Nerve Sparing Status On Sexual Function: 3-year Results From The Ceasar Study

Boston, MA ( Though recovery of sexual function is found attributable to the degree of nerve sparing (NS) during a radical prostatectomy, this study investigates the necessity, effect size, and impact on positive surgical margins of NS in men with low baseline function. Specifically, the effect of bilateral NS in men with low and high baseline function over three years was evaluated. The hypothesis followed that bilateral nerve sparing effect is significant in young men with high baseline function.

This was a population based study which included 3,439 patients accrued in 2011-2012 from the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study. Questionnaires pertaining to patient reported sexual function were measured using the 26-item Expanded Prostate Index Composite (EPIC) and administered at baseline, 6, 12, and 36 months after treatment. Nerve sparing status was extracted from operative reports. The exposure variables assessed were NS status, whether they were bilateral (BNS), unilateral (UNS), or none (NNS). Additionally, age, comorbidity: TIBI-Cap (cancer specific comorbidity measure), race, baseline sexual function and disease risk (measured by D’Amico classification).

Preliminary results showed no difference between UNS and NNS, so these two cohorts were grouped together and analysis was conducted on UNS and NNS together as NNS. When looking specifically at nerve sparing, the effect was not statistically significant in men with low baseline function, but it was increased in men with high baseline function. Moreover, NS was not associated with increased positive surgical margin rate, controlled for disease risk (p=0.72).

To conclude, the study found that bilateral nerve sparing results in better sexual function outcomes than UNS or NNS. It is found to be more significant in men with high baseline function and insignificant in men with low baseline function. A future direction may suggest the avoidance of NS in men with low baseline function to minimize the risk of positive surgical margin. Furthermore, it is important to note that surgical perception will continue to have a subjective impact on determining NS status. This highlights the crucial aspect of standardized NS classification.

Presented by: Svetlana Avulova

Authors: Svetlana Avulova, MD*, JoAnn Rudd Alvarez, MA, Tatsuki Koyama, PhD, Matthew J. Resnick, MD, MPH, David Penson, MD, MPH, Daniel A. Barocas, MD, MPH, Nasvhille, TN

Affiliation: Vanderbilt University Medical Center, Nashville Tennessee

Written By: Rita Derderian, University of California, Irvine for

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA