PURPOSE - To describe the efficacy of radical prostatectomy to achieve complete primary tumor excision while preserving erectile function in a cohort of patients with high risk features, in whom surgical resection was tailored according to clinical staging, biopsy data, preoperative imaging, and intraoperative findings.
MATERIALS AND METHODS - In a retrospective review, we identified 584 patients with high-risk features (Prostate-specific antigen ≥ 20ng/mL; clinical stage ≥ T3; preoperative Gleason grade 8-10) who underwent radical prostatectomy between 2006 and 2012. The probability of neurovascular bundle preservation was estimated based on preoperative characteristics. Positive surgical margin rates and erectile function recovery were determined in patients who had some degree of neurovascular bundle preservation.
RESULTS - The neurovascular bundles were resected bilaterally in 69/584 (12%), and unilaterally in 91/584 (16%) patients. The rest had some degree of bilateral neurovascular bundle preservation. Preoperative features associated with a lower probability of neurovascular bundle preservation were: biopsy primary Gleason grade 5, and clinical stage T3. Among patients who underwent some degree of neurovascular bundle preservation, 125/515(24%) had a positive surgical margin and 75/160(47%) men with preoperatively functional erections and available erectile function follow-up had recovered erectile function within 2 years.
CONCLUSIONS - High-risk features should not be considered an indication for complete bilateral neurovascular bundle resection. Some degree of neurovascular bundle preservation can be safely performed by high volume surgeons in the majority of these patients with an acceptable rate of positive surgical margins. Nearly half of high-risk patients with functional erections preoperatively recover erectile function after radical prostatectomy.
The Journal of urology. 2016 Feb 20 [Epub ahead of print]
Pedro Recabal, Melissa Assel, John E Musser, Ronald J Caras, Daniel D Sjoberg, Jonathan A Coleman, John P Mulhall, Raul O Parra, Peter T Scardino, Karim Touijer, James A Eastham, Vincent P Laudone
Urology Service, Department of Surgery; Urology service, Fundacion Arturo Lopez Perez, Santiago, Chile. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY., Tripler Army Medical Center, Honolulu, HI., Tripler Army Medical Center, Honolulu, HI., Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY., Urology Service, Department of Surgery., Urology Service, Department of Surgery., Urology Service, Department of Surgery., Urology Service, Department of Surgery., Urology Service, Department of Surgery., Urology Service, Department of Surgery., Urology Service, Department of Surgery.