EAU 2011 - Monolateral nerve sparing prostatectomy: Review of indications, functional and oncological outcomes - Session Highlights

VIENNA, AUSTRIA (UroToday.com) - This study was undertaken to determine surgical candidates for unilateral nerve sparing prostatectomy (URP) and evaluate the oncological and functional results.

Their database included 936 patients who underwent radical retropubic prostatectomy (RRP) for clinically localized prostate cancer; 463 patients (49.5%) did not have nerve sparing, 359 (38.3%) patients had bilateral nerve sparing (BRP), and 114 (12.2%) patients had URP. The 114 URP patients filled out preoperative IIEF questionnaires and 3,6,12,18 and 24 months after surgery. Criteria for performing URP were GS≤7, preoperative PSA<20ng/ml, 1 prostate lobe involvement at biopsy, and IIEF-5>19. Biochemical recurrence-free survival, and the correlation between URP and RRP were determined.

Mean age at surgery was 62.8 years, mean PSA was 8.52 ng/mL, biopsy GS<7 was in 70% of patients and =7 in 26.7%. Mean preoperative IIEF-5 was 22.1. Pathologic staging showed 56 pT2 (49.2%) and 45 pT3a (39.2%) tumors. Stages pT3b, pT4 and N+ cases were excluded. In 7 cases (7.4%) there were positive surgical margins on the side of the bundle preserved, 5 of them had >3 positive biopsy cores on the nerve sparing side, while in 2/7 cases the samples were 2, with an involvement >50% of the biopsy cores. The rate of positive surgical margins in URP patients was not statistically significant compared to RRP or BRP. Biochemical recurrence free survival for RRP, URP and BRP at 60 months was 71.7, 80.9 and 86.3%, respectively (p=0.0001, and URP vs. RRP p=0.01). Overall, spontaneous sexual potency or by additional use of PDE5-I was positive in 62 patients (54.2%), compared to 73.1% in the BRP (p=0.0015).



Presented by Lorenzo Masieri, MD, et al. at the 26th Annual European Association of Urology (EAU) Congress - March 18 - 21, 2011 - Austria Centre Vienna, Vienna, Austria


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