Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.St Vincent's Prostate Cancer Centre, St Vincent's Clinic, Sydney, NSW; Douglass Hanly Moir Pathology, Macquarie Park, NSW; Department of Urology, Royal North Shore Hospital, St Leonards, NSW, Australia.
Study Type - Therapy (case series) Level of Evidence 4.
What's known on the subject? and What does the study add? Nerve sparing radical prostatectomy has been associated with increased risk of positive surgical margins due to the close anatomical relationship of the neurovascular bundle to the posterolateral aspect of the prostatic fascia. Our study of 945 men who underwent radical prostatectomy be one experienced surgeon found no increased risk of positive surgical margins, whether the cancer was organ confined or extracapsular extension was present.
To examine whether nerve-sparing surgery (NSS) is a risk factor for positive surgical margins (PSMs) in patients with either organ-confined prostate cancer or extracapsular extension (ECE).
Clinicopathological outcome data on 945 consecutive patients treated with radical prostatectomy (RP) were prospectively collected. All patients underwent RP (bilateral, unilateral or non-NSS) by one surgeon between 2002 and 2007. Risk of PSMs and their locations with respect to NSS was determined by multivariate logistic regression analysis adjusting for preoperative risk factors for PSMs within pT2, pT3a and pT3b tumours.
Overall a PSM was identified in 19.6% of patients in an unscreened population with mean prostate-specific antigen (PSA) level of 8.1 ng/mL. There was no significant difference in rates of PSMs between NSS groups on multivariate analysis (P= 0.147). There was no significant difference in pT2 (P= 0.880), pT3a (P= 0.175) or pT3b (P= 0.354) tumours. The only significant predictor of PSMs was preoperative PSA level (risk ratio 1.289, P= 0.006). There was no significant difference in the location of PSMs except for the pT3a group, where the patients that had bilateral NSS were at higher risk of a posterolateral PSM (P= 0.028).
With appropriate selection of patients, NSS does not increase the risk of PSMs, whether the cancer is organ confined or ECE is present. The adverse impact of the NSS procedure in the hands of an experienced surgeon is minimal and is a realistic compromise to obtain the increase in health-related quality of life offered by NSS.
Moore BM, Savdie R, Pebenito RA, Haynes AM, Matthews J, Delprado W, Rasiah KK, Stricker PD. Are you the author?
Reference: BJU Int. 2011 Jun 28. Epub ahead of print.