Prostate Capsule, Nerve Sparing Cystectomies Offer Similar Outcomes

In a small randomized trial, functional and oncologic results did not differ significantly between the 2 approaches
In a small randomized trial, functional and oncologic results did not differ significantly between the 2 approaches

Prostate capsule sparing and nerve sparing radical cystectomy are associated with similar functional and oncologic outcomes, a new study suggests.

The study, led by Alon Z. Weizer, MD, of the University of Michigan Comprehensive Cancer Center in Ann Arbor, enrolled 40 patients. Investigators randomized 20 patients each to undergo each surgical approach and stratified them by Sexual Health Inventory for Men score (greater than 21 vs. 21 or less). A score of 21 of less indicates sexual dysfunction. The primary endpoint was 12-month overall urinary function as measured by the Bladder Cancer Index, which consists of 34 items in a total of 3 primary domains: urinary, sexual, and bowel. Scores range from 0 to 100 points, with higher scores corresponding to better health states.

Urinary function at 12 months decreased by 13 and 28 points in the prostate capsule and nerve sparing groups, respectively, a non-significant difference between groups, the authors reported in The Journal of Urology (2015;193:64–70). The researchers observed a similar pattern with sexual function and found no difference in recurrence-free, metastasis-free, or overall survival. The 2 groups also had similar rates of incidentally detected prostate cancer.

Dr. Weizer and his colleagues noted, however, that their study was underpowered due to a lack of patient accrual. It is unclear whether statistically significant differences in urinary and sexual function between the 2 approaches may have emerged had they attained their target recruitment of 82 patients.

“Nevertheless, our study findings improve our understanding of urinary and erectile function outcomes after prostate capsule sparing and nerve sparing approaches as well as the oncologic implications of the approaches.”

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