Nerve-sparing radical prostatectomy (NSRP) yields comparable oncologic outcomes to surgery that does not spare the neurovascular bundles in men with high-risk prostate cancer, investigators report.
In a study of 726 consecutive patients at a single institution undergoing open radical prostatectomy with extended pelvic lymph node dissection, 609 patients (84%) underwent unilateral or bilateral, partial or full NSRP.
The proportion of patients with positive surgical margins was comparable between the NSRP and non-NSRP groups (47% vs 49%), Marc A. Furrer, MD, of the University of Bern in Bern, Switzerland, and colleagues reported in BJU International. The risk for post-operative adjuvant or salvage radiation therapy did not differ significantly between groups.
NSRP did not significantly increase the risk for recurrence. Progression-free survival, cancer-specific survival, and overall survival rates over a median 8 years proved similar between groups, the investigators reported.
The clinicians defined high-risk cases using pathologic specimens. Unlike D’Amico criteria, they used one or more of the following criteria to define high-risk: preoperative PSA greater than 20 ng/mL, postoperative Gleason grade group 4 or 5, pT3 or higher disease, and/or pN1. Nerve-sparing was attempted only if there was no ipsilateral capsular involvement in the preoperative mpMRI, no palpable induration in the digital rectal examination, and no contraindication based on intraoperative appraisal of tissue planes from senior surgeons. The high-volume surgeons had extensive experience in incremental and full NSRP.
As this was an observational study, there is inherent selection bias in which patients were chosen for NSRP vs non-NSRP.
“Careful patient selection remains the crux of ensuring unimpaired oncological results of nerve-sparing surgery in high-risk disease,” according to Dr Furrer’s team.
Furrer MA, Sathianathen N, Gahl B, et al. Oncological outcomes after attempted nerve sparing radical prostatectomy in patients with high-risk prostate cancer are comparable to standard non-nerve sparing radical prostatectomy: a longitudinal long-term propensity-matched single-centre study. BJU Int. Published online August 7, 2023. doi:10.1111/bju.16126