Details

Autor(en) / Beteiligte

• Palisaar, Rein-Jüri
• Noldus, Joachim
• Graefen, Markus
• Erbersdobler, Andreas
• Haese, Alexander
• Huland, Hartwig

Titel

Influence of Nerve-Sparing (NS) Procedure during Radical Prostatectomy (RP) on Margin Status and Biochemical Failure

Ist Teil von

• European urology, 2005-02, Vol.47 (2), p.176-184

Ort / Verlag

Oxford: Elsevier B.V

Erscheinungsjahr

2005

Quelle

MEDLINE

Beschreibungen/Notizen

• To evaluate whether nerve-sparing procedure itself is a risk factor for biochemical recurrence in carefully selected patients. We compared patients of our historical series who in retrospect were candidates for nerve-sparing (NS) procedure with a contemporary cohort of patients. With respect to stage migration and selection bias between these two groups we performed a multivariate analysis adjusting for all explanatory variables in the model. NS was performed in n = 723 patients (bilateral n = 359, unilateral n = 364) in comparison to n = 620 patients undergoing non-NS RP, comprising n = 756 patients within the favorable pT2 category. We examined the association of clinical and histopathological parameters in relation to PSA recurrence in uni- and multivariate analyses including NS as a variable. Furthermore, for each prostate lobe separately we determined whether surgical procedure (nerve-sparing vs. non-nerve-sparing RP) resulted in a positive margin. In univariate analysis there was no difference in pT2 (log rank p = 0.091), pT3a (log rank p = 0.171) and pT3b (log rank p = 0.110) cancers between patients treated with NS compared to non-NS surgery. The 3- and 5-year recurrence free survival rate for patients with pT2, pT3a and pT3b cancers treated by NS vs. non-NS were 96.3/94.9 vs. 94.9/90.8, 75.0/61.8 vs. 73.4/55.0 and 46/30 vs. 38/23. Multivariate regression analysis showed no association with PSA failure ( p = 0.798) for patients who underwent NS. Capsular penetration ( p < 0.001), lymph-node status ( p < 0.001), seminal vesicle invasion ( p < 0.001), surgical margin status ( p = 0.0130), Gleason score ( p < 0.001) and preoperative PSA ( p = 0.005) were significantly associated with risk of failure. The positive margin rate per each prostate lobe in pT2 cancers was 6.5% vs. 5.1% in NS and non-NS cases, 10.3% vs. 17.3% in patients with extracapsular extension and 15.0% vs. 25.1% in cases with seminal vesicle invasion respectively. NS RP is an oncologically safe procedure provided that appropriate preoperative selection of patients by means of a validated nomogram is performed. Moreover, evaluation of positive margins in patients undergoing NS and non-NS RP revealed no evidence that adequacy of tumor excision is compromised by NS procedure.