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Influence of nerve-sparing (NS) procedure during radical prostatectomy (RP) on margin status and biochemical failure.
Eur Urol. 2005 Feb; 47(2):176-84.EU

Abstract

PURPOSE

To evaluate whether nerve-sparing procedure itself is a risk factor for biochemical recurrence in carefully selected patients.

MATERIAL AND METHODS

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.

RESULTS

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.

CONCLUSION

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.

Authors+Show Affiliations

Department of Urology, University Clinics of Bochum, Marienhospital Herne, 44627 Herne, Germany. rein-jueri.palisaar@marienhospital-herne.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15661411

Citation

Palisaar, Rein-Jüri, et al. "Influence of Nerve-sparing (NS) Procedure During Radical Prostatectomy (RP) On Margin Status and Biochemical Failure." European Urology, vol. 47, no. 2, 2005, pp. 176-84.
Palisaar RJ, Noldus J, Graefen M, et al. Influence of nerve-sparing (NS) procedure during radical prostatectomy (RP) on margin status and biochemical failure. Eur Urol. 2005;47(2):176-84.
Palisaar, R. J., Noldus, J., Graefen, M., Erbersdobler, A., Haese, A., & Huland, H. (2005). Influence of nerve-sparing (NS) procedure during radical prostatectomy (RP) on margin status and biochemical failure. European Urology, 47(2), 176-84.
Palisaar RJ, et al. Influence of Nerve-sparing (NS) Procedure During Radical Prostatectomy (RP) On Margin Status and Biochemical Failure. Eur Urol. 2005;47(2):176-84. PubMed PMID: 15661411.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of nerve-sparing (NS) procedure during radical prostatectomy (RP) on margin status and biochemical failure. AU - Palisaar,Rein-Jüri, AU - Noldus,Joachim, AU - Graefen,Markus, AU - Erbersdobler,Andreas, AU - Haese,Alexander, AU - Huland,Hartwig, PY - 2004/09/03/accepted PY - 2005/1/22/pubmed PY - 2005/7/16/medline PY - 2005/1/22/entrez SP - 176 EP - 84 JF - European urology JO - Eur Urol VL - 47 IS - 2 N2 - PURPOSE: To evaluate whether nerve-sparing procedure itself is a risk factor for biochemical recurrence in carefully selected patients. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSION: 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. SN - 0302-2838 UR - https://www.unboundmedicine.com/medline/citation/15661411/Influence_of_nerve_sparing__NS__procedure_during_radical_prostatectomy__RP__on_margin_status_and_biochemical_failure_ DB - PRIME DP - Unbound Medicine ER -