Oncological safety of nerve-sparing radical prostatectomy: evaluation of histopathological outcomes and recurrence-free survival


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Objective: To evaluate histopathological outcomes and biochemical recurrence (BCR) free survival in patients after nerve-sparing radical prostatectomy (nsRP). Materials and methods: Prospective study group comprised 313 patients who underwent uni- or bilateral nsRP from 2014 to 2018; control group included 592 patients with clinically localized prostate cancer who underwent non-nsRP from 2014 to 2018. Mann-Whitney U-test was performed to assess continuous variables; chi-squared test was used for comparative analysis of categorical data. BCR free survival was evaluated with Kaplan-Meier method, log-rank test was used to compare survival outcomes. Results: Adverse histopathological findings were lower in the study group: extracapsular extension was found in 9,4% and 18,75% (p<0,001), grade group upgrade in 23% and 29,3% (p=0,04), positive surgical margins (PSM) in 15% and 22,1% (p=0,01). Subanalysis according to cancer risk groups showed lower PSM rates in high-risk patients (15,6% and 30,3%, p=0,017) and tendency for higher PSM rates in low-risk patients in the study group with no significant difference (12,6% and 7%, p=0,16). BCR free survival after 12 months was 100% and 88,2%, after 20 months - 92,3% and 86,4%, p=0,04. PSM ratesin the study group were notsignificantly different depending on the type of surgery: 13,9% in robotic-assisted approach and 15,4% in retropubic approach, p=0,75. Conclusions: Relatively favorable histopathological outcomes and BCR free survival can be achieved after nsRP. However, obtained results could not be considered optimal and clearly indicate the need for further improvement of preoperative planning and intraoperative quality control of surgical treatment.

Full Text

Restricted Access

About the authors

E. A Sokolov

Russian Medical Academy of Continuous Professional Education; S.P. Botkin’s State Clinical Hospital

Email: sokolov.yegor@yandex.ru

E. I Veliev

Russian Medical Academy of Continuous Professional Education; S.P. Botkin’s State Clinical Hospital

Email: veliev@urotop.ru

A. B Bogdanov

Russian Medical Academy of Continuous Professional Education; S.P. Botkin’s State Clinical Hospital

Email: abbogdanov@hotmail.com

R. A Veliev

Russian Medical Academy of Continuous Professional Education

Email: ragifvel@mail.ru

D. A Goncharuk

Russian Medical Academy of Continuous Professional Education

Email: gonch.urology@yandex.ru

References

  1. Bekelman J.E., Rumble R.B., Chen R.C. et al. Clinically Localized Prostate Cancer: ASCO Clinical Practice Guideline Endorsement of an American Urological Association/American Society for Radiation Oncology/Society of Urologic Oncology Guideline. J. Clin. Oncol. 2018;36(32):3251-3258. doi: 10.1200/JCO.1800606.
  2. Lardas M., Liew M., van den Bergh R.C. et al. Quality of Life Outcomes after Primary Treatment for Clinically Localised Prostate Cancer: A Systematic Review. Eur. Urol. 2017;72(6):869-885. Doi: 10.1016/j. eururo.2017.06.035.
  3. Avulova S., Zhao Z., Lee D. et al. The Effect of Nerve Sparing Status on Sexual and Urinary Function: 3-Year Results from the CEASAR Study. J. Urol. 2018;199(5):1202-1209. doi: 10.1016/j.juro.2017.12.037.
  4. Mottet N., Bellmunt J., Bolla M. et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur. Urol. 2017;71(4):618-629. Doi: 10.1016/j. eururo.2017.08.003
  5. Bonet X., Ogaya-Pinies G., Woodlief T. et al. Nerve-sparing in salvage robot-assisted prostatectomy: surgical technique, oncological and functional outcomes at a single high-volume institution. BJU Int. 2018;122(5):837-844. doi: 10.1111/bju.145178.
  6. Walz J., Epstein J.I., Ganzer R. et al. A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur. Urol. 2016;70(2):301-311. Doi: 10.1016/j. eururo.2016.01.026.
  7. Preston M.A., Breau R.H., Lantz A.G. et al. The association between nerve sparing and a positive surgical margin during radical prostatectomy. Urol. Oncol. 2015;33(1):18.e1-18.e6. Doi: 10.1016/j. urolonc.2014.09.006.
  8. Zhang L., Wu B., Zha Z. et al. Positive surgical margin is associated with biochemical recurrence risk following radical prostatectomy: a meta-analysis from high-quality retrospective cohort series. World J. Surg. Oncol. 2018;16(1):124-136. doi: 10.1186/s12957-018-1433-3.
  9. Rayn K.N., Bloom J.B., Gold S.A. et al. Added Value of Multiparametric Magnetic Resonance Imaging to Clinical Nomograms for Predicting Adverse Pathology in Prostate Cancer. J. Urol. 2018;200(5): 1041- 1047. doi: 10.1016/j.juro.2018.05.094.
  10. Weng H., Zeng X.T., Li S. et al. Intrafascial versus interfascial nerve sparing in radical prostatectomy for localized prostate cancer: a systematic review and meta-analysis. Sci. Rep. 2017;7(1):11454. doi: 10.1038/s41598-017-11878-7.
  11. Геворгян Г.С., Костин А.А., Воробьев Н.В. и соавт. Анатомия сосудисто-нервного пучка и методы её сохранения при нервосберегающей простатэктомии. Исследования и практика в медицине. 2018;5(3):53-66) doi: 10.17709/2409-2231-2018-5-3-5.
  12. Nguyen L.N., Head L., Witiuk K. et al. The Risks and Benefits of Cavernous Neurovascular Bundle Sparing during Radical Prostatectomy: A Systematic Review and Meta-Analysis. J. Urol. 2017;198(4):760-69. doi: 10.1016/j.juro.2017.02.3344.
  13. Kumar A., Samavedi S., Bates A.S. et al. Safety of selective nerve-sparing in high risk prostate cancer during robot-assisted radical prostatectomy. J. Robot. Surg. 2017; 11(2): 129-138. Doi: 10.1007/ s.11701-016-0627-3.
  14. Медведев В.Л., Лысенко В.В., Роша Л.Г. и соавт. Влияние дооперационного стадирования рака предстательной железы на частоту позитивного хирургического края после радикальной простатэктомии. Инновационная медицина Кубани. 2018;2(10):13-16.
  15. Audenet F., Rozet F., Resche-Rigon M. et al. Grade Group Underestimation in Prostate Biopsy: Predictive Factors and Outcomes in Candidates for Active Surveillance. Clin. Genitourin. Cancer. 2017; 15(6):e907-e913. doi: 10.1016/j.clgc.2017.04.024.
  16. Schiavina R., Bianchi L., Borghesi M. et al. MRI Displays the Prostatic Cancer Anatomy and Improves the Bundles Management Before Robot-Assisted Radical Prostatectomy. J. Endourol. 2018;32(4):315- 321. doi: 10.1089/end.2017.0701.
  17. Druskin S.C., Liu J.J., Young A. et al. Prostate MRI prior to radical prostatectomy: effects on nerve sparing and pathological margin status. Res. Rep. Urol. 2017;9:55-63. doi: 10.2147/RRU.S128499.
  18. Гончарук Д.А., Велиев Е.И., Соколов Е.А. и соавт. Оценка потенциала измеряемого коэффициента диффузии мультипараметрической магнитно-резонансной томографии в определении низкой степени злокачественности рака предстательной железы после радикальной простатэктомии. Consilium Medicum. 2018;20(7): 15-19). doi: 10.26442/2075-1753_2018.7.15-19.
  19. Martini A., Gupta A., Lewis S.C. et al. Development and internal validation of a side-specific, multiparametric magnetic resonance imaging-based nomogram for the prediction of extracapsular extension of prostate cancer. BJU Int. 2018;122(6):1025-1033. doi: 10.1111/bju.14353.
  20. Nyarangi-Dix J., Wiesenfarth M., Bonekamp D. et al. Combined Clinical Parameters and Multiparametric Magnetic Resonance Imaging for the Prediction of Extraprostatic Disease-A Risk Model for Patient-tailored Risk Stratification When Planning Radical Prostatectomy. Eur. Urol. Focus. 2018;4569(18):30336-30335. doi: 10.1016/j.euf.2018.11.004.
  21. Martini A., Cumarasamy S., Haines K.G. III, Tewari A.K. An updated approach to incremental nerve sparing for robot-assisted radical prostatectomy. BJU Int. 2018; doi: 10.1111/bju.14655.
  22. Schlomm T., Tennstedt P., Huxhold C. et al. Neurovascular structure-adjacent frozen-section examination (NeuroSAFE) increases nerve-sparing frequency and reduces positive surgical margins in open and robot-assisted laparoscopic radical prostatectomy: experience after 11,069 consecutive patients. Eur. Urol.2012;62(2):333-340. doi: 10.1016/j.eururo.2012.04.057.
  23. Mirmilstein G., Rai B.P., Gbolahan O. et al. The neurovascular structure-adjacent frozen-section examination (NeuroSAFE) approach to nerve sparing in robot-assisted laparoscopic radical prostatectomy in a British setting - a prospective observational comparative study. BJU Int. 2018;121(6):854-862. doi: 10.1111/bju.14078.
  24. Oxley J., Bray A., Rowe E. Could a Mohs technique make NeuroSAFE a viable option? BJU Int. 2018; 122(3):358-359. Doi: 10.1111/ bju.14377.
  25. Yoon Y., Jeon S.H., Park Y.H. et al. Visualization of prostatic nerves by polarization-sensitive optical coherence tomography. Biomedical Optics Express. 2016;7(9):3170-3183. doi: 10.1364/BOE.7.003170.
  26. Panarello D., Comperat E., Seyde O. et al. Atlas of Ex Vivo Prostate Tissue and Cancer Images Using Confocal Laser Endomicroscopy: A Project for Intraoperative Positive Surgical Margin Detection During Radical Prostatectomy. Eur. Urol. Focus. 2019. Doi: 10.1016/j. euf.2019.01.004.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2020 Bionika Media

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies