Oncologic outcomes of patients with incidental prostate cancer who underwent RARC: a comparison between nerve sparing and non-nerve sparing approach
- 4 May 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of Robotic Surgery
- Vol. 15 (1), 105-114
- https://doi.org/10.1007/s11701-020-01081-8
Abstract
Background Incidental Prostate cancer (iPCa) is a relatively common finding during histopathological evaluation of radical cystectomy (RC) specimens. To reduce the high impact of RC on erectile function, several sexual-preserving techniques have been proposed. The aim of this study was to evaluate and compare the oncologic outcomes of patients with iPCa who underwent nerve spring and no-nerve sparing robot-assisted radical cystectomy (RARC). Methods The clinicopathologic data of male patients who underwent RARC at our institution between 2006 and 2016 were retrospectively analysed. Patients with iPCa at definitive pathological examinations were stratified in two groups, according to the preservation of the neurovascular bundles (nerve sparing vs no nerve sparing). Significant PCa was defined as any Gleason score ≥ 3 + 4. Biochemical recurrence (BR) was defined as a sustained PSA level > 0.2 ng/mL on two or more consecutive appraisals. BR rate was assessed only in patients with incidental prostate cancer and at least 2 years of follow-up. Differences in categorical and continuous variables were analysed using the chi-squared test and the Mann–Withney U test, respectively. Biochemical recurrence curves were generated using the Kaplan–Meier method and compared with the Log-rank test. Results Overall, 343 male patients underwent RARC for bladder cancer within the study period. Nerve-sparing surgery was performed in 143 patients (41%), of these 110 had at least 2 years of follow up after surgery. Patients who underwent nerve-sparing surgery were significantly younger (p < 0.001). Clinically significant PCa was found in 24% of patients. No significant differences regarding preoperative PSA value (p = 0.3), PCa pathological stage (p = 0.5), Gleason score (p = 0.3) and positive surgical margin rates (p = 0.3) were found between the two groups. After a median follow-up of 51 months only one patient, in the no-nerve-sparing group had developed a biochemical recurrence (p = 0.4). Conclusions In our series most of the iPca detected in RC specimens can be considered as insignificant with a low rate of BR (0.9%). Nerve-sparing RARC is a safe procedure which did not affect oncological outcomes of patients with iPCa.This publication has 23 references indexed in Scilit:
- Should Antibiotics Be Given Prior to Outpatient Cystoscopy? A Plea to Urologists to Practice Antibiotic StewardshipEuropean Urology, 2014
- Robot-assisted Radical Cystectomy: Description of an Evolved Approach to Radical CystectomyEuropean Urology, 2013
- Incidental Prostate Cancer in Patients with Bladder Urothelial Carcinoma: Comprehensive Analysis of 1,476 Radical Cystoprostatectomy SpecimensJournal of Urology, 2013
- The American Joint Committee on Cancer: the 7th Edition of the AJCC Cancer Staging Manual and the Future of TNMAnnals of Surgical Oncology, 2010
- Incidental prostate cancer at radical cystoprostatectomy: implications for apex-sparing surgeryBJU International, 2010
- Clinical outcome following prostatic capsule- and seminal-sparing cystectomy for bladder cancer in 25 menScandinavian Journal of Urology and Nephrology, 2009
- Risk Assessment of Prostatic Pathology in Patients Undergoing Radical CystoprostatectomyEuropean Urology, 2008
- Clinicopathologic Features of Prostate Adenocarcinoma Incidentally Discovered at the Time of Radical Cystectomy: An Evidence-Based AnalysisEuropean Urology, 2007
- Characteristics of incidental prostatic adenocarcinoma in contemporary radical cystoprostatectomy specimensBJU International, 2007
- Pathologic characterization of prostate cancers with a very low serum prostate specific antigen (0–2 ng/mL) incidental to cystoprostatectomy: is PSA a useful indicator of clinical significance?Urologic Oncology, 2004