PURPOSE: Surgical margin (SM) status is widely reported as a significant risk factor for prostate cancer recurrence following radical prostatectomy (RP). It has been presupposed that preserving the neurovascular bundle may compromise cancer control due to the limited surgical margin obtained with a resultant increase in treatment failure. We examined whether neurovascular bundle preservation during RP is a risk factor for positive SMs and progression-free survival after adjusting for disease severity. MATERIALS AND METHODS: Outcomes following RP in 7,268 men between 1990 and 2000 were examined retrospectively. Median followup in those last known to be alive is 6.4 years. RP was performed by a total of 21 surgeons in the same basic fashion with strict attention to anatomical detail. RESULTS: Overall a positive SM was identified in 38% of patients. The positive SM rate was higher for wide excision than for nerve sparing (NS) (42% vs 34%) (p </= 0.001). The OR for positive SMs in patients undergoing NS-RP was 0.86 (95% CI 0.76 to 0.97, p = 0.012) after incorporating age, clinical stage, biopsy grade, year of surgery and prostate specific antigen. Similarly NS-RP had no significant impact on biochemical progression rates after controlling for these variables (HR 0.98, 95% CI 0.88 to 1.08, p = 0.64). CONCLUSIONS: NS-RP is not an independent adverse risk factor for positive SMs or progression-free survival. Tumor biology appears set prior to technically skilled anatomical radical prostatectomy independent of wide excision of the neurovascular bundles. All patients with organ confined prostate cancer should be considered candidates for an NS operation.
PURPOSE: Surgical margin (SM) status is widely reported as a significant risk factor for prostate cancer recurrence following radical prostatectomy (RP). It has been presupposed that preserving the neurovascular bundle may compromise cancer control due to the limited surgical margin obtained with a resultant increase in treatment failure. We examined whether neurovascular bundle preservation during RP is a risk factor for positive SMs and progression-free survival after adjusting for disease severity. MATERIALS AND METHODS: Outcomes following RP in 7,268 men between 1990 and 2000 were examined retrospectively. Median followup in those last known to be alive is 6.4 years. RP was performed by a total of 21 surgeons in the same basic fashion with strict attention to anatomical detail. RESULTS: Overall a positive SM was identified in 38% of patients. The positive SM rate was higher for wide excision than for nerve sparing (NS) (42% vs 34%) (p </= 0.001). The OR for positive SMs in patients undergoing NS-RP was 0.86 (95% CI 0.76 to 0.97, p = 0.012) after incorporating age, clinical stage, biopsy grade, year of surgery and prostate specific antigen. Similarly NS-RP had no significant impact on biochemical progression rates after controlling for these variables (HR 0.98, 95% CI 0.88 to 1.08, p = 0.64). CONCLUSIONS: NS-RP is not an independent adverse risk factor for positive SMs or progression-free survival. Tumor biology appears set prior to technically skilled anatomical radical prostatectomy independent of wide excision of the neurovascular bundles. All patients with organ confined prostate cancer should be considered candidates for an NS operation.
Authors: H Wadhwa; M K Terris; W J Aronson; C J Kane; C L Amling; M R Cooperberg; S J Freedland; M R Abern Journal: Prostate Cancer Prostatic Dis Date: 2016-10-04 Impact factor: 5.554
Authors: Jae Seung Chung; Han Yong Choi; Hae-Ryoung Song; Seok-Soo Byun; Seong il Seo; Cheryn Song; Jin Seon Cho; Sang Eun Lee; Hanjong Ahn; Eun Sik Lee; Won-Jae Kim; Moon Kee Chung; Tae Young Jung; Ho Song Yu; Young Deuk Choi Journal: J Korean Med Sci Date: 2010-09-17 Impact factor: 2.153
Authors: Sultan Saud Alkhateeb; Shabbir M Alibhai; Antonio Finelli; Neil E Fleshner; Michael A Jewett; Alexandre R Zlotta; John Trachtenberg Journal: Urol Ann Date: 2010-05
Authors: Luke T Lavallée; Andrew Stokl; Sonya Cnossen; Ranjeeta Mallick; Chris Morash; Ilias Cagiannos; Rodney H Breau Journal: Can Urol Assoc J Date: 2016 Jan-Feb Impact factor: 1.862