Oncological outcomes after attempted nerve-sparing radical prostatectomy (NSRP) in patients with high-risk prostate cancer are comparable to standard non-NSRP: a longitudinal long-term propensity-matched single-centre study

Marc A Furrer; Niranjan Sathianathen; Brigitta Gahl; Niall M Corcoran; Christopher Soliman; Jose Antonio Rodriguez Calero; Gallus B Ineichen; Miriam Gahl; Bernhard Kiss; George N Thalmann

doi:10.1111/bju.16126

Oncological outcomes after attempted nerve-sparing radical prostatectomy (NSRP) in patients with high-risk prostate cancer are comparable to standard non-NSRP: a longitudinal long-term propensity-matched single-centre study

BJU Int. 2024 Jan;133(1):53-62. doi: 10.1111/bju.16126. Epub 2023 Aug 21.

Authors

Marc A Furrer^{1

2

3}, Niranjan Sathianathen^{3

4}, Brigitta Gahl⁴, Niall M Corcoran^{3

5}, Christopher Soliman^{3

4}, Jose Antonio Rodriguez Calero⁶, Gallus B Ineichen¹, Miriam Gahl¹, Bernhard Kiss¹, George N Thalmann¹

Affiliations

¹ Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² Department of Urology, Solothurner Spitäler AG, Kantonsspital Olten and Bürgerspital Solothurn, Biberist, Switzerland.
³ Department of Urology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.
⁴ Clinical Trials Unit Bern, University of Bern, Bern, Switzerland.
⁵ Department of Urology, Western Health, St Albans, Victoria, Australia.
⁶ Department of Pathology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

PMID: 37548822
DOI: 10.1111/bju.16126

Abstract

Objective: To assess the long-term safety of nerve-sparing radical prostatectomy (NSRP) in men with high-risk prostate cancer (PCa) by comparing survival outcomes, disease recurrence, the need for additional therapy, and perioperative outcomes of patients undergoing NSRP to those having non-NSRP.

Patients and methods: We included consecutive patients at a single, academic centre who underwent open RP for high-risk PCa, defined as preoperative prostate-specific antigen level of > 20 ng/mL and/or postoperative International Society of Urological Pathology Grade Group 4 or 5 (i.e., Gleason score ≥ 8) and/or ≥pT3 and/or pN1 assessing the RP and lymph node specimen. We calculated a propensity score and used inverse probability of treatment weighting to match baseline characteristics of patients with high-risk PCa who underwent NSRP vs non-NSRP. We analysed oncological outcome as time-to-event and calculated hazard ratios (HRs).

Results: A total of 726 patients were included in this analysis of which 84% (n = 609) underwent NSRP. There was no evidence for the positive surgical margin rate being different between the NSRP and non-NSRP groups (47% vs 49%, P = 0.64). Likewise, there was no evidence for the need for postoperative radiotherapy being different in men who underwent NSRP from those who underwent non-NSRP (HR 0.78, 95% confidence interval [CI] 0.53-1.15). NSRP did not impact the risk of any recurrence (HR 0.99, 95% CI 0.73-1.34, P = 0.09) and there was no evidence for survival being different in men who underwent NSRP to those who underwent non-NSRP (HR 0.65, 95% CI 0.39-1.08). There was also no evidence for the cancer-specific survival (HR 0.56, 95% CI 0.29-1.11) or progression-free survival (HR 0.99, 95% CI 0.73-1.34) being different between the groups.

Conclusion: In patients with high-risk PCa, NSRP can be attempted without compromising long-term oncological outcomes provided a comprehensive assessment of objective (e.g., T Stage) and subjective (e.g., intraoperative appraisal of tissue planes) criteria are conducted.

Keywords: high-risk prostate cancer; nerve sparing; oncological outcomes; open radical prostatectomy; tumour recurrence.

MeSH terms

Humans
Longitudinal Studies
Male
Neoplasm Grading
Neoplasm Recurrence, Local / pathology
Prostatectomy / adverse effects
Prostatic Neoplasms* / pathology