1642 NERVE-SPARING IS ASSOCIATED WITH AN INCREASED RISK OF PROSTATE INCISION INTO TUMOR (PT2R1) DURING RADICAL PROSTATECTOMY (2012)

You have accessJournal of UrologyProstate Cancer: Localized VIII1 Apr 20121642 NERVE-SPARING IS ASSOCIATED WITH AN INCREASED RISK OF PROSTATE INCISION INTO TUMOR (PT2R1) DURING RADICAL PROSTATECTOMY Mark Preston, Rodney Breau, Andrea Lantz, Christopher Morash, Ronald Gerridzen, Steve Doucette, James Eastham, Peter Scardino, and Ilias Cagiannos Mark PrestonMark Preston Boston, MA More articles by this author , Rodney BreauRodney Breau Ottawa, Canada More articles by this author , Andrea LantzAndrea Lantz Ottawa, Canada More articles by this author , Christopher MorashChristopher Morash Ottawa, Canada More articles by this author , Ronald GerridzenRonald Gerridzen Ottawa, Canada More articles by this author , Steve DoucetteSteve Doucette Ottawa, Canada More articles by this author , James EasthamJames Eastham New York, NY More articles by this author , Peter ScardinoPeter Scardino New York, NY More articles by this author , and Ilias CagiannosIlias Cagiannos Ottawa, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1459AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate incision into organ-confined tumor (pT2R1) during radical prostatectomy (RP) increases the risk of biochemical recurrence. However, factors influencing the likelihood of prostate incision are largely unknown. Our objective was to evaluate the impact of nerve-sparing on risk of prostate incision into tumor. METHODS We evaluated a historical cohort of consecutive RP patients treated at the Ottawa Hospital or Memorial Sloan–Kettering Cancer Center between 1985 and 2010. Our primary outcome was the presence of prostate incision into tumor (positive margins with no extraprostatic extension). The association between nerve-sparing and prostate incision was adjusted for PSA, Gleason sum, clinical stage, RP modality, and RP date in the multivariate model. Patients who received pre-operative hormones (n=369), radiation (n=5) or had incomplete data (n=2891) were excluded. RESULTS Of 9915 eligible patients, 4347 had open RP, 1581 had laparoscopic RP and 631 had a robotic RP. Approximately 6.2% (414/6650) of patients had prostate incision. Patients with bilateral nerve-spare were significantly more likely to have prostate incision (OR 2.89 (1.35, 6.15), p=0.006) compared to those with nerve resection. Adjusting for potential confounders, patients with bilateral nerve-spare were more likely to have prostate incision (OR 2.29 (1.06, 4.91), p=0.03) than those who had nerve resection. Prostate incision was significantly less likely in patients treated with open (OR 0.59 (0.40, 0.88, p=0.01) or laparoscopic RP (OR 0.53 (0.35, 0.80, p=0.003) compared to robotic. Risk of prostate incision has decreased over time (OR 0.93/year (0.90, 0.99), p<0.0001). Clinical stage, PSA, and unilateral nerve sparing were not significantly associated with prostate incision. CONCLUSIONS Bilateral nerve-sparing during RP significantly increases the likelihood of prostate incision into tumor during radical prostatectomy. This data highlights the challenges of radical prostatectomy in balancing oncologic and functional outcomes in addition to the learning curve associated with technologic advancement. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e663-e664 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Metrics Author Information Mark Preston Boston, MA More articles by this author Rodney Breau Ottawa, Canada More articles by this author Andrea Lantz Ottawa, Canada More articles by this author Christopher Morash Ottawa, Canada More articles by this author Ronald Gerridzen Ottawa, Canada More articles by this author Steve Doucette Ottawa, Canada More articles by this author James Eastham New York, NY More articles by this author Peter Scardino New York, NY More articles by this author Ilias Cagiannos Ottawa, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...