Login to Access Video or Poster Abstract: MP93-06
Sources of Funding: None

Introduction

Radical prostatectomy is one of the standard treatments for localized prostate cancer. This procedure can significantly effect the quality of life. Nerve sparing (NS) has been proven to improve functional outcomes after radical prostatectomy. But in published literature, only 50% to 75 % of all eligible candidates get bilateral full NS during robotic-assisted radical prostatectomy (RALP). We planned to analyze factors affecting NS

Methods

We retrospectively analyzed our IRB approved database for low risk prostate cancer patients who underwent RALP. Men with NCCN low risk prostate cancer (LRPCa: PSA < 10 ng/ml, Gleason score ≤ 6 and Clinical stage T1/ T2a) without preoperative erectile dysfunction (no ED, SHIM score>21) are potentially ideal eligible candidates for full NS radical prostatectomy. Our pre-operative and intra-operative intention was to perform full nerve preservation in these patients. During surgery we noted the amount of nerve sparing performed and the level of difficulty of the nerve sparing. We also noted the reason for the challenge in sparing the nerves. We analyzed patient and tumor characteristics affecting the NS during RALP.

Results

Complete data was available for 1283 men with LRPCa and no ED that underwent RALP. 1085 (84.6%) of them received full NS and remaining 198 (15.4%) received partial NS. In univariate analysis advanced age, obesity, multiple comorbidity, and prior TURP adversely affected full NS. Low PSA level, less number of positive cores and smaller prostate positively influenced full NS. Multiple prior biopsies, more than 12 cores biopsy and PSA density did not affect NS. In multivariate analysis, technical difficulty in NS, number of positive cores, palpable nodule and age significantly affected the nerve sparing.

Conclusions

Even in the ideal candidate with an experienced surgeon performing the procedure, full NS during RALP is not always possible. Various anatomic, metabolic or functional reasons can prevent full NS and potentially effect recovery. Neither patient nor the surgeon should go into the operation assuming that low risk patients will have a full NS. It is important to counsel the patient on the possible adverse effects of surgery in this situation and weigh the risks and benefits of active surveillance in these patients.

Funding

None