Abstract: PD15-12
Sources of Funding: none

Introduction

Whether patients (pts) with high risk prostate cancer (HR PCa) should undergo radical prostatectomy (RP) remains a matter of debate. The aim of the present study was to assess functional and oncological outcomes following RP in pts with HR PCa.

Methods

We evaluated 316 consecutive pts with HR PCa (according to the NCCN guidelines: pT3a tumor, a PSA level greater than 20 ng/mL, or a Gleason score between 8 and 10) who underwent RP and pelvic lymph node dissection from 1996 to 2015. Continence (CO) and potency (PO) were assessed at 3, 6, 12 and 24 months (mts). Pts who reported absence of erection sufficient for penetration prior to RP were excluded for evaluation of potency. Multivariable logistic regression models tested whether uni- and bilateral nerve sparing (NS) were a predictor of CO or PO at different time points after RP. Occurrence of local recurrence was prospectively entered into our database. For evaluation of positive surgical margins (PSM), pathology reports were retrospectively analyzed together with an uropathologist.

Results

At 3, 6, 12, 24 mts, overall continence rates were 87%, 93%, 96% and 98%, respectively. Attempted NS RP was associated with higher continence rates at all time points compared to no NS RP (Fig). In multivariable analysis, NS was associated with a more than 2.5-fold higher probability of CO at 3 mts (OR 2.74, 95% CI 1.18-6.36, p=0.02)._x000D_ Overall potency rates were 15%, 31%, 47%, and 50% at 3, 6, 12, and 24 mts, respectively. Attempted nerve sparing RP was associated with higher potency rates at all time points compared to no NS RP (Fig). In multivariable analysis, NS was associated with a more than 6 to10-fold higher probability of PO at 6, 12 and 24 mts (p<0.0001, p=0.01 and p=0.001). The Clavien 30- and 90-day complication rate (p=0,3 and 0,2) as well as the percentage of major complications (p=0,2 and 0,1) were not higher in pts with attempted NS compared to pts without attempted NS. Likewise occurrence of PSM and local recurrence were not observed more frequently in pts with attempted NS._x000D_

Conclusions

Attempted NS in pts with HR PCa is associated with higher CO and PO rates after RP without compromising oncological outcome and occurrence of complications.

Funding

none