Nerve-sparing prostatectomy in high-risk cancer: similar early margins and recurrence, fewer pads

Design

Retrospective single-centre cohort (STROBE-reported), robotic prostatectomy 2021 to 2022

Population

1,385 men; 262 with two or more STAMPEDE high-risk features

Primary outcome

Positive margins, 12-month biochemical recurrence and continence by nerve-sparing status

Effect

Margins 21.3% vs 23.2% (P = 0.72); biochemical recurrence 6.7% vs 5.4% (P = 0.9); fewer pads with nerve sparing (P = 0.03)

A single-centre retrospective cohort of 1,385 men having robot-assisted radical prostatectomy in 2021 and 2022 within a structured patient-specific planning pathway was stratified by the number of STAMPEDE-defined high-risk features. Overall, 75.4% had nerve-sparing surgery. In the 262 men with two or more high-risk features, 57.3% had some nerve sparing.

In that group, positive surgical margin rates were 21.3% with nerve-sparing and 23.2% without (P = 0.72), and 12-month biochemical recurrence was 6.7% versus 5.4% (P = 0.9). Continence at three and twelve months was similar, but nerve-sparing patients used fewer pads at twelve months (P = 0.03).

Surgeons chose which men had nerve sparing, so those with more favourable disease on imaging and examination were probably selected. Twelve months is too short to judge cancer control. The authors call for prospective evaluation.

• 57.3% of men with two or more high-risk features had some nerve sparing.
• Margins and 12-month biochemical recurrence were similar.
• Pad use at 12 months was lower with nerve sparing.
• Selection by the surgeon and 12-month follow-up limit conclusions.
• Selection relied on structured imaging-based planning.

Why it matters

High-risk disease is usually treated as a reason to give up on nerve sparing, and this challenges that default in selected men.

Don't overread it

A retrospective single-centre cohort with surgeon selection and 12-month follow-up cannot show oncological safety.

The statistics, in plain English

P values of 0.72 and 0.9 show no detectable difference in a modest sample of 262 men, which is not proof of equivalence. Biochemical recurrence at 12 months misses most eventual recurrences.

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