Nerve-sparing prostatectomy in selected high-risk patients was not linked to worse early cancer control

Design

Single-centre retrospective cohort

Population

1,385 men having robotic radical prostatectomy; 262 with ≥2 STAMPEDE high-risk features

Primary outcome

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

Effect

Margins 21.3% vs 23.2%; 12-month BCR 6.7% vs 5.4% (nerve-sparing vs not)

A single centre reviewed 1,385 robotic radical prostatectomies from 2021 to 2022 performed within a structured patient-specific planning pathway (BJU International, 30 September 2026). Patients were grouped by the number of STAMPEDE-defined high-risk features.

Among 262 men with two or more high-risk features, 57.3% had some degree of nerve sparing. Compared with non-nerve-sparing surgery in this group, positive margins (21.3% vs 23.2%) and 12-month biochemical recurrence (6.7% vs 5.4%) were similar, as were pad-free continence rates at 3 and 12 months. Men who had nerve sparing used fewer pads at 12 months (P = 0.03).

With careful selection and planning, nerve sparing need not be ruled out by high-risk features alone. Longer follow-up is needed before drawing conclusions about recurrence.

• Do not exclude nerve sparing automatically on high-risk features; assess side-specific risk with imaging and biopsy mapping.
• Use a structured planning pathway when considering nerve sparing in higher-risk disease.
• Counsel that early cancer control appeared similar in this selected series, but follow-up is only 12 months.
• Discuss continence and erectile goals as part of the planning conversation.

Why it matters

It challenges the reflex to sacrifice the nerves whenever disease is high risk.

Don't overread it

This is a retrospective single-centre series with 12-month follow-up; selection explains much of the result.

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