A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy

Patel, Vipul; Sandri, Marco; Grasso, Angelica; Lorenzis, E. De; Palmisano, Franco; Albo, Giancarlo; Coelho, Rafael F.; Mottrie, Alexandre; Harvey, Tadzia; Kameh, Darian; Palayapalayam, Hariharan; Wiklund, Peter; Bòsari, Silvano; Puliatti, Stefano; Zuccolotto, Paola; Bianchi, Giampaolo; Rocco, Bernardo

doi:10.1111/bju.14026

Cited by 47 publications

(33 citation statements)

References 38 publications

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“…They use several binary logistic regressions to predict ECE, as well as various extents of ECE. Their model achieves high accuracy in predicting ECE; their model and ours both have similar area under the curve (AUC) values (0.81 vs 0.82) . One major difference is that our model incorporates mpMRI data in the prediction of ECE, which we believe to be a strength of our model given the increased use of mpMRI in the preoperative setting.…”

Section: Discussionmentioning

confidence: 71%

An updated approach to incremental nerve sparing for robot‐assisted radical prostatectomy

et al. 2019

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A.M. and S.C. contributed equally to this work ObjectivesTo update the algorithm for performing incremental nerve sparing (NS) using our multiparametric magnetic resonance imaging (mpMRI)-based nomogram. Patients and methodsWe applied the coefficients of the nomogram to the observations extracted from our population of patients who underwent robot-assisted radical prostatectomy between February 2014 and October 2015 and who received preoperative mpMRI. The information considered were PSA level, highest side-specific biopsy Gleason grade group, highest ipsilateral percentage core involvement with the highest Gleason grade group, and extracapsular extension (ECE) on mpMRI. The nomogram-derived probability [P (%)], after internal validation, was used as the independent variable on a classification tree to identify the most significant thresholds for ECE prediction. Incremental NS was performed as follows: Grade 1 NS: intrafascial dissection between the peri-prostatic veins and the pseudocapsule of the prostate; Grade 2 NS: inter-fascial dissection along the perivenous plane; Grade 3 NS: inter-fascial dissection through the outer compartment of the lateral prostatic fascia; Grade 4 NS: extrafascial dissection. ResultsData from 561 patients were considered, and 829 prostatic lobes with biopsy-documented tumour were analysed. Overall, 142 lobes presented ECE that was focal in 27 (19%) cases. The classification tree identified four risk categories. In the low-[P (%) ≤10], intermediate-[P (%) 10-21], high [P (%) 21-73] and very-high-risk [P(%) >73] groups, the ECE rates were 3.3%, 16%, 61.6% and 90%, respectively. Amongst those, ECE was focal in 41.7%, 31.7%, 7.9% and 0%, respectively. ConclusionWe suggest that Grade 1 NS (intrafascial) should be performed in the low-risk group. The inter-fascial approach, namely grades 2 and 3 NS, should be performed in the intermediate-and high-risk categories, respectively. Grade 4 NS (extrafascial) should be performed in the very-high-risk group. The current algorithm yields a better accuracy than the previous one; however, prospective validation is warranted.

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Section: Discussionmentioning

confidence: 71%

An updated approach to incremental nerve sparing for robot‐assisted radical prostatectomy

et al. 2019

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“…We did not insert NVB preservation among the parameters of the nomogram, since the nomogram itself is intended to be used in the pre‐operative setting. Nonetheless, clinical features, such as iPSA, clinical stage and GS, are good predictors of the possibility to perform NVB preservation (Alemozaffar et al, ; Eastham et al, ; Patel et al, ): in fact, patients with low‐risk disease are more likely to receive a nerve‐sparing procedure, while patients with disease features suggesting extracapsular extension (high PSA, T2/T3 clinical stage, Gleason score ≥8) often undergo a wide excision of the neurovascular bundles.…”

Section: Discussionmentioning

confidence: 99%

Sexual function recovery after robot‐assisted radical prostatectomy: Outcomes from an Italian referral centre and predicting nomogram

et al. 2019

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Aims of this study were to assess sexual recovery after robotic‐assisted radical prostatectomy (RARP) and to build a nomogram predicting 1‐year sexual function. From May 2015 to July 2016, all patients eligible for RARP at our institution were invited to enter the study. The Expanded Prostate cancer Index Composite (EPIC) questionnaire was administered pre‐operatively, then at 45 days, and at 3, 6, 9, and 12 months post‐operatively. According to sexual function scores, patients were divided into four classes. Multivariate analysis was used to investigate the influence of patient‐ and disease‐related features on sexual recovery. A total of 643 patients were included. Age was associated with baseline potency (p < .0001). Bioptic Gleason score (GS; p = .0002), American Society of Anesthesiologists (ASA) score ( = .002ASA Physical Status Classification System ) and Charlson Comorbidity Index (CCI; p = .02) were negatively associated with potency. Baseline sexual function was associated with potency recovery. A nomogram resulted from fitting a proportional odds logistic model for ordinal outcomes, with 1‐year sexual function as a dependent variable and baseline sexual potency, age, body mass index (BMI), clinical stage, biopsy GS, initial prostate‐specific antigen (iPSA), ASA score, and CCI as predictors. After further validation, this nomogram could be a useful tool for the pre‐operative counselling.

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“…Разработанная V. Patel и соавт. номограмма отрицает дополнительную ценность предоперационных данных мпМРТ, а J. Nyarangi-Dix и соавт., наоборот, предлагают использовать такие специфические и вариабельные показатели мпМРТ, как объем опухоли и длина контакта опухоли с капсулой [18,19]. Посередине находится разработанная A. Martini и соавт.…”

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Oncological results of radical prostatectomy depending on the data of multiparametric magnetic resonance imaging and patient selection for nerve-sparing technique

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et al. 2020

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Селекция пациентов для радикальной простатэктомии (РПЭ) с применением нервосберегающей техники (НСТ) является принципиально важным вопросом оптимизации онкологических и функциональных результатов. Соотношение данных мультипараметрической магнитно-резонансной томографии (мпМРТ) с результатами РПЭ остается недостаточно исследованным, а предложенные к настоящему моменту прогностические инструменты и номограммы показывают умеренную эффективность при сторонней валидизации и не лишены недостатков. Цель исследования-изучить патоморфологические результаты и оценить безрецидивную выживаемость пациентов после РПЭ в зависимости от данных мпМРТ; разработать алгоритм селекции пациентов для НСТ.

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A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy

Abstract: This novel tool predicts with good accuracy the presence and amount of ECE. Furthermore, the graphical interface available at www.prece.it can support surgeons in patient counselling and preoperative planning.

Cited by 47 publications

References 38 publications

An updated approach to incremental nerve sparing for robot‐assisted radical prostatectomy

An updated approach to incremental nerve sparing for robot‐assisted radical prostatectomy

Sexual function recovery after robot‐assisted radical prostatectomy: Outcomes from an Italian referral centre and predicting nomogram

Oncological results of radical prostatectomy depending on the data of multiparametric magnetic resonance imaging and patient selection for nerve-sparing technique

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