Impact of Nerve-Sparing Status on Positive Surgical Margin Location and Biochemical Recurrence in Patients with Prostate Cancer Post Radical Prostatectomy

Radical or Not-So-Radical Prostatectomy: Do Surgical Margins Matter?

“…In the nerve-sparing technique, dissection is performed very close to the prostate surface and the neurovascular bundles are spared to minimize the risk for erectile dysfunction and urinary incontinence [ 30 , 31 ], factors affecting quality of life after surgery. It is not surprising that the wide resection technique is linked with significantly lower rates of positive MOR compared with the nerve-sparing technique [ 32 ] lowering the risk of positive MOR by 60%, regardless of the tumor characteristics [ 22 ].…”

Unrecognized Pitfall When Doing Nerve-Sparing Surgery in Radical Prostatectomy

“…3,5 Among these PSM-associated parameters, in a study by Matsuda et al, the impact of nerve sparing in RP on the location of PSM and its effect on BCR was investigated, and two important findings are reported. 6 One finding is that PSM in the anterior apex was not associated with the risk of BCR after RP. 6 So far, there has been accumulating evidence that PSM at the apex had a weaker association with increased BCR risk compared with other locations.…”

“…6 One finding is that PSM in the anterior apex was not associated with the risk of BCR after RP. 6 So far, there has been accumulating evidence that PSM at the apex had a weaker association with increased BCR risk compared with other locations. 7,8 This has been attributed to a few reasons, including that the apex lacks a well-defined capsule, has fewer periprostatic tissues, undergoes stronger retraction during RP than other regions, and tends to have pathological artifacts, as the authors mention.…”

“…8 The present study reports that the impact of PSM at the anterior apex is not associated with an increased risk of BCR, although the data on PSM risk at the lateral, posterolateral, and posterior apex are not shown. 6 A possible cause is that the anterior region of the apex is in contact with the rhabdosphincter and there is no extra tissue to resect, resulting in tumor exposure at resected surface although the tumor is completely removed. Otherwise, tumors in the anterior apex may be biologically less malignant.…”

“…Another finding is that a high prevalence of PSM at the contralateral side in unilateral nerve sparing is associated with increased BCR risk if PSM is detected at the nonanterior apex. 6 So far, it has been considered that PSM at the contralateral side in unilateral nerve sparing is equivalent to PSM when nerve-sparing surgery is not performed. This is the first study that has investigated the contralateral PSM during unilateral nerve sparing, as the authors mention.…”