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Association of neurovascular bundle preservation with oncological outcomes in patients with high-risk prostate cancer

Prostate Cancer and Prostatic Diseases volume 24, pages 193–201 (2021)Cite this article

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Abstract

Objective

To investigate the oncologic safety of neurovascular bundles (NVB) preservation at radical prostatectomy (RP) in patients with high-risk and/or locally advanced prostate cancer (PCa).

Material and methods

Within a two-institutional high-volume center database we identified patients who harbored high-risk PCa at RP (2000–2017). Only patients with D’Amico high-risk PCa were included. Kaplan–Meier and multivariable Cox regression models tested the effect of NVB preservation on biochemical recurrence (BCR), metastasis and overall survival (OS). Subgroup analyses focused on patients with clinical stage T3 and/or biopsy ISUP grade 5 and pathologic stage T3.

Results

Of 4351 patients with D’Amico high-risk, 35.7% vs. 38.0% vs. 26.3% underwent bilateral vs. unilateral vs. no NVB preservation, respectively. At 120 months after RP BCR-free, metastasis-free survival and OS rates were 62.2% vs. 44.3% vs. 27.1% (p < 0.001), 83.7% vs. 66.7% vs. 60.3% (p < 0.001), and 91.8% vs. 87.5% vs. 72.3% (p < 0.001) for bilateral vs. unilateral vs. no NVB preservation, respectively. In multivariable Cox regression models, bilateral and unilateral compared to no NVB preservation did not increase the risk for BCR, metastasis or death in the entire cohort and in subgroups with clinical stage T3 and/or biopsy ISUP grade 5, as well as pathologic stage T3.

Conclusions

NVB preservation was not associated with worse oncological outcome in patients with high-risk and/or locally advanced PCa and may be offered to well-selected patients who are at risk of harboring nonorgan-confined PCa.

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Fig. 1: Biochemical recurrence free survival.
Fig. 2: Metastasis-free survival.
Fig. 3: Overall survival.

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Authors and Affiliations

  1. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany

    Felix Preisser, Farid Arad, Markus Graefen, Hartwig Huland & Derya Tilki

  2. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany

    Felix Preisser

  3. Division of Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy

    Giorgio Gandaglia, Marco Bandini, Francesco Montorsi & Alberto Briganti

  4. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada

    Pierre I. Karakiewicz

  5. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Raisa S. Pompe & Derya Tilki

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  1. Felix Preisser
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  2. Giorgio Gandaglia
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Correspondence to Derya Tilki.

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Preisser, F., Gandaglia, G., Arad, F. et al. Association of neurovascular bundle preservation with oncological outcomes in patients with high-risk prostate cancer. Prostate Cancer Prostatic Dis 24, 193–201 (2021). https://doi.org/10.1038/s41391-020-00266-4

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  • DOI: https://doi.org/10.1038/s41391-020-00266-4

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