Clinical and oncological outcomes of robot‑assisted radical prostatectomy with nerve sparing vs. non‑nerve sparing for high‑risk prostate cancer cases

  • Authors:
    • Kiyoshi Takahara
    • Makoto Sumitomo
    • Kosuke Fukaya
    • Takahito Jyoudai
    • Masashi Nishino
    • Masaru Hikichi
    • Kenji Zennami
    • Takuhisa Nukaya
    • Manabu Ichino
    • Naohiko Fukami
    • Hitomi Sasaki
    • Mamoru Kusaka
    • Ryoichi Shiroki
  • View Affiliations

  • Published online on: July 31, 2019     https://doi.org/10.3892/ol.2019.10692
  • Pages: 3896-3902
Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )


Abstract

Robot‑assisted radical prostatectomy (RARP) is one of the most widely used procedures for localized prostate cancer (PCa). In the present study, the clinical and oncological outcomes of RARP with bilateral or unilateral nerve sparing (NS) for D'Amico high‑risk PCa cases were assessed. Among the 767 cases who received RARP at Fujita Health University Hospital between August 2009 and December 2016, 230 high‑risk PCa cases who were observed for >6 months comprised the retrospective study cohort. Bilateral NS was performed with the bilateral neurovascular bundle in eight, unilateral in 125 and none in 97 cases. Perioperative parameters [surgery time, console time, estimated blood loss, pathological stage, positive lymph node metastases [pN (+)], and surgical margin positivity] did not exhibit significant differences between the NS and non‑NS cohorts. During a median follow‑up time of 25 months, the 1‑ and 3‑year biochemical recurrence (BCR)‑free survival rates in the NS/non‑NS cohorts were 84.4/86.0 and 72.7/75.0%, respectively. There were no significant differences identified between the two groups at each time period. According to multivariate analysis, the resection margin was an important factor for time to BCR, regardless of the NS technique used. The numbers of pads used daily at 3 and 6 months after RARP between the NS/non‑NS cohorts were 1.1/1.5 and 0.6/1.0, respectively (P=0.045 and P=0.009), suggesting that the NS technique resulted in significantly improved outcomes regarding urinary continence recovery. In selected high‑risk PCa cases, the NS technique resulted in equivalent oncological outcomes and improved urinary continence compared with the non‑NS RARP group.

Introduction

Prostate cancer (PCa) was the most commonly diagnosed and third most fatal cancer among males in 2008 in the developing world (1). Prostate-specific antigen (PSA) is widely used as a tumor marker and aids the diagnosis of PCa at an early stage (2). The most common curative treatment for localized PCa is radical prostatectomy (RP) (3), with robot-assisted radical prostatectomy (RARP) becoming a widely adopted procedure. According to a number of previous studies, RARP improves perioperative and functional outcomes, and at least comparable oncologic outcomes compared with open RP in the localized PCa (48). Pound et al (9) contributed in the establishment of the natural history of high-risk PCa in surgically-treated cases. After a median of 8 years, Pound et al (9) identified biochemical recurrence (BCR) in 15% of cases and reported the development of metastatic disease in 34% of the cohort. In survival analysis, time to biochemical progression, the Gleason score (GS) (10) and PSA doubling time are predictive factors of the probability and time to develop metastatic disease (9). Boorjian et al (11) reported that the risks of BCR and cancer-specific mortality are 3.3 and 11.5 times greater, respectively, in cases with high-risk PCa compared with cases of low-risk PCa. Therefore, high-risk localized PCa cases have been formerly characterized as having an increased risk of metastasis and requiring complex treatments, such as surgery (12). However, a number of previous studies support surgery as monotherapy for high-risk localized PCa cases and have revealed optimal outcomes (13,14).

In the RARP procedure, the excision of the neurovascular bundle (NVB) is often performed in patients with intermediate- or high-risk PCa to reduce the probability of a positive surgical margin (PSM) (15). When performing nerve sparing (NS) RARP, there should be a number of cases who obtain successful oncological and functional outcomes, since the ‘high-risk’ group is notably heterogenous (16).

The present study selected high-risk PCa cases based on original criteria. The patients underwent RARP with NS, to evaluate the feasibility, oncologic safety as compared with non-NS in the intermediate-term and functional outcomes.

Materials and methods

Study design

A total of 767 male cases received RARP at Fujita Health University Hospital (Toyoake, Japan) between August 2009 and December 2016. Median age was 66 years old and the range was from 45 to 88 years. Among the 767 cases screened for the present study, 230 high-risk PCa cases who were observed for >6 months comprised the study cohort for retrospective analysis. The mean age for the high-risk cohort is provided in Table I. All cases had non-metastatic and clinically high-risk PCa, as defined according to the D'Amico risk stratification system (17), and exhibited at least one of the following: i) A serum PSA level of >20 ng/ml (measured using a American Cancer Society-PSA kit (Ciba Corning Diagnostics Corp.) with chemiluminescent immunoassay, according to the manufacturer's instructions; ii) GS ≥8; or iii) clinical stage ≥T2c. TNM classification was defined using the American Joint Committee on Cancer staging manual (18). The following clinical variables were evaluated: Age, serum PSA level (ng/ml), clinical T stage, GS and neoadjuvant treatment. The criteria for NS RARP were: Bilateral NS, at least two factors (PSA <10 ng/ml, cT1c, <GS 7, <30% of positive-core ratio on the NS side); unilateral NS, <cT2b or <30% positive-core ratio on the NS side; non-NS, other than the aforementioned criteria. All patients received pelvic lymph node dissection. Surgery time, estimated blood loss (EBL), console time, pathological stage (pT stage), positive lymph node metastases [pN (+)], and surgical margin positivity were recorded to assess perioperative parameters. The schedule after RARP surgery consisted of a PSA assay every 3 months for the first 2 years, every 6 months for the following 3 years and annually thereafter. The number of pads used daily, at 3 months and 6 months after RARP, was checked to assess urinary continence recovery. The onset of BCR was defined as the date when the serum PSA level was >0.2 ng/ml. The time to events was calculated from the day of RARP.

Table I.

Clinical characteristics of NS and non-NS robot-assisted radical prostatectomy cases.

Table I.

Clinical characteristics of NS and non-NS robot-assisted radical prostatectomy cases.

Baseline patient characteristicsNS cohort (n=133), n (range or %)non-NS cohort (n=97), n (range or %)P-value
Mean age, years64.6 (45–76)67.1 (49–77)<0.01a
Mean serum PSA level, ng/ml10.2 (1.6–57.1)14.5 (3.9–158.3)0.01a
T stage
  cT1c12 (9.0)1 (1.0) <0.01a
  cT2a31 (23.3)7 (7.2)
  cT2b37 (27.8)9 (9.3)
  cT2c46 (34.6)65 (67.0)
  cT3a7 (5.3)14 (14.4)
  cT3b0 (0.0)1 (1.0)
Gleason score
  612 (9.0)15 (15.5) <0.01a
  743 (32.3)51 (52.6)
  855 (41.4)17 (17.5)
  923 (17.3)12 (12.4)
  100 (0)2 (2.1)
Neoadjuvant treatment
  Anti-androgen monotherapy46 (34.6)29 (29.9)0.10
  LHRH agonist alone5 (3.8)4 (4.1)
  Combined androgen blockade11 (8.3)16 (16.5)
  Others3 (2.3)7 (7.2)
  None68 (51.1)41 (42.3)

a P<0.05. LHRH, luteinizing hormone-releasing hormone; NS, nerve sparing; PSA, prostate-specific antigen.

The protocol of the present study was approved by the Ethics Committee of Fujita Health University Hospital (approval no. HM 18-115), and the present study was performed in accordance with the ethical standards laid down in the most recent version of the Declaration of Helsinki.

Statistical analysis

All values are presented as the mean ± standard deviation, and statistical comparison of the results was performed using a Student's t-test, a Mann-Whitney test, the χ2 test or Fisher's exact test. BCR-free survival was estimated using the Kaplan-Meier method, and a log-rank test was used to compare the survival curves. To assess prognostic factors, univariate analysis was performed using the following variables: Age, initial PSA, cT stage, GS, NS, neoadjuvant hormonal therapy (NHT) and resection margin. Significant preoperative variables in the univariate analysis were included in the multivariate analysis using a Cox proportional hazards regression model. P<0.05 was considered to indicate a statistically significant difference. All data were analyzed using IBM SPSS Statistics version 23 (IBM Corp.).

Results

Clinical characteristics of cases

Out of the 230 high-risk cases, 133 underwent RARP with NS, while 97 underwent RARP without NS (Table I). The mean age in the NS and non-NS cohorts was 64.6 and 67.1 years, respectively. The serum PSA level in the NS and non-NS cohorts was 10.2 and 14.5 ng/ml, respectively. The clinical stage with the highest number of cases, in each cohort, was T2c. GSs of 8 in the NS cohort and 7 in the non-NS cohort were observed most frequently. For neoadjuvant treatment, 68 cases (51.1%) in the NS cohort and 41 cases (42.3%) in the non-NS cohort did not receive NHT. Among the factors of age, PSA level, T stage, GS and NHT, only NHT exhibited no significant difference between the two cohorts (P=0.102).

Perioperative parameters

The mean operation times in the NS and non-NS cohorts were 171 and 179 min, respectively. The mean console times in the NS and non-NS cohorts were 131 and 137 min, respectively. The mean EBL was 177 ml in the NS cohort and 171 ml in the non-NS cohort. There were no significant differences identified for these three factors between cohorts (operation time, P=0.189; console tine, P=0.259; EBL, P=0.697; Fig. 1).

Urinary continence recovery

In the present study, urinary continence recovery was assessed by evaluating the quantity of pads used daily at 3 and 6 months after RARP. The mean ± standard deviation quantity of pads used daily at 3 months in the NS/non-NS cohorts was 1.12±1.08/1.48±1.11, and that at 6 months was 0.61±0.87/1.03±1.05 (Fig. 2). As expected, the NS procedure resulted in significantly improved outcomes regarding urinary continence.

Oncological findings

Oncological findings, including pT stage, PSM, pN (+) and BCR, are shown in Table II. pT stage T2c was most frequent in the NS and non-NS cohorts. The overall PSM rate was 22.6% (Fig. 1D), with rates of 18.0% in the NS group and 28.9% in the non-NS group. No significant difference in the PSM rates between cohorts was observed (P=0.053). The PSM rates in the NHT/non-NHT cohorts were 24.8 and 20.2%, respectively, with no significant differences identified between them (P=0.406). For pN (+), only one case was observed in each cohort. The BCR rates in the NS and non-NS cohorts were 23.3 and 19.6%, respectively, with no significant difference identified between them (P=0.501).

Table II.

Oncological findings of NS and non-NS robot-assisted radical prostatectomy cases.

Table II.

Oncological findings of NS and non-NS robot-assisted radical prostatectomy cases.

Oncological findingsNS cohort (n=133), n (%)Non-NS cohort (n=97), n (%)P-value
Pathological stage
  pT02 (1.5)2 (2.1)0.358
  pT2a23 (17.3)9 (9.3)
  pT2b12 (9.0)5 (5.2)
  pT2c69 (51.9)61 (62.9)
  pT3a15 (11.3)11 (11.3)
  pT3b12 (9.0)8 (8.2)
  pT40 (0.0)1 (1.0)
Positive surgical margin24 (18.0)28 (28.9)0.053
pN(+)1 (0.8)1 (1.0)0.823
Biochemical recurrence31 (23.3)19 (19.6)0.501

[i] NS, nerve sparing.

BCR-free survival rates

BCR-free survival rates in the NS and NHT categories are indicated in Figs. S1 and S2. A total of 16 cases (7.0%) were observed with PSA ≥0.2 ng/ml at the first postoperative measurement. The BCR-free survival rates at 3 years after RARP in the NS and non-NS cohorts were 72.7 and 75.0%, respectively (Fig. S1). When BCR-free survival rates within the NS and NHT categories were compared, no significant differences were observed (NS, P=0.6572; NHT, P=0.0812; Figs. S1 and S2). These results suggest that the NS and NHT treatments did not affect cancer control in D'Amico high-risk PCa cases.

Cox regression analysis for time to BCR

When risk parameters in high-risk PCa cases were compared, the factors of age, initial PSA, GS 7, and resection margin exhibited significant differences. In multivariate analysis, the factors of age, initial PSA, GS 8–10, and resection margin were associated with time to BCR, whereas the factors of cT stage, NS and NHT were not associated with time to BCR (Table III). These results suggest that NS and NHT did not affect BCR-free survival following RARP in high-risk PCa cases.

Table III.

Cox regression analysis for time to biochemical recurrence.

Table III.

Cox regression analysis for time to biochemical recurrence.

Univariate analysisMultivariate analysis


CharacteristicHR (95% CI)P-valueHR (95% CI)P-value
Age0.95 (0.91–0.99)0.019a0.95 (0.91–0.99)0.024a
Initial PSA1.02 (1.01–1.03)0.002a1.01 (1.00–1.03)0.042a
cT stage
  T1c, T2a, T2b
  T2c0.71 (0.29–1.75)0.462
  T3a, T3b0.48 (0.19–1.21)0.120
Gleason score
  6
  70.23 (0.05–0.94)0.041a0.25 (0.06–1.03)0.055
  8–100.58 (0.32–1.06)0.0770.50 (0.27–0.92)0.025a
Nerve sparing
  No
  Yes0.93 (0.52–1.64)0.789
Neoadjuvant hormonal therapy
  No
  Yes0.59 (0.33–1.04)0.068
Resection margin
  None
  Positive0.43 (0.25–0.77)0.004a0.43 (0.24–0.78)0.006a

a P<0.05. HR, hazard ratio; PSA, prostate-specific antigen.

Discussion

Walsh (19) was the first to demonstrate that NVBs run posterolateral to the prostate between two layers of lateral pelvic fascia, the prostatic fascia medially and levator fascia laterally, in an intraoperative study. The effect of the preservation of the NVBs during RP on erectile function is evident (20); however, its influence on urinary continence remains unclear. According to a recent cohort study, the NS technique is not associated with worse cancer outcomes but is associated with improved urinary and erectile function (21). Additionally, Michl et al (22) indicated that the meticulous apical dissection associated with the NS technique rather than the preservation of the NVBs, can impart a positive impact on long-term urinary continence rates.

RP with NS is challenging for D'Amico-classified high-risk PCa cases, as such cases are more likely to have ‘non-organ-confined disease’, which possibly leads to BCR (23). However, Shikanov et al (24) reported that even PCa cases whose preoperative biopsy GS is 8 had organ-confined (pT2N0) disease in 47% of this population. These findings indicate that the ‘high-risk’ group is heterogeneous, and it is important to select cases in the high-risk group when performing RP with NS. The criteria of RP with NS for high-risk PCa cases are unclear. In the present study, the criteria for NS RARP were: Bilateral NS, at least two factors (PSA <10 ng/ml, cT1c, <GS 7, <30% of positive-core ratio on the NS side); unilateral NS, <cT2b or <30% positive-core ratio on the NS side and non-NS, other than the aforementioned criteria. However, a recent study has reported their criteria as follows: Complete, non-palpable disease with <3 cores involved on the prostate biopsy; partial, non-palpable disease with <4 cores involved on the prostate biopsy; and none, clinically palpable disease with ≥4 cores involved on the prostate biopsy and intraoperative visual cues of locally advanced disease (25).

In the present study, there were no significant differences between the perioperative parameters of operation time, EBL, console time and PSM rates in the NS and non-NS cohorts of high-risk cases. Yossepowitch et al (15) reported that the long-term impact on survival of patients with PCa after radical prostatectomy is variable and largely affected by risk modifiers other than surgical margin positivity; however, it is still considered as an adverse oncological outcome. The overall PSM rate in the present study was 22.6%, whereas PSM rates have been reported as 35% (12–53%) following RARP in high-risk PCa cases in previous studies (24,26,27). The present study demonstrated that the factor of PSM was important for time to BCR regardless of the NS technique in RARP in high-risk cases. A number of studies have reported significant positive associations between NS and surgical margin positivity; however, other studies have not identified them (6,7,15). As a result, the association between NS and surgical margin positivity remains controversial.

In the context of NHT treatment, a number of previous studies have reported favorable BCR-free survival in high-risk PCa cases treated with a neoadjuvant gonadotropin-releasing hormone agonist or antagonist, and estramustine phosphate followed by RP surgery (28,29). However, in the present study, NHT treatment did not affect BCR-free survival rates in D'Amico high-risk PCa cases.

The role of NS during RARP in high-risk PCa cases has been reported in only a few previous studies (30,31). Kumar et al (25) reported that the overall BCR rate, at a mean follow-up of 24.3 months, was 19.2% and the mean time to BCR was 7.9 months in high-risk PCa cases, which is comparable to other previous studies (24,26,27,32,33). Kumar et al (25) performed RARP with NS in 89.4% of cases of high-risk PCa without compromising the PSM/BCR rate, while also providing improved postoperative continence and potency outcomes, using preoperative clinical variables along with intraoperative visual cues as a guide for NS. Consistent with these results, the present study reported that NS RARP in high-risk PCa resulted in equivalent oncological outcomes compared with non-NS RARP according to the estimation of BCR-free survival rates. Additionally, we demonstrated that NS and NHT did not affect BCR-free survival following RARP of high-risk PCa cases.

Limitations of the present study included the retrospective collection, its small sample size of a single center, a lack of well-designed analyses and short follow-up duration. Therefore, further studies are required to demonstrate the clinical utility of RARP with NS in high-risk PCa cases in the future.

In conclusion, NS RARP could provide intermediate-term oncological safety and successful functional outcomes in selected high-risk PCa cases based on the original criteria used in the present study. However, rigorous selection is required when performing NS RARP in high-risk PCa cases.

Supplementary Material

Supporting Data

Acknowledgements

Not applicable.

Funding

No funding was received.

Availability of data and materials

The datasets used and/or analyzed during the present study are available from the corresponding author on reasonable request.

Authors' contributions

KT, MS, HS, MK and RS conceived and designed the study. KT, KF, TJ, MN, MH, KZ, TN, MI and NF acquired the data. KT, MS, KZ and TN drafted the manuscript. KT, MS, KZ and MK performed the statistical analysis. RS supervised the study.

Ethics approval and consent to participate

The protocol of the present study was approved by the Ethics Committee of Fujita Health University Hospital (approval no. HM 18-115), and the present study was performed in accordance with the ethical standards laid down in the most recent version of the Declaration of Helsinki.

Patient consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

References

1 

Ferlay J, Shin HR, Bray F, Forman D, Mathers C and Parkin DM: Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 127:2893–2917. 2010. View Article : Google Scholar : PubMed/NCBI

2 

Reed AB and Parekh DJ: Biomarkers for prostate cancer detection. Expert Rev Anticancer Ther. 10:103–114. 2010. View Article : Google Scholar : PubMed/NCBI

3 

Bill-Axelson A, Holmberg L, Garmo H, Rider JR, Taari K, Busch C, Nordling S, Häggman M, Andersson SO, Spångberg A, et al: Radical prostatectomy or watchful waiting in early prostate cancer. N Engl J Med. 370:932–942. 2014. View Article : Google Scholar : PubMed/NCBI

4 

Coelho RF, Rocco B, Patel MB, Orvieto MA, Chauhan S, Ficarra V, Melegari S, Palmer KJ and Patel VR: Retropubic, laparoscopic, and robot-assisted radical prostatectomy: A critical review of outcomes reported by high-volume centers. J Endourol. 24:2003–2015. 2010. View Article : Google Scholar : PubMed/NCBI

5 

Ficarra V, Borghesi M, Suardi N, De Naeyer G, Novara G, Schatteman P, De Groote R, Carpentier P and Mottrie A: Long-term evaluation of survival, continence and potency (SCP) outcomes after robot-assisted radical prostatectomy (RARP). BJU Int. 112:338–345. 2013. View Article : Google Scholar : PubMed/NCBI

6 

Ficarra V, Cavalleri S, Novara G, Aragona M and Artibani W: Evidence from robot-assisted laparoscopic radical prostatectomy: A systematic review. Eur Urol. 51:45–56. 2007. View Article : Google Scholar : PubMed/NCBI

7 

Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M, Guazzoni G, Guillonneau B, Menon M, Montorsi F, et al: Retropubic, laparoscopic and robot-assisted radical prostatectomy: A systematic review and cumulative analysis of comparative studies. Eur Urol. 55:1037–1063. 2009. View Article : Google Scholar : PubMed/NCBI

8 

Srivastava A, Chopra S, Pham A, Sooriakumaran P, Durand M, Chughtai B, Gruschow S, Peyser A, Harneja N, Leung R, et al: Effect of a risk-stratified grade of nerve-sparing technique on early return of continence after robot-assisted laparoscopic radical prostatectomy. Eur Urol. 63:438–444. 2013. View Article : Google Scholar : PubMed/NCBI

9 

Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD and Walsh PC: Natural history of progression after PSA elevation following radical prostatectomy. JAMA. 281:1591–1597. 1999. View Article : Google Scholar : PubMed/NCBI

10 

Gleason DF and Mellinger GT: Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging. J Urol. 111:58–64. 1974. View Article : Google Scholar : PubMed/NCBI

11 

Boorjian SA, Karnes RJ, Rangel LJ, Bergstralh EJ and Blute ML: Mayo Clinic validation of the D'amico risk group classification for predicting survival following radical prostatectomy. J Urol. 179:1354–1361. 2008. View Article : Google Scholar : PubMed/NCBI

12 

Bastian PJ, Boorjian SA, Bossi A, Briganti A, Heidenreich A, Freedland SJ, Montorsi F, Roach M III, Schröder F, van Poppel H, et al: High-risk prostate cancer: From definition to contemporary management. Eur Urol. 61:1096–1106. 2012. View Article : Google Scholar : PubMed/NCBI

13 

Cooperberg MR, Vickers AJ, Broering JM and Carroll PR: Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer. 116:5226–5234. 2010. View Article : Google Scholar : PubMed/NCBI

14 

Petrelli F, Vavassori I, Coinu A, Borgonovo K, Sarti E and Barni S: Radical prostatectomy or radiotherapy in high-risk prostate cancer: A systematic review and metaanalysis. Clin Genitourin Cancer. 12:215–224. 2014. View Article : Google Scholar : PubMed/NCBI

15 

Yossepowitch O, Briganti A, Eastham JA, Epstein J, Graefen M, Montironi R and Touijer K: Positive surgical margins after radical prostatectomy: A systematic review and contemporary update. Eur Urol. 65:303–313. 2014. View Article : Google Scholar : PubMed/NCBI

16 

Mossanen M, Nepple KG, Grubb RL III, Androile GL, Kallogjeri D, Klein EA, Stephenson AJ and Kibel AS: Heterogeneity in definitions of high-risk prostate cancer and varying impact on mortality rates after radical prostatectomy. Eur Urol Oncol. 1:143–148. 2018. View Article : Google Scholar : PubMed/NCBI

17 

D'Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, Tomaszewski JE, Renshaw AA, Kaplan I, Beard CJ and Wein A: Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 280:969–974. 1998. View Article : Google Scholar : PubMed/NCBI

18 

Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR and Winchester DP: The eighth edition AJCC Cancer staging manual: Continuing to build a bridge from a population-based to a more ‘personalized’ approach to cancer staging. CA Cancer J Clin. 67:93–99. 2017. View Article : Google Scholar : PubMed/NCBI

19 

Walsh PC: Anatomic radical prostatectomy: Evolution of the surgical technique. J Urol. 160:2418–2424. 1998. View Article : Google Scholar : PubMed/NCBI

20 

Castiglione F, Ralph DJ and Muneer A: Surgical techniques for managing post-prostatectomy erectile dysfunction. Curr Urol Rep. 18:902017. View Article : Google Scholar : PubMed/NCBI

21 

Nguyen LN, Head L, Witiuk K, Punjani N, Mallick R, Cnossen S, Fergusson DA, Cagiannos I, Lavallée LT, Morash C and Breau RH: The risks and benefits of cavernous neurovascular bundle sparing during radical prostatectomy: A systematic review and meta-analysis. J Urol. 198:760–769. 2017. View Article : Google Scholar : PubMed/NCBI

22 

Michl U, Tennstedt P, Feldmeier L, Mandel P, Oh SJ, Ahyai S, Budäus L, Chun FKH, Haese A, Heinzer H, et al: Nerve-sparing surgery technique, not the preservation of the neurovascular bundles, leads to improved long-term continence rates after radical prostatectomy. Eur Urol. 69:584–589. 2016. View Article : Google Scholar : PubMed/NCBI

23 

D'Amico AV, Whittington R, Malkowicz SB, Fondurulia J, Chen MH, Kaplan I, Beard CJ, Tomaszewski JE, Renshaw AA, Wein A and Coleman CN: Pretreatment nomogram for prostate-specific antigen recurrence after radical prostatectomy or external-beam radiation therapy for clinically localized prostate cancer. J Clin Oncol. 17:168–172. 1999. View Article : Google Scholar : PubMed/NCBI

24 

Shikanov SA, Thong A, Gofrit ON, Zagaja GP, Steinberg GD, Shalhav AL and Zorn KC: Robotic laparoscopic radical prostatectomy for biopsy Gleason 8 to 10: Prediction of favorable pathologic outcome with preoperative parameters. J Endourol. 22:1477–1481. 2008. View Article : Google Scholar : PubMed/NCBI

25 

Kumar A, Samavedi S, Bates AS, Mouraviev V, Coelho RF, Rocco B and Patel VR: Safety of selective nerve sparing in high risk prostate cancer during robot-assisted radical prostatectomy. J Robot Surg. 11:129–138. 2017. View Article : Google Scholar : PubMed/NCBI

26 

Yuh B, Artibani W, Heidenreich A, Kimm S, Menon M, Novara G, Tewari A, Touijer K, Wilson T, Zorn KC and Eggener SE: The role of robot-assisted radical prostatectomy and pelvic lymph node dissection in the management of high-risk prostate cancer: A systematic review. Eur Urol. 65:918–927. 2014. View Article : Google Scholar : PubMed/NCBI

27 

Yuh BE, Ruel NH, Mejia R, Wilson CM and Wilson TG: Robotic extended pelvic lymphadenectomy for intermediate- and high-risk prostate cancer. Eur Urol. 61:1004–1010. 2012. View Article : Google Scholar : PubMed/NCBI

28 

Fujita N, Koie T, Ohyama C, Tanaka Y, Soma O, Matsumoto T, Yamamoto H, Imai A, Tobisawa Y, Yoneyama T, et al: Overall survival of high-risk prostate cancer patients who received neoadjuvant chemohormonal therapy followed by radical prostatectomy at a single institution. Int J Clin Oncol. 22:1087–1093. 2017. View Article : Google Scholar : PubMed/NCBI

29 

Koie T, Mitsuzuka K, Yoneyama T, Narita S, Kawamura S, Kaiho Y, Tsuchiya N, Tochigi T, Habuchi T, Arai Y, et al: Neoadjuvant luteinizing-hormone-releasing hormone agonist plus low-dose estramustine phosphate improves prostate-specific antigen-free survival in high-risk prostate cancer patients: A propensity score-matched analysis. Int J Clin Oncol. 20:1018–1025. 2015. View Article : Google Scholar : PubMed/NCBI

30 

Casey JT, Meeks JJ, Greco KA, Wu SD and Nadler RB: Outcomes of locally advanced (T3 or greater) prostate cancer in men undergoing robot-assisted laparoscopic prostatectomy. J Endourol. 23:1519–1522. 2009. View Article : Google Scholar : PubMed/NCBI

31 

Lavery HJ, Nabizada-Pace F, Carlucci JR, Brajtbord JS and Samadi DB: Nerve-sparing robotic prostatectomy in preoperatively high-risk patients is safe and efficacious. Urol Oncol. 30:26–32. 2012. View Article : Google Scholar : PubMed/NCBI

32 

Connolly SS, Cathcart PJ, Gilmore P, Kerger M, Crowe H, Peters JS, Murphy DG and Costello AJ: Robotic radical prostatectomy as the initial step in multimodal therapy for men with high-risk localised prostate cancer: Initial experience of 160 men. BJU Int. 109:752–759. 2012. View Article : Google Scholar : PubMed/NCBI

33 

Jayram G, Decastro GJ, Large MC, Razmaria A, Zagaja GP, Shalhav AL and Brendler CB: Robotic radical prostatectomy in patients with high-risk disease: A review of short-term outcomes from a high-volume center. J Endourol. 25:455–457. 2011. View Article : Google Scholar : PubMed/NCBI

Related Articles

Journal Cover

October 2019
Volume 18 Issue 4

Print ISSN: 1792-1074
Online ISSN:1792-1082

Sign up for eToc alerts

Recommend to Library

Copy and paste a formatted citation
x
APA
Takahara, K., Sumitomo, M., Fukaya, K., Jyoudai, T., Nishino, M., Hikichi, M. ... Shiroki, R. (2019). Clinical and oncological outcomes of robot‑assisted radical prostatectomy with nerve sparing vs. non‑nerve sparing for high‑risk prostate cancer cases. Oncology Letters, 18, 3896-3902. https://doi.org/10.3892/ol.2019.10692
MLA
Takahara, K., Sumitomo, M., Fukaya, K., Jyoudai, T., Nishino, M., Hikichi, M., Zennami, K., Nukaya, T., Ichino, M., Fukami, N., Sasaki, H., Kusaka, M., Shiroki, R."Clinical and oncological outcomes of robot‑assisted radical prostatectomy with nerve sparing vs. non‑nerve sparing for high‑risk prostate cancer cases". Oncology Letters 18.4 (2019): 3896-3902.
Chicago
Takahara, K., Sumitomo, M., Fukaya, K., Jyoudai, T., Nishino, M., Hikichi, M., Zennami, K., Nukaya, T., Ichino, M., Fukami, N., Sasaki, H., Kusaka, M., Shiroki, R."Clinical and oncological outcomes of robot‑assisted radical prostatectomy with nerve sparing vs. non‑nerve sparing for high‑risk prostate cancer cases". Oncology Letters 18, no. 4 (2019): 3896-3902. https://doi.org/10.3892/ol.2019.10692