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Oncologic outcomes of patients with incidental prostate cancer who underwent RARC: a comparison between nerve sparing and non-nerve sparing approach

Journal of Robotic Surgery volume 15, pages 105–114 (2021)Cite this article

Abstract

Background

Incidental Prostate cancer (iPCa) is a relatively common finding during histopathological evaluation of radical cystectomy (RC) specimens. To reduce the high impact of RC on erectile function, several sexual-preserving techniques have been proposed. The aim of this study was to evaluate and compare the oncologic outcomes of patients with iPCa who underwent nerve spring and no-nerve sparing robot-assisted radical cystectomy (RARC).

Methods

The clinicopathologic data of male patients who underwent RARC at our institution between 2006 and 2016 were retrospectively analysed. Patients with iPCa at definitive pathological examinations were stratified in two groups, according to the preservation of the neurovascular bundles (nerve sparing vs no nerve sparing). Significant PCa was defined as any Gleason score ≥ 3 + 4. Biochemical recurrence (BR) was defined as a sustained PSA level > 0.2 ng/mL on two or more consecutive appraisals. BR rate was assessed only in patients with incidental prostate cancer and at least 2 years of follow-up. Differences in categorical and continuous variables were analysed using the chi-squared test and the Mann–Withney U test, respectively. Biochemical recurrence curves were generated using the Kaplan–Meier method and compared with the Log-rank test.

Results

Overall, 343 male patients underwent RARC for bladder cancer within the study period. Nerve-sparing surgery was performed in 143 patients (41%), of these 110 had at least 2 years of follow up after surgery. Patients who underwent nerve-sparing surgery were significantly younger (p < 0.001). Clinically significant PCa was found in 24% of patients. No significant differences regarding preoperative PSA value (p = 0.3), PCa pathological stage (p = 0.5), Gleason score (p = 0.3) and positive surgical margin rates (p = 0.3) were found between the two groups. After a median follow-up of 51 months only one patient, in the no-nerve-sparing group had developed a biochemical recurrence (p = 0.4).

Conclusions

In our series most of the iPca detected in RC specimens can be considered as insignificant with a low rate of BR (0.9%). Nerve-sparing RARC is a safe procedure which did not affect oncological outcomes of patients with iPCa.

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Abbreviations

PCa:

Prostate cancer

iPCa:

Incidental prostate cancer

BCa:

Bladder cancer

RARC:

Robot-assisted radical cystectomy

RC:

Radical cystectomy

NS:

Nerve sparing

BR:

Biochemical recurrence

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Affiliations

  1. Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Palagi 9 street, 40134, Bologna, Italy

    F. Chessa, R. Schiavina, C. Distefano, Alessandro Bertaccini & E. Brunocilla

  2. S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy

    F. Chessa, R. Schiavina, Alessandro Bertaccini & E. Brunocilla

  3. Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy

    F. Chessa, R. Schiavina, Alessandro Bertaccini & E. Brunocilla

  4. Department of Molecular Medicine and Surgery Section of Urology Stockholm, Karolinska Institutet, Stockholm, Sweden

    F. Chessa, A. Möller, J. Collins, O. Laurin, M. Aly, C. Adding, O. Akre, A. Hosseini & P. Wiklund

  5. Department of Urology, Icahn School of Medicine, Mount Sinai, NY, USA

    P. Wiklund

Authors
  1. F. Chessa
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  2. A. Möller
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  3. J. Collins
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  4. O. Laurin
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  5. M. Aly
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  6. R. Schiavina
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  7. C. Adding
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  8. C. Distefano
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  9. O. Akre
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  10. Alessandro Bertaccini
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  11. A. Hosseini
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  12. E. Brunocilla
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  13. P. Wiklund
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Contributions

Idea: PW, FC; literature search: MA, AB, CD, AM, OL; data extraction: CD, AH; data analysis: FC, JC; critical review: OA, RS, EB, AH, RS, PW.

Corresponding author

Correspondence to F. Chessa.

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Conflict of interest

Francesco Chessa, Axel Moller, Justin Collins, Oscar Laurin, Markus Aly, Riccardo Schiavina, Cristofer Adding, Concetta Distefano, Alessandro Bertaccini, Olof Akre, Abolfazl Hosseini, Eugenio Brunocilla and Peter Wiklund declare that they have no conflict of interest.

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Chessa, F., Möller, A., Collins, J. et al. Oncologic outcomes of patients with incidental prostate cancer who underwent RARC: a comparison between nerve sparing and non-nerve sparing approach. J Robotic Surg 15, 105–114 (2021). https://doi.org/10.1007/s11701-020-01081-8

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  • DOI: https://doi.org/10.1007/s11701-020-01081-8

Keywords

  • Bladder cancer
  • Robotic surgery
  • Prostate cancer