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A side-specific nomogram for extraprostatic extension may reduce the positive surgical margin rate in radical prostatectomy

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Abstract

Purpose

Nomograms predicting side-specific extraprostatic extension (EPE) may be applied to reduce positive surgical margin (PSM) rates in patients planned for radical prostatectomy (RP). This study evaluates the impact of implementing an externally validated nomogram for side-specific EPE on PSM rate and degree of nerve-sparing.

Methods

In patients planned for RP, the side-specific nomogram predictions (based on MRI, ISUP grade group, and PSA density), with an advised threshold of 20% for safe nerve-sparing, were presented preoperatively to the urological surgeon. The surgeon completed a survey before RP about the planning with respect to side-specific nerve-sparing and change of management due to the result of the nomogram. PSM rates and degree of nerve-sparing were compared to a retrospective control group treated in the months prior to the introduction of the nomogram.

Results

A total of 100 patients were included, 50 patients in both groups representing 200 prostate lobes. Of the patients, 37% had histologically confirmed EPE, and 40% a PSM. In 12% of the 100 lobes planned after nomogram presentation, a change in management due to the nomogram was reported. A per-prostate lobe analysis of all the lobes showed comparable rates of full nerve-sparing (45% vs. 30%; p = 0.083) and lower rates of PSM on the lobes with histological EPE (45% vs. 85%; p < 0.05) in the intervention (nomogram) group versus the control group.

Conclusion

Implementing a predictive nomogram for side-specific EPE in the surgical planning for nerve-sparing leads to lower rates PSM on the side of the histological EPE without compromising nerve-sparing.

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Authors and Affiliations

  1. Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Utrecht-Nieuwegein, The Netherlands

    Joris G. Heetman, Timo F. W. Soeterik, Aswin R. Meyer, Jody E. Nuininga, Robert J. van Soest, Harm H. E. van Melick & Roderick C. N. van den Bergh

  2. Department of Urology, Canisius Wilhelmina Hospital, Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands

    Lieke Wever & Jean-Paul P. A. van Basten

Authors
  1. Joris G. Heetman
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  2. Timo F. W. Soeterik
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  3. Lieke Wever
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  4. Aswin R. Meyer
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  5. Jody E. Nuininga
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  6. Robert J. van Soest
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  7. Harm H. E. van Melick
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  8. Jean-Paul P. A. van Basten
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  9. Roderick C. N. van den Bergh
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Contributions

RCNvdB contributed to project development, data collection, manuscript editing; JPAvB contributed to project development, manuscript editing; HHEvM contributed to project development, manuscript editing; RJvS contributed to data collection, manuscript editing; JEN contributed to data collection, manuscript editing; ARM contributed to data collection, manuscript editing; LW contributed to data analysis, manuscript editing; TFWS contributed to project development, data analysis, manuscript editing; JGH contributed to project development, data collection, data analysis and manuscript writing.

Corresponding author

Correspondence to Joris G. Heetman.

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There are no potential conflicts of interest.

Ethical approval

The Medical research Ethics Committee United (METC-U) registered the study protocol under W19.179 and concluded that the study protocol was not subjected to the Human Subject Act.

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The METC-U concluded that informed consent was not needed.

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Heetman, J.G., Soeterik, T.F.W., Wever, L. et al. A side-specific nomogram for extraprostatic extension may reduce the positive surgical margin rate in radical prostatectomy. World J Urol 40, 2919–2924 (2022). https://doi.org/10.1007/s00345-022-04191-0

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