Nerve-Sparing Robotic-Assisted Radical Prostatectomy Based on the Absence of Prostate Imaging-Reporting and Data System ≥3 or Biopsy Gleason Pattern ≥4 in the Peripheral Zone.
{"title":"Nerve-Sparing Robotic-Assisted Radical Prostatectomy Based on the Absence of Prostate Imaging-Reporting and Data System ≥3 or Biopsy Gleason Pattern ≥4 in the Peripheral Zone.","authors":"Yoichiro Tohi, Hiroyuki Tsunemori, Kengo Fujiwara, Takuma Kato, Kana Kohashiguchi, Asuka Kaji, Satoshi Harada, Yohei Abe, Hirohito Naito, Homare Okazoe, Rikiya Taoka, Nobufumi Ueda, Mikio Sugimoto","doi":"10.3390/cancers17060962","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background/Objectives</b>: The objective of this study was to evaluate the oncological outcomes and safety of nerve-sparing (NS) robot-assisted radical prostatectomy (RARP) when applied without Prostate Imaging-Reporting and Data System (PI-RADS) ≥3 lesions or Gleason pattern ≥4 on biopsy in the peripheral zone (PZ). <b>Methods</b>: We retrospectively analyzed 208 patients who underwent RARP between August 2017 and December 2022, excluding those who had received preoperative hormonal therapy. After NS status stratification and patient characteristic adjustment using propensity score matching (PSM), positive resection margin (RM) rates and prostate-specific antigen (PSA) recurrence-free survival were compared. Urinary and sexual quality of life (QOL) were assessed using the Expanded Prostate Cancer Index Composite, along with predictive factors associated with positive RM and RM locations in the NS group. <b>Results</b>: NS was performed in 68.6% (<i>n</i> = 129) patients. After PSM, there were no significant differences in RM positivity (<i>p</i> = 0.811) or PSA recurrence-free survival (Log-rank <i>p</i> = 0.79), regardless of NS status. There was no difference in sexual function between groups, but urinary QOL was significantly better in the NS group from the third month onward. In the NS group, RM positivity was 27.9% (n = 36), and diagnostic PSA (odds ratio [OR], 1.110, <i>p</i> = 0.038) and clinical T stage (OR, 1.400, <i>p</i> = 0.038) were predictive factors. The RM positivity rate on the NS side was 10.8%. <b>Conclusions</b>: NS, based on the absence of PI-RADS ≥3 lesions or Gleason pattern ≥4 in PZ, did not increase RM positivity rate and increased early urinary QOL.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 6","pages":""},"PeriodicalIF":4.5000,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11940342/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancers","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3390/cancers17060962","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background/Objectives: The objective of this study was to evaluate the oncological outcomes and safety of nerve-sparing (NS) robot-assisted radical prostatectomy (RARP) when applied without Prostate Imaging-Reporting and Data System (PI-RADS) ≥3 lesions or Gleason pattern ≥4 on biopsy in the peripheral zone (PZ). Methods: We retrospectively analyzed 208 patients who underwent RARP between August 2017 and December 2022, excluding those who had received preoperative hormonal therapy. After NS status stratification and patient characteristic adjustment using propensity score matching (PSM), positive resection margin (RM) rates and prostate-specific antigen (PSA) recurrence-free survival were compared. Urinary and sexual quality of life (QOL) were assessed using the Expanded Prostate Cancer Index Composite, along with predictive factors associated with positive RM and RM locations in the NS group. Results: NS was performed in 68.6% (n = 129) patients. After PSM, there were no significant differences in RM positivity (p = 0.811) or PSA recurrence-free survival (Log-rank p = 0.79), regardless of NS status. There was no difference in sexual function between groups, but urinary QOL was significantly better in the NS group from the third month onward. In the NS group, RM positivity was 27.9% (n = 36), and diagnostic PSA (odds ratio [OR], 1.110, p = 0.038) and clinical T stage (OR, 1.400, p = 0.038) were predictive factors. The RM positivity rate on the NS side was 10.8%. Conclusions: NS, based on the absence of PI-RADS ≥3 lesions or Gleason pattern ≥4 in PZ, did not increase RM positivity rate and increased early urinary QOL.
期刊介绍:
Cancers (ISSN 2072-6694) is an international, peer-reviewed open access journal on oncology. It publishes reviews, regular research papers and short communications. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced.