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
Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Ethics Statements
2.2. Study Design and Patients
2.3. Data Collection and Outcome Evaluation
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
NS | nerve-sparing |
RARP | robot-assisted radical prostatectomy |
PI-RADS | Prostate Imaging-Reporting and Data System |
PZ | peripheral zone |
PSM | propensity score matching |
RM | resection margin |
PSA | prostate-specific antigen |
QOL | quality of life |
OR | odds ratio |
PCa | prostate cancer |
MRI | magnetic resonance imaging |
EAU | European Association of Urology |
NVB | neurovascular bundle |
EPIC | Expanded Prostate Cancer Index Composite |
SF-8 | Short Form 8 |
IQR | interquartile range |
CI | confidence interval |
NeuroSAFE | neurovascular structure–adjacent frozen section examination |
References
- Walz, J.; Epstein, J.I.; Ganzer, R.; Graefen, M.; Guazzoni, G.; Kaouk, J.; Menon, M.; Mottrie, A.; Myers, R.P.; Patel, V.; et al. A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: An update. Eur. Urol. 2016, 70, 301–311. [Google Scholar] [CrossRef] [PubMed]
- Ficarra, V.; Novara, G.; Ahlering, T.E.; Costello, A.; Eastham, J.A.; Graefen, M.; Guazzoni, G.; Menon, M.; Mottrie, A.; Patel, V.R.; et al. Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur. Urol. 2012, 62, 418–430. [Google Scholar] [CrossRef] [PubMed]
- Avulova, S.; Zhao, Z.; Lee, D.; Huang, L.C.; Koyama, T.; Hoffman, K.E.; Conwill, R.M.; Wu, X.C.; Chen, V.; Cooperberg, M.R.; et al. The effect of nerve sparing status on sexual and urinary function: 3-year results from the CEASAR study. J. Urol. 2018, 199, 1202–1209. [Google Scholar] [CrossRef] [PubMed]
- Vis, A.N.; van den Bergh, R.C.N.; van der Poel, H.G.; Mottrie, A.; Stricker, P.D.; Graefen, M.; Patel, V.; Rocco, B.; Lissenberg-Witte, B.; van Leeuwen, P.J. Selection of patients for nerve sparing surgery in robot-assisted radical prostatectomy. BJUI Compass 2022, 3, 6–18. [Google Scholar] [CrossRef]
- Eastham, J.A.; Auffenberg, G.B.; Barocas, D.A.; Chou, R.; Crispino, T.; Davis, J.W.; Eggener, S.; Horwitz, E.M.; Kane, C.J.; Kirkby, E.; et al. Clinically localized prostate cancer: AUA/ASTRO guideline, Part II: Principles of active surveillance, principles of surgery, and follow-up. J. Urol. 2022, 208, 19–25. [Google Scholar] [CrossRef]
- European Association of Urology (EAU). EAU Guidelines on Prostate Cancer. Available online: https://uroweb.org/guidelines/prostate-cancer (accessed on 21 December 2024).
- Yossepowitch, O.; Briganti, A.; Eastham, J.A.; Epstein, J.; Graefen, M.; Montironi, R.; Touijer, K. Positive surgical margins after radical prostatectomy: A systematic review and contemporary update. Eur. Urol. 2014, 65, 303–313. [Google Scholar] [CrossRef]
- Abdollah, F.; Sun, M.; Suardi, N.; Gallina, A.; Capitanio, U.; Bianchi, M.; Tutolo, M.; Fossati, N.; Castiglione, F.; Freschi, M.; et al. Presence of positive surgical margin in patients with organ-confined prostate cancer equals to extracapsular extension negative surgical margin. A plea for TNM staging system reclassification. Urol. Oncol. 2013, 31, 1497–1503. [Google Scholar] [CrossRef]
- Tohi, Y.; Kohashiguchi, K.; Miura, T.; Miyauchi, Y.; Matsuoka, Y.; Kato, T.; Taoka, R.; Tsunemori, H.; Ueda, N.; Sugimoto, M. Impact of the severity of urethrovesical anastomotic leakage on urinary continence following robot-assisted laparoscopic prostatectomy. J. Robot. Surg. 2022, 16, 1175–1181. [Google Scholar] [CrossRef]
- Tohi, Y.; Osaki, Y.; Kato, T.; Honda, T.; Abe, Y.; Naito, H.; Matsuoka, Y.; Okazoe, H.; Taoka, R.; Ueda, N.; et al. Impact of the coronavirus disease pandemic on robot-assisted radical prostatectomy and urologists’ treatment behaviors: A single tertiary center retrospective study. Int. J. Urol. 2024, 31, 899–905. [Google Scholar] [CrossRef]
- Tewari, A.K.; Srivastava, A.; Huang, M.W.; Robinson, B.D.; Shevchuk, M.M.; Durand, M.; Sooriakumaran, P.; Grover, S.; Yadav, R.; Mishra, N.; et al. Anatomical grades of nerve sparing: A risk-stratified approach to neural-hammock sparing during robot-assisted radical prostatectomy (RARP). BJU Int. 2011, 108, 984–992. [Google Scholar] [CrossRef]
- Kakehi, Y.; Takegami, M.; Suzukamo, Y.; Namiki, S.; Arai, Y.; Kamoto, T.; Ogawa, O.; Fukuhara, S. Health related quality of life in Japanese men with localized prostate cancer treated with current multiple modalities assessed by a newly developed Japanese version of the Expanded Prostate Cancer Index Composite. J. Urol. 2007, 177, 1856–1861. [Google Scholar] [CrossRef] [PubMed]
- Fukuhara, S.; Suzukamo, Y. Manual of the SF-8; Institute for Health Outcomes & Process Evaluation Research: Kyoto, Japan, 2004. (In Japanese) [Google Scholar]
- Kanda, Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013, 48, 452–458. [Google Scholar] [CrossRef] [PubMed]
- Nelles, J.L.; Freedland, S.J.; Presti, J.C., Jr.; Terris, M.K.; Aronson, W.J.; Amling, C.L.; Kane, C.J. Impact of nerve sparing on surgical margins and biochemical recurrence: Results from the SEARCH database. Prostate Cancer Prostatic Dis. 2009, 12, 172–176. [Google Scholar] [CrossRef] [PubMed]
- Katz, R.; Salomon, L.; Hoznek, A.; de la Taille, A.; Antiphon, P.; Abbou, C.C. Positive surgical margins in laparoscopic radical prostatectomy: The impact of apical dissection, bladder neck remodeling and nerve preservation. J. Urol. 2003, 169, 2049–2052. [Google Scholar] [CrossRef]
- Moris, L.; Gandaglia, G.; Vilaseca, A.; Van den Broeck, T.; Briers, E.; De Santis, M.; Gillessen, S.; Grivas, N.; O’Hanlon, S.; Henry, A.; et al. Evaluation of oncological outcomes and data quality in studies assessing nerve-sparing versus non-nerve-sparing radical prostatectomy in nonmetastatic prostate cancer: A systematic review. Eur. Urol. Focus 2022, 8, 690–700. [Google Scholar] [CrossRef]
- Lavallée, L.T.; Stokl, A.; Cnossen, S.; Mallick, R.; Morash, C.; Cagiannos, I.; Breau, R.H. The effect of wide resection during radical prostatectomy on surgical margins. Can. Urol. Assoc. J. 2016, 10, 14–17. [Google Scholar] [CrossRef]
- Weaver, J.K.; Kim, E.H.; Vetter, J.M.; Fowler, K.J.; Siegel, C.L.; Andriole, G.L. Presence of magnetic resonance imaging suspicious lesion predicts Gleason 7 or greater prostate cancer in biopsy-naive patients. Urology 2016, 88, 119–124. [Google Scholar] [CrossRef]
- Schlomm, T.; Tennstedt, P.; Huxhold, C.; Steuber, T.; Salomon, G.; Michl, U.; Heinzer, H.; Hansen, J.; Budäus, L.; Steurer, S.; et al. Neurovascular structure-adjacent frozen-section examination (NeuroSAFE) increases nerve-sparing frequency and reduces positive surgical margins in open and robot-assisted laparoscopic radical prostatectomy: Experience after 11,069 consecutive patients. Eur. Urol. 2012, 62, 333–340. [Google Scholar] [CrossRef]
- Kroon, L.J.; van der Slot, M.A.; van den Bergh, R.C.N.; Roobol, M.J.; van Leenders, G.J.L.H. Neurovascular structure-adjacent frozen-section examination (NeuroSAFE) during radical prostatectomy: A systematic review and meta-analysis. Eur. Urol. Oncol. 2024, in press. [Google Scholar] [CrossRef]
- Bauckneht, M.; Checcucci, E.; Cisero, E.; Rizzo, A.; Racca, M.; De Cillis, S.; Amparore, D.; De Luca, S.; Fiori, C.; Rescigno, P.; et al. The prognostic role of next-generation imaging-driven upstaging in newly diagnosed prostate cancer patients. Eur. J. Nucl. Med. Mol. Imaging 2024, 51, 864–870. [Google Scholar] [CrossRef]
- Checcucci, E.; Bauckneht, M.; Cisero, E.; Volpi, G.; Rizzo, A.; Zattoni, F.; Bianchi, L.; De Angelis, M.; Cangemi, D.; Heetman, J.; et al. PSMA PET-targeted biopsy for prostate cancer diagnosis: Initial experience from a multicenter cohort. Urology 2025, 196, 178–185. [Google Scholar] [CrossRef] [PubMed]
- Checcucci, E.; Pecoraro, A.; Amparore, D.; De Cillis, S.; Granato, S.; Volpi, G.; Sica, M.; Verri, P.; Piana, A.; Piazzolla, P.; et al. The impact of 3D models on positive surgical margins after robot-assisted radical prostatectomy. World J. Urol. 2022, 40, 2221–2229. [Google Scholar] [CrossRef] [PubMed]
- Porpiglia, F.; Fiori, C.; Checcucci, E.; Amparore, D.; Bertolo, R. Augmented reality robot-assisted radical prostatectomy: Preliminary experience. Urology 2018, 115, 184. [Google Scholar] [CrossRef] [PubMed]
- Porpiglia, F.; Bertolo, R.; Amparore, D.; Checcucci, E.; Artibani, W.; Dasgupta, P.; Montorsi, F.; Tewari, A.; Fiori, C.; ESUT. Augmented reality during robot-assisted radical prostatectomy: Expert robotic surgeons’ on-the-spot insights after live surgery. Minerva Urol. Nefrol. 2018, 70, 226–229. [Google Scholar] [CrossRef]
- Porpiglia, F.; Checcucci, E.; Amparore, D.; Autorino, R.; Piana, A.; Bellin, A.; Piazzolla, P.; Massa, F.; Bollito, E.; Gned, D.; et al. Augmented-reality robot-assisted radical prostatectomy using hyper-accuracy three-dimensional reconstruction (HA3D™) technology: A radiological and pathological study. BJU Int. 2019, 123, 834–845. [Google Scholar] [CrossRef]
- Checcucci, E.; Piana, A.; Volpi, G.; Piazzolla, P.; Amparore, D.; De Cillis, S.; Piramide, F.; Gatti, C.; Stura, I.; Bollito, E.; et al. Three-dimensional automatic artificial intelligence-driven augmented-reality selective biopsy during nerve-sparing robot-assisted radical prostatectomy: A feasibility and accuracy study. Asian J. Urol. 2023, 10, 407–415. [Google Scholar] [CrossRef]
- Reeves, F.; Preece, P.; Kapoor, J.; Everaerts, W.; Murphy, D.G.; Corcoran, N.M.; Costello, A.J. Preservation of the neurovascular bundles is associated with improved time to continence after radical prostatectomy but not long-term continence rates: Results of a systematic review and meta-analysis. Eur. Urol. 2015, 68, 692–704. [Google Scholar] [CrossRef]
- Song, L.J.; Lu, H.K.; Wang, J.P.; Xu, Y.M. Cadaveric study of nerves supplying the membranous urethra. Neurourol. Urodyn. 2010, 29, 592–595. [Google Scholar] [CrossRef]
- Michl, U.; Tennstedt, P.; Feldmeier, L.; Mandel, P.; Oh, S.J.; Ahyai, S.; Budäus, L.; Chun, F.K.; Haese, A.; Heinzer, H.; et al. Nerve-sparing surgery technique, not the preservation of the neurovascular bundles, leads to improved long long-term continence rates after radical prostatectomy. Eur. Urol. 2016, 69, 584–589. [Google Scholar] [CrossRef]
- Fukuda, K.; Muto, S.; China, T.; Koyasu, H.; Noma, Y.; Ashizawa, T.; Hirano, H.; Kitamura, K.; Shimizu, F.; Nagata, M.; et al. Clinical use of expanded prostate cancer index composite-based health-related quality of life outcomes after robot-assisted radical prostatectomy for localized prostate cancer. Prostate Int. 2022, 10, 62–67. [Google Scholar] [CrossRef]
Variables | Nerve-Sparing Group | No-Nerve-Sparing Group | p-Value |
---|---|---|---|
Patients | 129 | 59 | |
Age, median (IQR) | 70 (66–74) | 72 (67.5–76) | 0.023 |
BMI, kg/m2, median (IQR) | 22.9 (21.6–25.1) | 23.7 (21.8–25.8) | 0.264 |
PSA at diagnosis, ng/mL median (IQR) | 6.38 (4.78–9.02) | 6.80 (5.30–9.88) | 0.288 |
Clinical stage, n (%) | <0.001 | ||
cT1c | 15 (11.6) | 5 (5.1) | |
cT2a | 90 (69.8) | 31 (52.5) | |
cT2b | 3 (2.3) | 8 (13.6) | |
cT2c | 3 (2.3) | 9 (15.3) | |
cT3a | 15 (11.6) | 6 (10.2) | |
cT3b | 3 (2.3) | 2 (3.4) | |
Gleason grade group, n (%) | 0.007 | ||
1 | 24 (18.6) | 1(1.7) | |
2 | 33 (25.6) | 24(40.7) | |
3 | 37 (28.7) | 16(27.1) | |
4 | 25 (19.4) | 12(20.3) | |
5 | 10 (7.8) | 6 (10.2) | |
D’Amico risk, n (%) | 0.034 | ||
Low | 15 (11.6) | 1 (1.7) | |
Intermediate | 64 (49.6) | 28 (47.5) | |
High | 50 (38.8) | 30 (50.8) | |
Prostate volume, mL, median (IQR) | 28.26 (22–36) | 26 (19.5–32) | 0.087 |
Lymph node dissection, n (%) | 42 (32.6) | 30 (50.8) | 0.023 |
Follow-up period, month, median (IQR) | 39 (22–56) | 39 (23–48) | 0.852 |
Odds Ratio | 95% CI | p Value | |
---|---|---|---|
PSA at diagnosis | 1.110 | 1.010, 1.220 | 0.038 |
Gleason grade group at biopsy | 1.120 | 0.792, 1.580 | 0.526 |
cT stage | 1.400 | 1.020, 1.940 | 0.038 |
Percentage of biopsy positive core | 0.997 | 0.983, 1.010 | 0.680 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Tohi, Y.; Tsunemori, H.; Fujiwara, K.; Kato, T.; Kohashiguchi, K.; Kaji, A.; Harada, S.; Abe, Y.; Naito, H.; Okazoe, H.; et al. 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. Cancers 2025, 17, 962. https://doi.org/10.3390/cancers17060962
Tohi Y, Tsunemori H, Fujiwara K, Kato T, Kohashiguchi K, Kaji A, Harada S, Abe Y, Naito H, Okazoe H, et al. 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. Cancers. 2025; 17(6):962. https://doi.org/10.3390/cancers17060962
Chicago/Turabian StyleTohi, Yoichiro, Hiroyuki Tsunemori, Kengo Fujiwara, Takuma Kato, Kana Kohashiguchi, Asuka Kaji, Satoshi Harada, Yohei Abe, Hirohito Naito, Homare Okazoe, and et al. 2025. "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" Cancers 17, no. 6: 962. https://doi.org/10.3390/cancers17060962
APA StyleTohi, Y., Tsunemori, H., Fujiwara, K., Kato, T., Kohashiguchi, K., Kaji, A., Harada, S., Abe, Y., Naito, H., Okazoe, H., Taoka, R., Ueda, N., & Sugimoto, M. (2025). 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. Cancers, 17(6), 962. https://doi.org/10.3390/cancers17060962