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External validation of an algorithm to personalize nerve sparing approaches during robot-assisted radical prostatectomy in men with unilateral high-risk prostate cancer

Prostate Cancer and Prostatic Diseases (2024)Cite this article

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Abstract

Limited evidence exists about preserving neurovascular bundles during radical prostatectomy (RP) for high-risk prostate cancer (HRPCa) patients. Hence, we validated an existing algorithm predicting contralateral extraprostatic extension (cEPE) risk in unilateral high-risk cases. This algorithm aims to assist in determining the suitability of unilateral nerve-sparing RP. Among 264 patients, 48 (18%) had cEPE. The risk of cECE varied: 8%, 17.2%, and 30.8% for the low, intermediate, and high-risk groups, respectively. Despite a higher risk of cECE among individuals classified as low-risk in the development group compared to the validation group, our algorithm’s superiority over always/never nerve-sparing RP was reaffirmed by decision curve analysis. Therefore, we conclude that bilateral excision may not always be justified in men with unilateral HRPCa. Instead, decisions can be based on our suggested nomogram.

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Fig. 1: External validation of an algorithm classifying the risk of contralateral extracapsular extension in cases of unilateral high-risk prostate cancer.

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References

  1. Mottet N, Cornford P, van den Bergh RCN, Briers E, Eberli D, De Meerleer G, et al. EAU-EANM-ESTROESUR- ISUP-SIOG guidelines on prostate cancer. Arnhem, The Netherlands: European Association of Urology; 2022.

  2. Schaeffer EM, Srinivas S, Adra N, An Y, Barocas D, Bitting R, et al. NCCN Guidelines® Insights: prostate cancer, version 1.2023. J Natl Compr Cancer Netw JNCCN. 2022;20:1288–98.

    PubMed  Google Scholar 

  3. Martini A, Soeterik TFW, Haverdings H, Rahota RG, Checcucci E, De Cillis S, et al. An algorithm to personalize nerve sparing in men with unilateral high-risk prostate cancer. J Urol. 2022;207:350–7.

    Article  PubMed  Google Scholar 

  4. Martini A, Wever L, Soeterik TFW, Rakauskas A, Fankhauser CD, Grogg JB, et al. Unilateral pelvic lymph node dissection in prostate cancer patients diagnosed in the era of magnetic resonance imaging-targeted biopsy: a study that challenges the dogma. J Urol. 2023;210:117–27.

    Article  PubMed  Google Scholar 

  5. Mossanen M, Nepple KG, Grubb RL, Androile GL, Kallogjeri D, Klein EA, et al. Heterogeneity in definitions of high-risk prostate cancer and varying impact on mortality rates after radical prostatectomy. Eur Urol Oncol. 2018;1:143–8.

    Article  PubMed  Google Scholar 

  6. Lombardo R, De Nunzio C. Nomograms in PCa: where do we stand. Prostate Cancer Prostatic Dis. 2023;26:447–8.

    Article  PubMed  Google Scholar 

  7. Diamand R, Roche JB, Lievore E, Lacetera V, Chiacchio G, Beatrici V, et al. External validation of models for prediction of side-specific extracapsular extension in prostate cancer patients undergoing radical prostatectomy. Eur Urol Focus. 2023;9:309–16.

    Article  PubMed  Google Scholar 

  8. Kováčik V, Maciak M, Baláž V, Babeľa J, Kubas V, Bujdák P, et al. Advanced Reconstruction of Vesicourethral Support (ARVUS) during robot-assisted radical prostatectomy: first independent evaluation and review of other factors influencing 1 year continence outcomes. World J Urol. 2020;38:1933–41.

    Article  PubMed  Google Scholar 

  9. Kim M, Park M, Pak S, Choi SK, Shim M, Song C, et al. Integrity of the urethral sphincter complex, nerve-sparing, and long-term continence status after robotic-assisted radical prostatectomy. Eur Urol Focus. 2019;5:823–30.

    Article  PubMed  Google Scholar 

  10. Avulova S, Zhao Z, Lee D, Huang LC, Koyama T, Hoffman KE, et al. The effect of nerve sparing status on sexual and urinary function: 3-year results from the CEASAR study. J Urol. 2018;199:1202–9.

    Article  PubMed  Google Scholar 

  11. Nguyen LN, Head L, Witiuk K, Punjani N, Mallick R, Cnossen S, et al. The risks and benefits of cavernous neurovascular bundle sparing during radical prostatectomy: a systematic review and meta-analysis. J Urol. 2017;198:760–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. These authors contributed equally: Lara Rodriguez-Sanchez, Alberto Martini.

  2. These authors jointly supervised this work: Massimo Valerio, Giancarlo Marra.

Authors and Affiliations

  1. Department of Urology, Institut Mutualiste Montsouris, Paris, France

    Lara Rodriguez-Sanchez, Qusay Mandoorah & Luciano Haiquel

  2. Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy

    Alberto Martini, Giorgio Gandaglia & Alberto Martini

  3. Vita-Salute San Raffaele University, Milan, Italy

    Alberto Martini

  4. Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, PR China

    Junlong Zhuang & Hongqiao Guo

  5. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

    Pawel Rajwa, Shahrokh F. Shariat & Pawel Rajwa

  6. Department of Urology, Medical University of Silesia, Zabrze, Poland

    Pawel Rajwa

  7. Department of Urology, Weill Cornell Medical College, New York, NY, USA

    Shahrokh F. Shariat

  8. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic

    Shahrokh F. Shariat

  9. Department of Urology, University of Texas Southwestern, Dallas, TX, USA

    Shahrokh F. Shariat

  10. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan

    Shahrokh F. Shariat

  11. Department of Urology, Geneva University Hospital, Geneva, Switzerland

    Massimo Valerio

  12. Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy

    Giancarlo Marra

Authors
  1. Lara Rodriguez-Sanchez
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  2. Alberto Martini
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  3. Junlong Zhuang
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  4. Hongqiao Guo
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  5. Pawel Rajwa
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  6. Qusay Mandoorah
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  7. Luciano Haiquel
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  8. Shahrokh F. Shariat
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  9. Giorgio Gandaglia
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  10. Massimo Valerio
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  11. Giancarlo Marra
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Consortia

Young Academic Urologists Working Group on Prostate Cancer of the European Association of Urology

  • Alberto Martini
  • , Pawel Rajwa
  • , Giorgio Gandaglia
  • , Massimo Valerio
  •  & Giancarlo Marra

Contributions

LRS, AM, HG, SS, GG, MV, and GM were involved in the conception of research, interpretation of results, and manuscript approval. Data was collected by JZ, PR, QM, and LH. Statistical analysis was carried out by AM.

Corresponding author

Correspondence to Lara Rodriguez-Sanchez.

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Competing interests

The authors declare no competing interests.

Ethics approval

The data utilized in this study were derived from preexisting records and databases, and no novel data were solicited from patients for the purpose of this research. To safeguard privacy, all patient data underwent de-identification procedures. Patient identities were anonymized, and any personal information was meticulously managed to uphold confidentiality.

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Rodriguez-Sanchez, L., Martini, A., Zhuang, J. et al. External validation of an algorithm to personalize nerve sparing approaches during robot-assisted radical prostatectomy in men with unilateral high-risk prostate cancer. Prostate Cancer Prostatic Dis (2024). https://doi.org/10.1038/s41391-023-00779-8

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  • DOI: https://doi.org/10.1038/s41391-023-00779-8

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