Evaluating the Impact of PSA as a Selection Criteria for Nerve Sparing Radical Prostatectomy in a Screened Cohort

Abstract EN

Purpose.

We investigated whether NS-RP increased risk of PSA failure and whether PSA should be included as a selection criterion for NS.

Methods.

We evaluated 357 consecutive men with screen-detected PC who underwent open RP without adjuvant radiotherapy between 9/11/2001 and 12/30/2008.

Criteria for NS included Gleason score ≤3 + 4, percentage of positive biopsies (PPB) ≤50%, percentage of core involvement ≤50%, nonapical location, no perineural invasion, and no palpable disease on pre- or intraoperative exam but did not include a PSA threshold.

Cox multivariable regression assessed whether increasing PSA or unilateral- or bilateral-NS versus non-NS-RP was associated with PSA failure adjusting for prognostic factors.

Results.

After a median follow-up of 3.96 years, 34 men sustained PSA failure (9.5%).

Increasing PSA was significantly associated with increased risk of PSA failure in the interaction model (adjusted hazard ratio (AHR): 1.09 [95% CI: 1.03–1.16]; P=0.005), whereas unilateral (AHR: 1.24 [95% CI: 0.36–4.34]; P=0.73) or bilateral NS (AHR: 0.41 [95% CI: 0.06–2.59]; P=0.34) versus non-NS RP was not.

Conclusion.

NS-RP in a screened cohort did not increase risk of PSA failure using NS criteria not including PSA.