PURPOSE: In radical prostatectomy (RP) procedures, sparing the neurovascular bundles adjacent to the posterolateral aspect of the prostatic fascia has often been suggested as a possible risk factor for positive surgical margins. Here we aimed to quantify the probability of extracapsular extension (ECE) at the posterolateral side of the prostate to aid in nerve-sparing decision making.
MATERIALS AND METHODS: We evaluated 472 patients who underwent RP between July 2007 and January 2012. All patients underwent preoperative magnetic resonance imaging (MRI) with diffusion-weighted imaging and apparent diffusion coefficient mapping. We analyzed 944 side-specific prostate lobes with preoperative variables. To quantify the risk of side-specific posterolateral ECE after RP, we developed a risk-stratification scoring system through logistic regression analysis.
RESULTS: Overall, 20.6% of 944 prostate lobes had ECE. In the multivariate analysis, prostate-specific antigen (PSA), biopsy Gleason score ≥7, percentage of side-specific cores with tumor, and posterolateral ECE on MRI were independent predictive factors of posterolateral ECE. On internal and external validation to calculate the predicted risk, the Hosmer-Lemeshow goodness-of-fit test showed good calibration (p=0.396).
CONCLUSIONS: PSA, biopsy Gleason score, percentage of side-specific cores with tumor, and posterolateral ECE on MRI are independent predictors of posterolateral ECE. The scoring system derived from this study will provide objective parameters for use when deciding if the neurovascular bundle can be safely spared.
Written by:
Pak S1, Park S2, Ryu J1, Hong S3, Song SH1, You D1, Jeong IG1, Song C1, Hong JH1, Kim CS1, Ahn H1 Are you the author?
1Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 2Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea. 3Department of Urology, Dankook University College of Medicine, Cheonan, Korea.
Reference: Korean J Urol. 2013 Dec;54(12):824-9 (Epub 2013 Dec 10)
doi: 10.4111/kju.2013.54.12.824
PubMed Abstract
PMID: 24363862
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