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Prostate Cancer: Localized: Surgical Therapy III (MP50): Moderated Poster 50: Sunday, September 12, 2021


van der Slot, Michelle; Bakker, Michael den; Kweldam, Charlotte; Remmers, Sebastiaan; Tan, Tamara; Klaver, Sjoerd; Kliffen, Mike; Busstra, Martijn; Rietbergen, John; Gan, Melanie; Hamoen, Karen; Budel, Leo; Goemaere, Natascha; Bangma, Chris; Helleman, Jozien; Roobol, Monique; van leenders, Geert

doi: 10.1097/JU.0000000000002076.02
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Nerve-sparing surgery is expected to improve functional outcomes after radical prostatectomy, but could compromise oncological outcomes. Intra-operative neurovascular structure-adjacent frozen section examination (NeuroSAFE) might improve the nerve-sparing frequency. In this study, we report the results of the NeuroSAFE technique in Anser prostate cancer network, a high volume center in the Netherlands.


Between 2018 and 2020, NeuroSAFE was performed in 818 patients undergoing robot-assisted radical prostatectomy. When intraoperative histological evaluation showed tumor in the surgical margin a secondary resection of the ipsilateral neurovascular bundle was performed. The NeuroSAFE cohort was compared with a historical cohort of 797 radical prostatectomies performed by the same surgeons in three hospitals during 2016-2018. The effect of NeuroSAFE on nerve preservation was evaluated using multinomial logistic regression, the effect on surgical margin status using logistic regression. Cox regression was used to identify predictors of biochemical recurrence. Biochemical recurrence was defined as psa≥0.2.


In the NeuroSAFE cohort patients had more often ≥pT3 (46% versus 36%; p=0.06) and ISUP grade≥2 (91% versus 81%; p<0.001) tumors compared to the historical cohort. NeuroSAFE significantly improved the odds of performing nerve-sparing surgery with OR of 3.5 (95% CI: 2.6-4.7) in none versus unilateral nerve-sparing (Table 1). In none versus bilateral nerve-sparing the OR was 4.4 (95%CI 3.3-6.0). The NeuroSAFE technique did not affect the positive surgical margin rate (p=0.3). PSA follow-up of at least 6 months after surgery was available in 17% of NeuroSAFE cohort and in 24% of historical cohort. Median follow up of patients without a biochemical recurrence was 11.4 (IQR 9.6-14.6) and 21.1 months (IQR 12.5-36.6), respectively. The NeuroSAFE technique (HR 0.7; 95% CI 0.4-1.1; p=0.1) did not affect the biochemical recurrence rate corrected for PSA, ISUP grade, pathological stage, surgical margin status and lymph node metastasis in this subset with short-term follow-up.


The introduction of NeuroSAFE led to a higher chance of having nerve-sparing surgery without affecting the surgical margin and biochemical recurrence rate.

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© 2021 by American Urological Association Education and Research, Inc.