361 QUALITY OF LIFE OUTCOMES IN MEN UNDERGOING TREATMENT OF LOCALIZED PROSTATE CANCER: INITIAL RESULTS FROM THE KAISER PERMANENTE SOUTHERN CALIFORNIA REGION

Abstract

INTRODUCTION AND OBJECTIVES: Risk-stratification based on preoperative data cannot reliably predict organ-confined disease. This is of particular relevance for selecting patients for nerve-sparing (NS) radical prostatectomy (RP). We assessed the impact of our intraoperative neurovascular structure adjacent frozen section examination (NeuroSAFE) guided nerve-sparing approach on the frequency of nerve-sparing and surgical margin rates in D’Amico low-, intermediate-, and high-risk patients, applying a novel score (SAFE-R), combining surgical margin status (SM) and extend of NS. METHODS: From January 2002 to January 2011, 9,674 consecutive RPs were performed at our center. Of these, 4,518 (47%) were conducted with NeuroSAFE. Proportions of NS, SM-status were assessed. Subsequently, a score for oncological safe NS (SAFE-R) was developed. SAFE-R was categorized as 3 (for negative SM and bilateral NS), 2 (for negative SM and unilateral NS), 1 (for negative SM without NS) and 0 (for patients with positive SM), respectively. The impact of NeuroSAFE on SAFE-R was analyzed by chi-square test and confirmed with a multinominal logistic regression, controlling for preoperative risk-factors. All analyses were stratified for patients of lowintermediateor high-risk according to the D’Amico classification. RESULTS: D’Amico high-, intermediateand low-risk profile was found in 1,319 (13.6%), 4,245 (43.9%) and 4,110 (42.5%) of all patients respectively. Within the low-risk group, a SAFE-R-0 (positive SM) was significantly less prevalent and SAFE-R scores of 2 or 3 (unior bilateral NS and negative SM) were more prevalent in patients undergoing neuroSAFE, compared to non-neuroSAFE patients (10.5 vs. 13.2%, and 88.1 vs. 85.7%, respectively, p 0.001). Similarly, in intermediate and high-risk patients, neuroSAFE resulted in lower proportions of SAFE-R score 0 (15.9 vs. 19.9% and 27.6 vs. 33.6%) and higher proportions of SAFE-R score 3 (53.7 vs. 44.1% and 32.4 vs. 17.3%, respectively, all p 0.001). Linkage between the neuroSAFE approach and SAFE-R was confirmed after multinominal logistic adjustment for preoperative risk factors. CONCLUSIONS: SAFE-R represents a novel score to assess and report on oncological safe nerve-sparing in RP. Frozen section navigated nerve-sparing (NeuroSAFE) is associated with enhanced SAFE-R-scores without compromising oncological safety, even in highrisk patients.