Functional and oncological outcomes of men under 60 years of age having endoscopic surgery for prostate cancer are optimal following intrafascial endoscopic extraperitoneal radical prostatectomy

Abstract

Background Endoscopic extraperitoneal radical prostatectomy (EERPE) is a well-established procedure for treatment of prostate cancer (PCa). Intrafascial nerve-sparing EERPE (nsEERPE) aims to preserve the neurovascular bundle and subsequently erectile function. This study assessed the functional and oncological outcomes of nsEERPE with particular regard to younger patients. Methods Data on 353 men undergoing EERPE between February 2006 and December 2009 was collected prospectively. Non-nerve-sparing EERPE was performed in men diagnosed with PCa with a Gleason score >6 and/or PSA >10 μg/l. nsEERPE was undertaken in men diagnosed PCa with PSA ≤10 μg/l and Gleason score ≤6. Biochemical failure (BF) was defined as PSA ≥0.2 μg/l after nadir or never reached nadir. Men were deemed continent if dry or using 1 confidence pad. Erections satisfactory for intercourse (ESI) or unsatisfactory for intercourse (EUI) were recorded. Results 102 Men (29%) had nsEERPE and 126 (36%) EERPE. pT2 positive surgical margin (PSM) rates were 20.5% for nsEERPE and 21.3% for EERPE ( P = 1). Continence rates following nsEERPE were 59%, 86%, 97% and 52%, 76%, 86% following EERPE at 3, 6 and 12 months of follow-up respectively ( P > 0.05). Erectile function rates for nsEERPE were 24%, 52%, 71% compared to 6%, 14%, 29% for EERPE at 3, 6 and 12 months respectively ( P < 0.001). Erectile function in men <60 y having nsEERPE was 75% at 12 months. Conclusions Continence returned more rapidly and erectile function was improved following nsEERPE vs. EERPE. These results suggest that nsEERPE can be performed with particularly good oncological and functional outcome in <60 y men.