Intraoperative Frozen Section Analysis to Monitor Nerve-Sparing Radical Prostatectomy

Abstract

Nerve-sparing radical prostatectomy (RPE) represents a standard surgical treatment for clinically localized prostate cancer (PCA). Preservation of continence and potency are important quality of life issues that must be considered carefully in every individual patient undergoing RPE. However, RPE represents an oncologic surgery that primarily should focus on the long-term cure, especially of young patients, and on avoiding positive surgical margins associated with a high risk for biochemical recurrence. In the past, intraoperative findings such as palpable tumour nodules and adhesion of the neurovascular bundle to the prostate have been considered as contraindication for nerve-sparing RPE [1]. In the current article, the authors report on the experience of a single surgeon with regard to the use and efficacy of intraoperative frozen section analysis (FSA) of palpable tumour nodules during nervesparing RPE for clinically localized PCA in a cohort of 608 consecutive patients [2]. Fourteen percent of the patients demonstrated palpable nodules suspicious for extraprostatic extension, making an intraoperative adaptation of the surgical strategy necessary. Most interestingly, 93% of all nodules contained cancer but only one third of the nodules was associated with pT3 PCA, demonstrating that even in cases with palpable lesions a nerve-sparing approach can be attempted without negatively affecting the frequency of positive surgical margins. Especially for pT3 tumours the frequency of positive surgical margins dropped by nearly 25%— a finding