Three‐dimensional 26‐core biopsy‐based patient selection criteria for nerve‐sparing radical prostatectomy

Abstract

Most of the previously reported patient selection criteria for nerve-sparing radical prostatectomy were based on conventional sextant biopsy, and those based on extended biopsy have been scarcely investigated. In the current study, we developed patient selection criteria for nerve-sparing RP based on the three-dimensional 26-core (3D26) biopsy-derived variables. We evaluated 202 non-nerve-spared sides in 109 consecutive patients in whom prostate cancer was diagnosed by the 3D26 biopsy and who underwent RP without neoadjuvant treatment. Associations of clinical and pathological variables with side-specific posterolateral extraprostatic extension (SS-PL-EPE) were analyzed. Subgroup analysis using transperineal 14-core (TP14) and transrectal 12-core (TR12) biopsies as representative subsets of the 3D26 biopsy was also performed. Maximum cancer length in positive cores > or =5 mm and biopsy Gleason score > or =4 + 3 were independent and were significant risk factors of SS-PL-EPE in the 3D26 cohort at multivariate analysis. In the prostatic side with none, one, and two risk factors, the incidences of SS-PL-EPE were 0, 14 and 52% in the 3D26 cohort, 3.4,15 and 57% in the TP14 cohort and 2.6, 20 and 61% in the TR12 cohort, respectively. We developed simple patient selection criteria for nerve-sparing RP. According to our criteria, the nerve-sparing side can be selected in the majority of patients who undergo the 3D26, TP14 or TR12 biopsy with a less-than-4% risk of SS-PL-EPE.