Men with good sexual function before surgery are more likely to benefit from nerve-sparing prostatectomy than those with poor function, suggests new research in the Journal of Urology.
Nerves surrounding the prostate gland are essential for sexual and urinary function, but those nerves can be damaged in the course of surgery. In nerve sparing procedures, surgeons try to preserve as many nerves as possible. In unilateral procedures, nerves on one side of the prostate are spared. Bilateral procedures aim to preserve nerves on both sides.
While nerve sparing has its benefits, it is not necessarily effective for men at risk for a positive surgical margin (when cancer cells are present to the edge of tissue removed.)
With this in mind, researchers considered the degree of nerve sparing in the outcomes of 991 men diagnosed with localized prostate cancer in 2011 and 2012. The men were participants in the larger CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation) study.
Seventy-five men had non-nerve sparing procedures, and 11 underwent unilateral surgeries. Together, these men (average age 63) comprised one group for comparison. The remaining men (average age 61) had bilateral procedures.
Sexual and urinary function was assessed at baseline, and 6-, 12-, and 36-month follow-up points using the 26-item Expanded Prostate Index Composite (EPIC) questionnaire. The men also completed questionnaires related to comorbidities, demographics, anxiety, and depression.
At 36 months, the researchers found that men in the bilateral group had better sexual and urinary function results compared to men in the unilateral/non-nerve sparing group. However, the degrees of benefit were higher for men who had good baseline sexual function. Benefits were less evident for men who had poor sexual function before surgery.
For example, score results for the EPIC’s sexual function domain showed an effect of 8.2 points for men with high baseline sexual function. For the men with low baseline function, the effect was 4.0 points. (Note: Higher scores indicate better function.)
The authors did not find any patients with positive surgical margins but noted that their findings “suggest that men with low baseline sexual function who elect radical prostatectomy should be considered for [non-nerve sparing] surgery.”
They added that 44% of the study participants who underwent nerve sparing procedures had low risk disease. Observation, rather than surgery, might have been an appropriate choice for these men.
“These findings should be strongly considered when counseling men regarding treatment outcomes,” they wrote.
Resources
BreastCancer.org
“Surgical Margins”
(Last modified: January 26, 2017)
https://www.breastcancer.org/symptoms/diagnosis/margins
The Journal of Urology
Avulova, Svetlana, et al.
“The Effect of Nerve Sparing Status on Sexual and Urinary Function: 3-Year Results from the CEASAR Study”
(Full-text. Published online: December 15, 2017)
https://www.jurology.com/article/S0022-5347(17)78114-1/fulltext
MedPage Today
Kneisel, Kate
“Nerve-Sparing Prostatectomy Doesn't Help Everyone”
(April 25, 2018)
https://www.medpagetoday.com/hematologyoncology/prostatecancer/72541