Oncological and continence outcomes after nerve‐sparing robot‐assisted radical prostatectomy in selected
STAMPEDE‐defined
high‐risk prostate cancer
Andreia Bilé‐Silva, Prabhakar Rajan, Benjamin Lamb, Mehmet Özalevli, Louise Dickinson, Justin Collins, Anand Kelkar, John Kelly, Senthil Nathan, Greg Shaw, Prasanna Sooriakumaran, Ashwin Sridhar, Zafer Tandogdu Objectives
To examine the association between the nerve‐sparing (NS) technique applied during radical prostatectomy (RP) and early oncological and continence outcomes in patients with Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE)‐defined high‐risk prostate cancer (PCa) undergoing robot‐assisted RP (RARP) within a structured patient‐specific surgical planning (PSSP) pathway.
Patients and Methods
A retrospective single‐centre cohort study of 1385 patients who underwent primary RARP between 2021 and 2022 was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Patients were stratified into three groups according to the number of STAMPEDE‐defined high‐risk factors: none, one, and two or more. Outcomes were compared across these cohorts and between NS‐ and non‐NS (nNS)‐ RARP, within each risk stratum.
Results
Overall, NS‐RARP was performed in 75.4% of patients (1044/1385). In the STAMPEDE‐defined high‐risk cohort (two or more high‐risk criteria) 57.3% (150/262) of patients underwent some sort of NS. Among those with at least two STAMPEDE‐defined risk factors, oncological outcomes were similar between NS and nNS surgery (positive surgical margin rate 21.3% vs 23.2%, P = 0.72; 12‐month biochemical recurrence rate 6.7% vs 5.4%, P = 0.9), and urinary continence rates at 3 and 12 months were also similar ( P = 0.2 and P = 0.5, respectively). However, high‐risk patients undergoing NS‐RARP used significantly fewer pads at 12 months ( P = 0.03).
Conclusion
In a contemporary RARP cohort within a PSSP pathway, NS was feasible in over half of high‐risk patients and was not associated with worse short‐term oncological outcomes. Although pad‐free continence rates were similar between NS and nNS groups, patients undergoing NS‐RARP used significantly fewer pads at 12 months, suggesting a potential functional benefit that warrants further prospective evaluation of NS strategies in selected cases.