Is the Presence of Perineural and Perivascular Invasion a Risk Factor for Positive Surgical Margins during Neurovascular Bundle Preservation Radical Prostatectomy Procedure?

Can We Predict Real T3 Stage Prostate Cancer in Patients with Clinical T3 (cT3) Disease before Radical Prostatectomy?

“…Although currently, DRE, biopsy GS, and serum PSA alone or in combination do not accurately predict disease extent for the individual patient, a combination of all three has been recommended as a basis of predictive algorithms for prostate cancer staging. Partin tables, a pretreatment table using the combination of preoperative serum PSA, biopsy GS, and clinical stage are the most widely used tools to predict the final histopathology in clinically organ-confined disease (stage cT1c-cT2c) and have been demonstrated to be more accurate than any single clinical staging method alone 7. Since the introduction of these nomograms at Johns Hopkins Hospital, the presence of pathologically non-organ-confined cancers has dropped from about two-thirds in the prenomogram era to less than half, and the incidence of either seminal vesicle involvement or pelvic lymph node metastasis decreased from 20% to 10%.…”

“…Of the total 67 patients with cT3 stage disease, the neurovascular bundle saving technique was applied to 10 (15%) patients (unilateral: 2, bilateral: 8) in our study. The patient parameters for performing "safe" nerve-sparing surgery are controversial and generally, those who are young and have organ-confined diseases were considered optimal candidates in terms of the rates of achieving a cure and maintaining a proper erectile function 7. Various clinical parameters have recently been investigated as potential selection criteria to define the cancer-specific safety of nerve-sparing surgery.…”

“…Although Partin tables which use a combination of preoperative PSA, biopsy GS, and clinical stages are the most widely used tool to predict final pathological staging after RP for organ-confined tumors, rare useful preoperative predictive parameters for locally advanced disease are available 6. In addition, retrospective data show that the patients who are young and have organ confined diseases demonstrate the best postoperative results in terms of curative and erectile function 7. If over-staged cT3 prostate cancer could be reliably identified before determining the treatment plan by clinical parameters, these predictors could be used as selection criteria of patients that can benefit from RP and can be a candidate for nerve-preservation.…”