title: [Development of a preoperative criterion to select candidates for nerve-sparing radical prostatectomy at Kyoto University Hospital].
abstract: Neurovascular bundle (NVB) preservation is a mandatory procedure to maintain erectile function of localized prostate cancer patients after radical prostatectomy (RP). However, in terms of cancer control, indications to select appropriate patients for nerve-sparing RP are still controversial. In this study, we examined the pathological findings of RP specimens to develop a preoperative criterion for NVB preservation during RP. The study included 76 patients who underwent RP at our institution from 2006 to 2008, and we retrospectively analyzed RP specimens pathologically. The distance between NVB and foci of prostate cancer was measured in 135 prostate sides, and preoperative factors which predict the distance of ≤2 mm was evaluated. Univariate analysis showed that side-specific positive biopsy core rate ≥33.3%, side-specific maximum tumor length in biopsy core ≥5 mm and side-specific tumor involvement rate in biopsy core ≥50% was associated with the risk of the distance of ≤2 mm. Multivariate analysis revealed that side-specific positive biopsy core rate ≥33.3% was the only significant predictor of the ipsilateral NVB-tumor distance ≤2 mm (p = 0.0055, odds ratio 3.49). Based on this study, a nerve-sparing criterion of ＜33.3% side-specific percent positive biopsy core was developed at our institution. Prospective data on patients who were applied this criterion are needed to evaluate its clinical safety and feasibility.
authors.affiliation: The Department of Urology, Kyoto University Graduate School of Medicine.
authors.forename: Kei
authors.initials: K
authors.lastname: Mizuno
authors.affiliation: The Department of Urology, Kyoto University Graduate School of Medicine.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Inoue
authors.affiliation: The Department of Urology, Kyoto University Graduate School of Medicine.
authors.forename: Yu
authors.initials: Y
authors.lastname: Miyazaki
authors.affiliation: The Department of Urology, Kyoto University Graduate School of Medicine.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Makino
authors.affiliation: The Department of Urology, Kyoto University Graduate School of Medicine.
authors.forename: Naoki
authors.initials: N
authors.lastname: Terada
authors.affiliation: The Department of Urology, Kyoto University Graduate School of Medicine.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: The Department of Urology, Kyoto University Graduate School of Medicine.
authors.forename: Toshinari
authors.initials: T
authors.lastname: Yamasaki
authors.affiliation: The Department of Urology, Kyoto University Graduate School of Medicine.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Matsui
authors.affiliation: The Department of Urology, Kyoto University Graduate School of Medicine.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Kamba
authors.affiliation: The Department of Urology, Kyoto University Graduate School of Medicine.
authors.forename: Koji
authors.initials: K
authors.lastname: Yoshimura
authors.affiliation: The Department of Diagnostic Pathology, Kyoto University School of Medical Science.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Mikami
authors.affiliation: The Department of Urology, Kyoto University Graduate School of Medicine.
authors.forename: Osamu
authors.initials: O
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D001706:Biopsy; D007172:Erectile Dysfunction / Q000517:prevention & control; D006785:Hospitals, University; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D059351:Organ Sparing Treatments / Q000379:methods*; D018579:Patient Selection; D010410:Penile Erection; D011183:Postoperative Complications / Q000517:prevention & control; D057234:Preoperative Period; D011467:Prostate / Q000098:blood supply / Q000294:innervation* / Q000473:pathology; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D012015:Reference Standards; D012189:Retrospective Studies