Prevalence and risk factors of contralateral extraprostatic extension in men undergoing radical prostatectomy for unilateral disease at biopsy: A global multi-institutional experience.
BACKGROUND
We assessed the incidence of contralateral prostate cancer (cPCa), contralateral EPE (cEPE) and contralateral positive surgical margins (cPSM) in patients diagnosed preoperatively with unilateral prostate cancer and evaluated risk factors predictive of contralateral disease extension.


METHODS
The occurrence of cPCa, cEPE and cPSM and the side-specific nerve-sparing technique performed were collected postoperatively from 327 men diagnosed with unilateral prostate cancer at biopsy. Parameters, such as the localization, proportion, and percentage of cancer in positive cores, were prospectively collected.


RESULTS
Overall, 50.5% of patients had bilateral disease, and were at higher risk when associated with a positive biopsy core at the apex (p = 0.016). The overall incidence of ipsilateral EPE and cEPE were 21.4% and 3.4%, respectively (p < 0.001). Compared to cPCa, ipsilateral disease was at an almost 4-fold higher risk of extending out of the prostate (p < 0.001). None of the criteria tested were identified as useful predictors for cEPE. The low incidence of cEPE in our cohort could limit our ability to detect significance. The overall incidence of ipsilateral PSM and cPSM were 15.3% and 5.8%, respectively (p < 0.001). More aggressive nerve-sparing was not associated with a higher incidence of PSM. Prostate sides selected for more aggressive nerve-sparing were associated with younger patients (p < 0.001), a smaller prostate (p = 0.006), and a lower percentage of cancer in biopsy material (p = 0.008).


CONCLUSIONS
Although the risk of cPCa is high in patients diagnosed with unilateral prostate cancer at biopsy, the risk of cEPE and cPSM is low, yet not insignificant. Contralateral aggressive nerve-sparing should be used with caution and should not compromise oncological outcome.
Faculty of Medicine, University of Montreal, Montreal, QC;
Marc
M
Bienz
Department of Urology, University of Montreal Hospital Centre (CHUM), Hôpital St. Luc, Montreal, QC;
Pierre-Alain
PA
Hueber
Department of Urology, University of Montreal Hospital Centre (CHUM), Hôpital St. Luc, Montreal, QC;
Vincent
V
Trudeau
Department of Urology, University of Montreal Hospital Centre (CHUM), Hôpital St. Luc, Montreal, QC;
Abdullah M
AM
Alenizi
Department of Urology, University of Montreal Hospital Centre (CHUM), Hôpital St. Luc, Montreal, QC;
Roger
R
Valdivieso
Associated Medical Professionals of New York, New York, NY;
Modar
M
Alom
Memorial Sisli Hospital, Department of Urology, Istanbul, Turkey;
Mevlana Derya
MD
Balbay
Yildirim Beyazit University, School of Medicine, Ankara Ataturk Training and Research Hospital, Department of Urology, Ankara, Turkey;
Abdullah Erdem
AE
Canda
Associated Medical Professionals of New York, New York, NY;
Vladimir
V
Mouraviev
Associated Medical Professionals of New York, New York, NY;
David M
DM
Albala
Memorial Sisli Hospital, Department of Urology, Istanbul, Turkey;
Assaad
A
El-Hakim
Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
Quoc-Dien
QD
Trinh
Department of Urology, University of Montreal Hospital Centre (CHUM), Hôpital St. Luc, Montreal, QC;
Mathieu
M
Latour
Department of Urology, University of Montreal Hospital Centre (CHUM), Hôpital St. Luc, Montreal, QC;
Fred
F
Saad
Department of Urology, University of Montreal Hospital Centre (CHUM), Hôpital St. Luc, Montreal, QC;
Kevin C
KC
Zorn