Oncological outcomes after attempted nerve‐sparing radical prostatectomy (NSRP) in patients with high‐risk prostate cancer are comparable to standard non‐NSRP: a longitudinal long‐term propensity‐matched single‐centre study

Objective To assess the long‐term safety of nerve‐sparing radical prostatectomy (NSRP) in men with high‐risk prostate cancer (PCa) by comparing survival outcomes, disease recurrence, the need for additional therapy, and perioperative outcomes of patients undergoing NSRP to those having non‐NSRP. Patients and methods We included consecutive patients at a single, academic centre who underwent open RP for high‐risk PCa, defined as preoperative prostate‐specific antigen level of > 20 ng/mL and/or postoperative International Society of Urological Pathology Grade Group 4 or 5 (i.e., Gleason score ≥ 8) and/or ≥pT3 and/or pN1 assessing the RP and lymph node specimen. We calculated a propensity score and used inverse probability of treatment weighting to match baseline characteristics of patients with high‐risk PCa who underwent NSRP vs non‐NSRP. We analysed oncological outcome as time‐to‐event and calculated hazard ratios (HRs). Results A total of 726 patients were included in this analysis of which 84% ( n = 609) underwent NSRP. There was no evidence for the positive surgical margin rate being different between the NSRP and non‐NSRP groups (47% vs 49%, P = 0.64). Likewise, there was no evidence for the need for postoperative radiotherapy being different in men who underwent NSRP from those who underwent non‐NSRP (HR 0.78, 95% confidence interval [CI] 0.53–1.15). NSRP did not impact the risk of any recurrence (HR 0.99, 95% CI 0.73–1.34, P = 0.09) and there was no evidence for survival being different in men who underwent NSRP to those who underwent non‐NSRP (HR 0.65, 95% CI 0.39–1.08). There was also no evidence for the cancer‐specific survival (HR 0.56, 95% CI 0.29–1.11) or progression‐free survival (HR 0.99, 95% CI 0.73–1.34) being different between the groups. Conclusion In patients with high‐risk PCa, NSRP can be attempted without compromising long‐term oncological outcomes provided a comprehensive assessment of objective (e.g., T Stage) and subjective (e.g., intraoperative appraisal of tissue planes) criteria are conducted.