A systematic review of nerve-sparing surgery for high-risk prostate cancer.

Background We provide a systematic analysis of NSS to assess and summarize the risks and benefits of NSS in high-risk PCa. Methods We have undertaken a systematic search of original articles at 3 databases (Medline (PubMed), Scopus, and Web of Science). Original articles in English containing outcomes of nerve-sparing RP for high-risk PCa were included. The primary outcomes were oncological results: the rate of positive surgical margins and biochemical relapse. The secondary outcomes were functional results: EF and urinary continence. Results The rate of positive surgical margins differed considerably, from zero to 47%. The majority of authors found no correlation between NSS and a positive surgical margin rate. The rate of biochemical relapse ranged from 9.3% to 61%. Most of the articles lacked data on OR for positive margin and biochemical relapse. The presented results showed no effect of NS on positive margin (OR=0.81, 0.6-1.09) or biochemical relapse (HR=0.93, 0.52 1.64). A strong association between NSS and potency rate was observed. Without NSS, between 0% and 42% of patients were potent, with unilateral 79-80%, with bilateral - up to 90-100%. Urinary continence was not strongly associated with NSS and was relatively good in both patients with or without NSS. Conclusions NSS may provide benefits for patients with urinary continence and significantly improves EF in high-risk patients. Moreover, it is not associated with an increased risk of relapse in short- and middle-term follow-up. However, the advantages of using such a surgical technique are unclear.