Mp68-18 Balancing Precision and Caution: The Dilemma of Fascia and Nerve-Sparing Radical Prostatectomy Amidst the Surge of High-Risk Cancer: Results From a Contemporary National Cancer Database Study

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II (MP68)1 May 2024MP68-18 BALANCING PRECISION AND CAUTION: THE DILEMMA OF FASCIA AND NERVE-SPARING RADICAL PROSTATECTOMY AMIDST THE SURGE OF HIGH-RISK CANCER: RESULTS FROM A CONTEMPORARY NATIONAL CANCER DATABASE STUDY Pedro F. S. Freitas, Adam D. C. Williams, Ruben Blachman-Braun, Nachiketh Soodana-Prakash, Chad R. Ritch, Sanoj Punnen, Mark L. Gonzalgo, Dipen J. Parekh, and Bruno Nahar Pedro F. S. FreitasPedro F. S. Freitas , Adam D. C. WilliamsAdam D. C. Williams , Ruben Blachman-BraunRuben Blachman-Braun , Nachiketh Soodana-PrakashNachiketh Soodana-Prakash , Chad R. RitchChad R. Ritch , Sanoj PunnenSanoj Punnen , Mark L. GonzalgoMark L. Gonzalgo , Dipen J. ParekhDipen J. Parekh , and Bruno NaharBruno Nahar View All Author Informationhttps://doi.org/10.1097/01.JU.0001008744.60568.e8.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The shift toward managing lower-grade prostate cancer (PCa) with focal therapy and active surveillance, along with swings in screening policies, has led to more aggressive disease becoming the focus of radical prostatectomy (RP). We aimed to analyze the consequent trends in risk stratification, pathologic T3 (pT3), and positive surgical margins (PSM) in a contemporary RP population. METHODS: We queried the National Cancer Database for trends in clinicodemographic and postoperative data from all men undergoing upfront RP between 2004 – 2020. They were evaluated according to National Cancer Center Network (NCCN) risk groups and compared among 3 time periods: 2004 – 2009, 2010 – 2015, and 2016 – 2020. Primary endpoints were rates of pT3 and PSM across different time periods, categorized by NCCN risk groups. RESULTS: 665,217 patients were included. Between the three time periods, there were statistically significant increases in median age (61 to 63 years), percentage of black patients (9.8% to 14.1%), higher Charlson comorbidity scores (2.0% to 5.2% with scores >1), and use of robot-assisted RP (76% to 84%). Rates of high and intermediate-risk PCa increased by 55% and 16%, respectively while low-risk group dropped by 66% (Figure 1). pT3 rates rose from 18% to 37% and PSM from 20% to 27% across the time periods (p<0.001), with all risk groups experiencing this significant increase, though at varying rates (Figure 2). CONCLUSIONS: Recent trends indicate a shift in RP towards more advanced PCa, marked by rising rates of PSM and pT3 across all NCCN risk groups. This shift mandates a careful balance in applying fascia and nerve-sparing strategies to avoid compromising oncologic safety. Surgical protocols and prognostic models may require updates to meet the increased complexity of current cases. Download PPTDownload PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1115 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Pedro F. S. Freitas More articles by this author Adam D. C. Williams More articles by this author Ruben Blachman-Braun More articles by this author Nachiketh Soodana-Prakash More articles by this author Chad R. Ritch More articles by this author Sanoj Punnen More articles by this author Mark L. Gonzalgo More articles by this author Dipen J. Parekh More articles by this author Bruno Nahar More articles by this author Expand All Advertisement PDF downloadLoading ...