A spare tool.

Selection of definitive prostate cancer treatment largely comes down to which path will afford the best quality of life. When it comes to surgery, sexual health largely hinges on the ability ot spare nearby nerves. And while a nerve-sparing radical prostatectomy is a great option for many, not so when it also means sparing cancer. This group has developed a model using three parameters—PSA density, grade group, and T stage per multiparametric prostate MRI—to predict side-specific extracapsular extension (ECE). When retrospectively applied to pre-op data on 1870 robot-assisted radical prostatectomies, if the nerve-sparing approach was forgone at each side with a predicted ECE risk of ≥20%, 1980/2908 (68%) prostatic lobes without ECE would have received a nerve-sparing approach, and 642/832 (77%) lobes with ECE would not. What does this mean for radiation? That patients ineligible for nerve-sparing surgery may want to more heavily consider an alternative definitive therapy. | Soeterik, Eur Urol Oncol 2022

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