ANALYSIS OF THE CLINICAL PARAMETERS COMMONLY USED TO CHOOSE NERVE-SPARING PROSTATECTOMY FOR PATIENTS WITH POSITIVE BIOPSY AT THE TRANSITION ZONE ALONE

Aim: The aim of this study was to analyze the indication for nerve-sparing surgery for patients with positive prostate biopsies at the level of the transition zone (even in patients with PSA above l0 ng/ml), the impact of this factor on biochemical recurrence-free survival (BCR) and extracapsular extension (ECE). Patients and Methods: The study included 273 patients undergoing open radical prostatectomy and pelvic lymphadenectomy for clinically organ-confined prostate cancer (OC), not submitted to neoadjuvant therapy, with preoperative biopsy of peripheral (PZ) and transitional zone (TZ). Clinical and pathological data were available from our prospectively maintained institutional registry of 936 consecutive patients. The correlation between clinicopathological parameters and the site of the biopsy were investigated with the chi-square and Mann–Whitney U-tests. The impact of these variables on biochemical progression-free survival was evaluated by Kaplan–Meier survival curves. Results: The mean follow-up was 26.9 (range, 7 62, median 24) months. The mean age was 65.7 (range 49-78, median 66) years. At the final pathological examination, 152/273 (55.6%) patients presented OC disease, while 121 patients presented ECE, with a prevalence of 44.4%. We identified 54/273 patients (19.8%) with positive biopsies at the level of TZ only. Among these, 36 (66.7%) had PSA <10 ng/ml, 15 (27.7%) had a PSA in the range 10-20 ng/ml, and 3 (5.6%) >20 ng/ml. Of the 18 patients with PSA >10 ng/ml, only 3 presented ECE. The OC disease incidence in patients with positive biopsy only in the TZ and with PSA >10 ng/ml was significantly higher than in those patients with same PSA level and positive biopsy in the PZ alone (p<0.05). Patients with positive biopsy of the TZ showed a significantly higher incidence of OC tumor (83.3%) compared to those patients with positivity in the PZ alone (50.5%) (p=0.014). In univariate analysis, the localization (TZ or PZ) of the tumor did not prove to be predictor of relapse-free survival (p-value was non-¬significant): the BCR at five years amounted to 94.4% and 90.2%, respectively. Of the 54 patients with positive samples in the TZ, 51 (94.4%) had bioptic GS ≤ 6, three (5.6%) had bioptic GS=7, while 33 (61.1%) had a pathological GS ≤6, and 21 (38.9%) had a GS=7. Conclusion: Our records show that tumors diagnosed in the TZ alone are associated with a lower risk of ECE after radical prostatectomy. In particular, even with PSA >10 ng/ml, the probability of OC disease remains significantly higher than in patients with positivity of the PZ alone. These data should be assessed in order to extend the possibility of a nerve-sparing surgery to patients with positive bioptic cores only in the transitional zone and PSA>10 ng/ml.