Functional Outcomes in Patients With Prostate Cancer Undergoing Frozen Section Guided Radical Prostatectomy

Patients with an intermediate risk prostate cancer (PCa) are not routinely offered nerve sparing (NS). Implementation of whole surface frozen section (FS) made NS-radical prostatectomy (RP) available and oncologically safe. In the present study, we aimed to assess the impact of the addition of FS on NS during RP and potentially improved functional outcomes.

Institutional data of patients (PSA ≤ 20 ng/mL, Gleason-Score ≤ 7, cT1c-cT2c) undergoing RP between 06/2011 and 11/2014 were prospectively collected. Decision for NS was made by the surgeon supported by FS. Only patients with a preoperative International Index of Erectile Function (IIEF-5) ≥ 17 were analyzed for potency. Continence was defined as pad use of ≤ 1 pad/day. Separate multivariable regression analyses were employed to examine predictors for both endpoints (i.e., potency and continence).

Overall, 702 patients were included in this study. Final nerve-sparing surgery was performed in 671 patients (95.6%). Before the introduction of FS, only 392 patients (56%) would have undergone NS-RP. FS enabled intraoperative/final NS for 688 (98%) and 666 (95%) patients. No differences at overall follow-up between low- and intermediate-risk patients regarding continence (n = 122 (84.1%) vs. n = 223 (82.6%), p = 0.689) and potency (IIEF-5 ≥ 17, n = 16/47 vs. 26/68, p = 0.646) were detected. Surgeon volume was associated with improved continence (OR 3.69, 95% CI 1.86-7.32, p < 0.001) and erectile function (EF) (OR 2.49, 95% CI 1.23-5.03, p = 0.011).

The introduction of FS expanded NS to patients with an intermediate-risk PCa and selected high-risk PCa. This may lead to improved functional outcomes as more patients were eligible for NS.