Long-term function and oncologic outcomes following nerve-spare or wide resection during radical prostatectomy

INTRODUCTION: Nerve sparing during radical prostatectomy (RP) is associated with improved postoperative erectile function and urinary continence but may increase the risk of positive surgical margins. This study sought to compare the long-term outcomes of patients treated with nerve spare (NS) compared to wide resection (WR). METHODS: A historical cohort of consecutive patients was reviewed. A standardized surgical approach of lobe-specific NS or WR was performed. The primary outcome was treatment failure, defined as prostate-specific antigen (PSA) recurrence (PSA ≥0.2 ng/mL) or receipt of postoperative radiation. Secondary outcomes included time to metastases, urinary continence, and erectile function. RESULTS: Of 193 consecutive patients, 123 (63%) received bilateral NS, 36 (19%) received unilateral NS, and 34 (18%) bilateral WR. Patients undergoing any NS had lower preoperative PSA, tumor stage, and grade group compared to WR patients (all p