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nerve sparing RP and recurrence

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Posted 4/28/2015 4:55 PM (GMT 0)
Hey gang:
Has anyone come across any studies, comments, opinions, etc.. that as a 'general' statement persons who have had nerve sparing RP's have a greater chance of BCR?
Kelly
Posted 4/28/2015 6:14 PM (GMT 0)
Hey Kelly,

I don't have any studies etc. but did ask dr. and was told that the nerves weren't generally an issue and if he missed anything it was near the bladder neck. I'm not sure what they see under the daVinci or in the open procedure but the nerve area would seem difficult to sort out and a good place for PCa to hide.

Hope you get some data in response. An interesting question.

Luther
Posted 4/28/2015 8:31 PM (GMT 0)
Since my bipopsy should cancer only on one side my doc recommended removing the nerve on that side (which he did). Trying to think back, I swear he threw out some stat of higher recurrence if I would have elected to leave it.
My memory of those days is pretty fuzzy (and some of these days, too -Ha!). Since I may have recurrence I guess it's all academic for me but I thought it is an interesting question for the board.
Kelly
Posted 4/28/2015 9:57 PM (GMT 0)
Sorry, I meant to say that in my case the dr. didn't see any problem in the nerves and was able to spare them and didn't think that we left anything around the nerves. I'm guessing they error on the side of removal unless they are pretty sure the nerves are clean. I'm not clear how the dr. makes the visual call.

Anyway your .04 is a long way from bcr. Enjoy the spared nerve.

Luther
Posted 4/28/2015 10:12 PM (GMT 0)
I'm certainly in the recurrence zone and currently halfway through SRT.
Interestingly my PSA doubling time was as early as 8 months after having clear margins and no Lymphnode involvement.
Nerve sparing was all of one side and partial sparing the other.
Posted 4/28/2015 10:32 PM (GMT 0)
Aussie, I'm just underway with SRT. Today was 2 of 39. The Truebeam took a dive and I got to find out if I could stay in position for fifty minutes while the repair was made. Good news, no extra charge for the extended time.

Best,

Luther
Posted 4/28/2015 10:41 PM (GMT 0)
I have come across a couple published papers that showed a higher rate of BCR because of nerve sparing surgery. It is fairly common knowledge that sparing the nerve bundles on each side of the prostate can cause positive margins and an increase likelihood for BCR. That is why many surgeons make the determinations during surgery if the nerves can be saved without increasing the risk appreciable. My oncology urologist did this for me during my robotic surgery.

A side note is that saving the nerves also aids in minimizing incontinence.
Posted 4/28/2015 10:56 PM (GMT 0)
ferrtx,

See Does nerve-sparing radical prostatectomy increase the risk of positive surgical margins and biochemical progression? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943681/

Conclusion NSRP does not seem to increase the risk of positive surgical margins (PSM) and disease progression.

This, and other studies nearly always show better results for the guys with nerve-sparing radical prostatectomy (NSRP). The men that do not get NSRP are generally higher risk.

Once at the linked page note the "Related citations in PubMed" box to the right for more related articles.

HMS
Posted 4/28/2015 11:32 PM (GMT 0)
I think the surgeon will only spare the "nerves" only when they are confident they are safe of cancer risk.
My case the surgeon after looking @ the images..stand firm to "no".
I got a "good" path report post surgery but.....my sig.
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