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• W2604447984 abstract "No AccessJournal of UrologyAdult Urology1 Sep 2017Functional Outcomes Following Nerve Sparing Prostatectomy Augmented with Seminal Vesicle Sparing Compared to Standard Nerve Sparing Prostatectomy: Results from a Randomized Controlled Trial Scott M. Gilbert, Rodney L. Dunn, David C. Miller, Jeffrey S. Montgomery, Ted A. Skolarus, Alon Z. Weizer, David P. Wood, and Brent K. Hollenbeck Scott M. GilbertScott M. Gilbert Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida Health Outcomes and Behavior Programs, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida More articles by this author , Rodney L. DunnRodney L. Dunn Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , David C. MillerDavid C. Miller Veterans Affairs Health Services Research and Development Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan Financial interest and/or other relationship with Blue Cross Blue Shield of Michigan. More articles by this author , Jeffrey S. MontgomeryJeffrey S. Montgomery Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Ted A. SkolarusTed A. Skolarus Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Alon Z. WeizerAlon Z. Weizer Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , David P. WoodDavid P. Wood Beaumont Health Systems, Royal Oak, Michigan More articles by this author , and Brent K. HollenbeckBrent K. Hollenbeck Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.03.133AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Seminal vesicle sparing may reduce the risk of neurovascular bundle injury and improve functional outcomes after prostatectomy. While several observational studies have shown better functional outcomes following seminal vesicle sparing approaches, evidence from randomized trials is lacking. We performed a randomized controlled trial comparing functional and cancer control outcomes between nerve sparing prostatectomy augmented with seminal vesicle sparing and standard nerve sparing prostatectomy. Materials and Methods: A total of 140 men with early stage prostate cancer were enrolled in a randomized phase II trial comparing nerve sparing prostatectomy augmented with seminal vesicle sparing to standard nerve sparing prostatectomy. Patient reported sexual and urinary functional scores were assessed prior to surgery, and 6 and 12 months postoperatively. Surgical margin status and prostate specific antigen recurrence were evaluated as secondary outcomes. Results: There were no differences in sexual or urinary function scores after surgery between the study groups. The median urinary incontinence domain score was 92 in the nerve sparing group and 87.5 in the nerve plus seminal vesicle sparing group at 12 months (p = 0.77). Median sexual function domain scores were 73.7 in the nerve sparing group and 77.1 in the nerve sparing plus seminal vesicle sparing group at 12 months (p = 0.29). Margin status and 12-month biochemical recurrence were similar in the groups. Conclusions: Recovery of continence and sexual function was similar between the groups in this randomized controlled trial. Seminal vesicle sparing did not negatively affect margin status or 12-month biochemical (prostate specific antigen) recurrence. These results suggest limited usefulness of seminal vesicle sparing prostatectomy. References 1 : 20-Year outcomes following conservative management of clinically localized prostate cancer. JAMA2005; 293: 2095. Google Scholar 2 : Biochemical outcomes after radical prostatectomy, external bean radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA1998; 280: 969. 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Decision curve analysis of European Society of Urologic Oncology criteria. European Society of Urology Oncology. J Urol2009; 181: 609. Link, Google Scholar 15 : Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology2000; 56: 899. Crossref, Medline, Google Scholar 16 : Contemporary update of prostate cancer staging nomograms (Partin tables) for the new millennium. Urology2001; 58: 834. Google Scholar 17 : The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology1997; 49: 822. Crossref, Medline, Google Scholar 18 : Design issues of randomized phase II trials and a proposal for phase II screening trials. J Clin Oncol2005; 23: 7199. Google Scholar 19 : Randomized phase II clinical trials. Cancer Treat Rep1985; 69: 1375. 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J Urol2003; 170: 1291. Google Scholar 26 : Seminal vesicle sparing perineal prostatectomy improves early functional results in patients with low-risk prostate cancer. BJU Int2007; 100: 1050. Google Scholar 27 : The effect of seminal vesicle-sparing radical prostatectomy on serum prostate-specific antigen level. BJU Int2003; 92: 920. Google Scholar 28 : Is seminal vesicle ablation mandatory for all patients undergoing radical prostatectomy? A multivariate analysis on 1283 patients. Eur Urol2004; 46: 42. Google Scholar 29 : Radical prostatectomy, sparing of seminal vesicles, and painful orgasm. J Sex Med2013; 10: 1417. Google Scholar 30 : AJCC Cancer Staging Manual, 5th ed. New York: Lippincott-Raven1997. Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySmith J (2017) This Month in Adult UrologyJournal of Urology, VOL. 198, NO. 3, (453-455), Online publication date: 1-Sep-2017. Volume 198Issue 3September 2017Page: 600-607 Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordsprostatectomytreatment outcomeprostatic neoplasmsdissectionseminal vesiclesMetricsAuthor Information Scott M. Gilbert Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida Health Outcomes and Behavior Programs, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida More articles by this author Rodney L. Dunn Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author David C. Miller Veterans Affairs Health Services Research and Development Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan Financial interest and/or other relationship with Blue Cross Blue Shield of Michigan. More articles by this author Jeffrey S. Montgomery Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Ted A. Skolarus Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Alon Z. Weizer Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author David P. Wood Beaumont Health Systems, Royal Oak, Michigan More articles by this author Brent K. Hollenbeck Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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