Fusion of Magnetic Resonance Imaging and Real-Time Elastography to Visualize Prostate Cancer: A Prospective Analysis using Whole Mount Sections after Radical Prostatectomy.

PURPOSE: To determine whether the fusion of multiparametric magnetic resonance imaging (MRI) with transrectal real-time elastography (RTE) improves the visualization of PCa lesions compared to MRI alone. MATERIALS AND METHODS: In a prospective setting, 45 patients with biopsy-proven PCa received prostate MRI prior to radical prostatectomy (RP). T2 and diffusion-weighted imaging (T2WI/DW-MRI) and, if applicable, dynamic contrast-enhanced sequences (T2WI/DW/DCE-MRI) were used to perform MRI/RTE fusion. The probability of PCa on MRI was graded according to the PI-RADS score for 12 different prostate sectors per patient. MRI images were fused with RTE to stratify suspicious from non-suspicious sectors. Imaging results were compared to whole mount sections using nonparametrical receiver operating characteristic curves and the area under these curves (AUC). RESULTS: 41 of 45 patients were eligible for final analyses. Histopathology confirmed PCa in 261 (53%) of 492 prostate sectors. MRI alone provided an AUC of 0.62 (T2WI/DW-MRI) and 0.65 (T2WI/DW/DCE-MRI) to predict PCa and was meaningfully enhanced to 0.75 (T2WI/DW-MRI) and 0.74 (T2WI/DW/DCE-MRI) using MRI/RTE fusion. Sole MRI showed a sensitivity and specificity of 57.9% and 61% with the best results for ventral prostate sectors whereas RTE was superior in dorsal and apical sectors. MRI/RTE fusion improved sensitivity and specificity to 65.9% and 75.3%, respectively. Additional use of DCE sequences showed a sensitivity and specificity of 65% and 55.7% for MRI and 72.1% and 66% for MRI/RTE fusion. CONCLUSION: MRI/RTE fusion provides improved PCa visualization by combining the strength of both imaging techniques in regard to prostate zonal anatomy and thereby might improve future biopsy-guided PCa detection.

[Early cystectomy-patient selection and technique]. / Indikationen und Technik der Frühzystektomie.

Early radical cystectomy (RC) is a therapeutic option for non-muscle invasive bladder cancer (NMIBC). The 15-year overall survival after early RC in NMIBC patients is about 70%. Nevertheless, RC is associated with significant morbidity and mortality and therefore requires careful patient selection. The aim of the following review is to assess the selection process for early RC in NMIBC. Especially, the new European Association of Urology (EAU) risk calculator identifying NMIBC patients with very high risk for disease progression is described in detail. Furthermore, the technical aspects of the procedure are evaluated. A review of the current literature (PubMed) and national and international guideline recommendations was also conducted.

[Quality assessment of radical cystectomy-opportunities, risks, challenges]. / Qualitätsparameter bei der radikalen Zystektomie ­ Chancen, Risiken, Herausforderungen.

Radical cystectomy (RC) is the standard treatment for nonmetastatic muscle-invasive urothelial carcinoma of the urinary bladder. It is associated with relevant morbidity and mortality. After RC, the 5­year overall survival rate is approximately 60%. In the context of the present work, quality parameters of RC divided into oncological/functional criteria and freedom from complications are identified and summarized. A PubMed search was performed. In addition to early criteria such as negative surgical margins, performance of pelvic lymphadenectomy, creation of a continent urinary diversion or preservation of sexual function, long-term criteria were identified such as the absence of higher-grade postoperative complications, recurrence-free survival and the preservation of health-related quality of life. The early criteria are suitable for individualized therapy planning, whereas the long-term criteria can be used for quality monitoring.

[The role of surgery in locally advanced prostate cancer]. / Stellenwert der radikalen Prostatektomie beim lokal fortgeschrittenen Prostatakarzinom.

Recent retrospective monocentric studies have demonstrated favorable 15-year cancer-specific survival (CSS) rates of up to 86% using radical prostatectomy as part of multimodal treatment in locally advanced prostate cancer (T3-4, N0, M0). Patients most likely to benefit from surgery include those with a biopsy Gleason score < or =8, a prostate-specific antigen level <20 ng/ml, and cT3a cancer. Patients must be informed that additional treatment after prostatectomy might be necessary (30-70%; radiotherapy, hormonal therapy). Urinary incontinence may occur in up to 20%, and severe incontinence (more than two pads per day) is observed in up to 6%.Adjuvant radiotherapy should be considered individually and is not routinely recommended. Extended pelvic lymphadenectomy should be performed, although it has only a minor impact on survival. However, even in patients with lymph node micrometastasis, 10-year CSS can be achieved in 85.6% with the use of additional hormonal therapy. Cancer progression can possibly be delayed by surgical excision of the primary tumor, even in patients with metastasis. The existing data must be checked in prospective randomized trials.

[Impact of elastography in clinical diagnosis of prostate cancer. A comparison of cancer detection between B-mode sonography and elastography-guided 10-core biopsies]. / Stellenwert der Elastographie in der klinischen Diagnostik des lokalisierten Prostatakarzinoms. Vergleich von Detektionsraten der B-Modus-Sonographie und der elastographieunterstützten systematischen 10fach-Biopsie.

BACKGROUND: To assess whether elastography guided prostate biopsies improve the cancer detection in men with suspected prostate cancer. PATIENTS AND METHODS: In this study, 351 prospectively randomized patients underwent prostate biopsies for the first time. The indication for biopsy was abnormal digital rectal examination (DRE) in 25% or suspicious prostate-specific antigen (PSA) elevation in 75%. In the elastography group (n=189) and the control group (n=162), we assessed PSA, DRE, and B-mode transrectal ultrasound (TRUS). Both groups underwent classic TRUS-guided 10-core biopsy. The elastography patients underwent additional elastographic examination prior to biopsy using a Voluson 730 ultrasound system (GE Medical). According to the ultrasound or elastographic findings for each biopsy location, the researcher tried to predict whether cancer was present. This prediction was correlated with histopathologic findings. The statistical power of this study was sufficient to detect a 15% difference in detection rate. RESULTS: The study groups did not differ in PSA, clinical stages, or prostate volume (p<0.05). The overall cancer detection rate was 39% (137/351): 40.2% (76/189) in the elastography group and 37.7% (61/189) in the control group, respectively. The difference in detection rate in clinical stages T2 and T3 between the elastography and the control groups was not statistically significant (p<0.05). Within the T1c subgroup, elastography showed a slightly higher detection rate of 55.6% versus 50% without reaching statistical significance (p>0.05). Histopathologic findings were adequately predicted by elastography in only 44.5%. CONCLUSIONS: Elastography did not improve the cancer detection rate in our collective.

[Radical cystectomy and urinary diversion-what is important ?] / Radikale Zystektomie und Harnableitung ­ worauf kommt es an?

BACKGROUND: In Germany, radical cystectomy with urinary diversion is the primary therapeutic option for localized muscle invasive urothelial bladder cancer. Modifications in the pre-, peri-, and postoperative phase have significantly improved outcomes. OBJECTIVES: Different factors and parameters are directly associated with patients' outcome. An overview on how to best approach this procedure is provided in this article. MATERIALS AND METHODS: The data regarding preparation and the procedure for the radical cystectomy followed by urinary diversion are separately analyzed. RESULTS: During the preoperative phase, Fast Track and ERAS (Enhanced Recovery after Surgery) concepts should be an integral part of therapeutic management. Different aspects of such models are presented and discussed. Comorbidities such as diabetes mellitus, hypertension, malnutrition or anemia should also be treated early. In the perioperative phase, optimized fluid management and close interaction with the anesthesiologist are needed. Use of vasopressors during surgery and controlled hypotension (about 80 mm Hg) help reduce perioperative blood loss. Blood product use should be minimized. The use of epidural anesthesia to improve the stress reaction of the body improves pain management and functional recovery. Radical cystectomy is associated with the best oncological outcome, preserving functional structures to maintain a good quality of life. Nerve-sparing procedures in men and women should be used where appropriate. The use of robotic assisted radical cystectomy (RARC) is also discussed. CONCLUSION: The ileum conduit is still the most common urinary diversion worldwide. However, numerous other urinary diversions to provide patients with the highest quality of life are available. Centers with a high case load seem to be associated with an improved outcome.

[Singular ileum interposition with bilateral implantation of the ureters after Wertheim-Meigs surgery]. / Singuläres Ileuminterponat mit beidseitiger Harnleiterimplantation nach Wertheim-Meigs-Operation.

Ileum or colon interpositions are qualified procedures for functional ureteral replacement in case of extended ureteric lesions. In most cases, a unilateral interposition is sufficient. Rarely, it is necessary to perform bilateral procedures. We report the case of a 41-year-old female patient with bilateral ureter implantation into a singular ileum segment.

[Postoperative monitoring of anastomosis after radical retropubic prostatectomy Transrectal ultrasound can replace cystography?]. / Postoperative Anastomosenkontrolle nach radikaler retropubischer Prostatektomie. Kann der transrektale Ultraschall die Zystographie ersetzen?

OBJECTIVE: We determined if transrectal ultrasound (TRUS) is as reliable as cystography in detecting vesicourethral extravasates after radical retropubic prostatectomy (RRP). PATIENTS AND METHODS: Between October 2005 and February 2006 we prospectively investigated 100 consecutive patients undergoing RRP. The vesicourethral anastomosis was proven 6 days after operation by a combined investigation with TRUS and cystography. RESULTS: In the majority of patients (79%) the vesicourethral anastomosis was watertight on postoperative day 6 (POD) or showed minimal leakage (8%) so that the urinary catheter was removed. Different degrees of paravasates were detected in 21 patients. Because of small, moderate, or marked paravasations the indwelling catheter was removed on POD 9, 14, and 21 in 5, 3, and 5 patients, respectively. Every paravasate documented by cystography had been detected by TRUS before. Therefore, TRUS showed no false-negative result in detecting insufficient anastomosis. In two patients paraurethral fluid was detected by TRUS mimicking anastomotic paravasation, without confirmation by cystography. CONCLUSIONS: TRUS can safely replace cystography to detect anastomotic leakage after radical prostatectomy.

[When is surgical resection of the primary tumor indicated in metastatic prostate cancer and what is the scientific rationale?] / Wann ist bei eingetretener Metastasierung des Prostatakarzinoms die operative Entfernung des Primärtumors angezeigt und gibt es eine wissenschaftliche Grundlage dafür?

Similar to other tumour entities, analyses of cancer databases giving hope that patients with advanced prostate cancer with osseous metastases benefit from cytoreductive surgery. Prospective clinical trials are in the process of proving this hypothesis. This review article focuses on molecular genetic pathways and clinical data.

Is there evidence for a close connection between side of intravesical tumor location and ipsilateral lymphatic spread in lymph node-positive bladder cancer patients at radical cystectomy? Results of the PROMETRICS 2011 database.

PURPOSE: To evaluate the possible association between bladder tumor location and the laterality of positive lymph nodes (LN) in a prospectively collected multi-institutional radical cystectomy (RC) series. METHODS: The study population included 148 node-positive bladder cancer (BC) patients undergoing RC and pelvic lymph node dissection in 2011 without neoadjuvant chemotherapy and without distant metastasis. Tumor location was classified as right, left or bilateral and compared to the laterality of positive pelvic LN. A logistic regression model was used to identify predictors of ipsilaterality of lymphatic spread. Using multivariate Cox regression analyses (median follow-up: 25 months), the effect of the laterality of positive LN on cancer-specific mortality (CSM) was estimated. RESULTS: Overall, median 18.5 LN [interquartile range (IQR), 11-27] were removed and 3 LN (IQR 1-5) were positive. There was concordance of tumor location and laterality of positive LN in 82% [95% confidence interval (CI), 76-89]. Patients with unilateral tumors (n = 78) harbored exclusively ipsilateral positive LN in 67% (95% CI 56-77). No criteria were found to predict ipsilateral positive LN in patients with unilateral tumors. CSM after 3 years in patients with ipsilateral, contralateral, and bilateral LN metastasis was 41, 67, and 100%, respectively (p = 0.042). However, no significant effect of the laterality of positive pelvic LN on CSM could be confirmed in multivariate analyses. CONCLUSIONS: Our prospective cohort showed a concordance of tumor location and laterality of LN metastasis in BC at RC without any predictive criteria and without any influence on CSM. It is debatable, whether these findings may contribute to a more individualized patient management.

[Success rates of two-layer, microsurgical vasovasostomy. Results from a patient questionnaire and comparison with one-layer technique]. / Erfolgsraten der zweischichtigen mikrochirurgischen Vasovasostomie. Ergebnisse einer Patientenbefragung und Vergleich mit der einschichtigen Technik.

UNLABELLED: Vasovasostomy is the most commonly performed procedures in the therapy for occlusive azoospermia after vasectomy. In our clinic the two-layer microsurgical technique (DL VVST) is considered to be the gold standard. We have examined the results of DL VVST by means of a questionnaire and compared them with those of the monolayer technique (ML VVST). MATERIALS AND METHOD: In the period from 1996 to 2001, a microsurgical DL VVST with 10 x 0 Prolene sutures under the operation microscope was performed in 141 patient. Aspects of the operation, social aspects and postoperative results (results of spermiogram, birth rates) were assessed by means of a questionnaire. The results were compared with those of a historical patient collective who had undergone a modified monolayer VVST with 7 x 0 Prolene (n = 64). RESULTS: The questionnaire could be sent to 90/141 patients, the response rate was 63/90 (70 %). The time interval between vasectomy and VVST was on average 9.5 years. The patency rate was 86 %, the birth rate 24 %. Severe or moderately sever complications did not occur. In the historical patient collective, the average occlusion interval was 6.9 years. The patency rate in these patients in whom the VVST was performed merely under the loupe and in a monolayer technique was 87 %, the pregnancy rate 48 %. CONCLUSION: The highly positive results of VVST with pregnancy rates > 80 % from earlier publications could not be reproduced. According to our results, the two-layer VVST does not afford better results than the monolayer technique.

[Primary renal angiosarcoma. Uncommon manifestation of a rare malignancy]. / Primär renales Angiosarkom. Ungewöhnliche Manifestation eines seltenen Tumors.

This article reports a case of primary renal angiosarcoma, a very rare and aggressive malignancy, in a 59-year-old male patient. The mean overall survival time is limited to a few months if the diagnosis is made when clinical symptoms are present but chances of a cure can be increased with surgical resection of smaller incidental findings. Due to the lack of a standard therapy, systemic treatment is based on the therapy of other soft tissue sarcomas. The role of adjuvant medical treatment particularly in angiosarcoma remains poorly studied but using a doxorubicin-based chemotherapy regimen, a survival benefit can be achieved.

[Clinical and histopathological parameters of prostate cancer: influence of anthropometric indices]. / Klinische und histopathologische Parameter des Prostatakarzinoms : Einfluss anthropometrischer Indizes.

BACKGROUND: Adipose tissue is increasingly considered as an endocrinal active organ and may have an influence on the development and progression of prostate cancer. Adverse body fat distribution, considered a risk factor for cardiovascular disease, is not reflected by the body mass index (BMI). OBJECTIVE: The purpose of this work was to assess anthropometric indices which provide a better estimate of body fat distribution and to evaluate their association with clinical and histopathological parameters of prostate cancer. PATIENTS AND METHODS: In patients scheduled for radical prostatectomy between March 2011 and March 2013, height, weight, waist circumference (WC) and hip circumference were measured, then the BMI, waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were calculated. The relationships between anthropometric measures and indices and clinical and histopathological features of PCA were evaluated with uni- and multivariate analyses. RESULTS: In 668 patients available for evaluation, obesity rates were 22.8 %, 50.6% and 30.2 % as defined by BMI ≥ 30, WHR ≥ 1 and WHtR ≥ 0.6, respectively. On univariate analysis, WC and WHtR ≥ 0.6 correlated with tumor volume (TV) > 2.1 cm(2) (p < 0.05), respectively. WC and WHtR were independent predictors of a TV ≥ 2.1 cm(2) (p < 0.05) and a WHtR ≥ 0.6 was an independent predictor of a TV ≥ 2.1 cm(2) (p < 0.018, risk ratio 1.506, 95 % confidence interval 1.072-2.115). CONCLUSION: In general a higher degree of adiposity seems to correlate with a higher tumor volume. Whether anthropometric indices have prognostic impact needs to be clarified during follow-up.

[Complications after ileal conduit: Urinary diversion-associated complications after radical cystectomy]. / Komplikationen nach Ileumconduitanlage : Harnableitungsspezifische Komplikationen nach radikaler Zystektomie.

BACKGROUND: We analyzed complications associated with urinary diversion after radical cystectomy (RC) and ileal conduit (IC) for bladder cancer (BCa). PATIENTS AND METHODS: A total of 305 BCa patients after RC with IC were included in the study (June 2003-December 2010). IC complications (peristomal hernia, IC stenosis, stenosis of the ureteral anastomosis, IC bleeding, urolithiasis, urinary infections, and renal insufficiency) were identified according to the Clavien-Dindo classification (CDC). Kaplan-Meier plots were generated. Uni- and multivariable Cox regression analyses with backward selection for prediction of high-grade complications (CDC ≥ III) and IC revision surgery were conducted; covariates included age, previous abdominal/pelvic radiation, body mass index (BMI), previous abdominal/pelvic surgery, comorbidities, and advanced tumor stage. RESULTS: An IC complication (CDC ≥ I) or a high-grade IC complication (CDC ≥ III) was experienced by 32.7 and 13.4 % of our cohort: 14.8 %, 4.3 %, 4.6 % developed a peristomal hernia, IC stenosis, stenosis of the ureteral anastomosis, respectively. IC revision was required by 10.5 % of patients (median follow-up 19.5 months, IQR 7-47 months). The estimated rate of IC complications at 5 years was 52 % (CDC ≥ I) and 22 % (CDC ≥ III). The final model of the multivariable analysis showed that patients with a history of previous radiation (HR 4.33), a BMI ≥ 30 (HR 2.24), or longer duration of surgery (HR 1.01; all p < 0.05) were at higher risk for IC revision surgery. A BMI ≥ 30 (HR 2.49, p = 0.011) was a risk factor for high-grade complications. CONCLUSION: The risk of experiencing a high-grade IC complication is moderate. Previous radiation, obesity, and comorbidities represent risk factors for IC revision surgery. Moreover, obesity is a risk factor for high-grade complications.

[Segmental testicular infarction. Unusual complication of intravenous immunoglobulin therapy for multifocal motor neuropathy]. / Hodeninfarkt. Ungewöhnliche Komplikation der intravenösen Immunglobulintherapie bei multifokaler motorischer Neuropathie.

We describe the previously unknown case of segmental testicular infarction as an iatrogenic complication of intravenous immunoglobulin administration in a patient with multifocal motor neuropathy.

Surgical therapy for localized prostatic carcinoma.

The intraoperative, immediate postoperative, and late postoperative morbidity and prostate-specific antigen (PSA) levels in 511 consecutive patients with clinical T1b, T1c, and T2 tumors, who underwent anatomical radical retropubic prostatectomy, have been discussed. Between 1988 and 1995, prostatic cancer was diagnosed in 511 patients on the basis of PSA and prostate biopsy, when life expectancy was more than 10 years and frozen sections of obturator lymph nodes were negative. All specimens were cut into 3 mm sections by the step-section technique, after the surgical margin had been inked with formalin-resistant dye to identify the margin status. The mean age of the 511 patients was 63.4 years. Blood loss during the operation decreased to 986 ml in the last 2 years. Of the patients, 4.3% had intraoperative rectal perforation; only 5 required a second operation, which was done with a simple rectal approach. Ureteral injury occurred in 1.4% and this was repaired during the operation; 11% had prolonged lymphocele; all were treated conservatively. Deep-venous thromboses were seen in 3.7%; 5 patients (1%) had pulmonary embolism, which was lethal in 3 patients (0.6% of the whole group). There were no intraoperative deaths. No patient death was observed in the last 3 years, when all lymphoceles were diagnosed with thorough ultrasonographic evaluation and drained immediately. Complete continence after 1 year was achieved in 92% of the patients; 5.8% of the patients had anastomotic stricture; most were treated with a single calibration. Twelve months after the operation, 80% of the patients had no measurable PSA. There was a clear correlation of PSA negativity to tumor stage. Anatomical radical prostatectomy is safe and can cure about 70% of patients with clinical T1b, T1c, and T2 prostatic tumors.

Limitations of transition zone needle biopsy findings in the prediction of transition zone cancer and tissue composition of benign nodular hyperplasia.

OBJECTIVES: The transition zone of the prostate is the origin of 30% of all prostate cancers and of almost all benign prostatic hyperplasia (BPH). We compared histologic findings in transition-zone biopsies to tissue composition of the transition zone from radical prostatectomy specimens from the same patients to determine the efficacy of needle biopsies to evaluate either cancer or BPH. METHODS: A quantitative evaluation of the transition zone for both cancer and BPH in 21 retrospective and 11 prospective radical prostatectomy specimens was made. All retrospective cases had transition-zone biopsies prior to radical prostatectomy; all prospective specimen transition zones were biopsied after surgical removal with an ink-filled needle to trace the needle tracks after specimen processing. For all 32 specimens, total prostate weight, width of transition zone, transition-zone tissue composition, and epithelial/stromal (E/S) ratio of nodular and internodular BPH tissue were noted; the corresponding biopsies were evaluated for the amount of cancer and the composition of nodular and internodular tissue. RESULTS: Eight carcinomas larger than 5.0 cc were detected at biopsy, whereas 5 cancers smaller than 2.0 cc were undetected. Biopsies did not reliably predict BPH tissue composition or epithelial density of prostatectomy specimens; both were markedly underestimated. Dyed needle tracts showed selective sampling of internodular tissue versus nodules by biopsy as an explanation for low correlations. CONCLUSIONS: Transition-zone needle biopsies efficiently detect cancers larger than 5.0 cc and miss cancers smaller than 2.0 cc. Biopsies do not reliably predict BPH tissue composition because of selective sampling of the internodular tissue.

Dyeing: a simple method for detecting positive or negative surgical margins.

Artists' pigments have been used in more than 150 radical prostatectomy specimens and many other malignant surgical specimens for detecting positive surgical margins. Their advantages are rapid drying, resistance to tissue processing, and the ability to mark many planes of excision simultaneously with different colors.

Effect of flutamide and flutamide plus castration on prostate size in patients with previously untreated prostate cancer.

OBJECTIVES: Transrectal ultrasonography (TRUS) was used in previously untreated men with prostate cancer undergoing hormonal therapy to provide objective observations on the decrease in prostate size and to assess the usefulness of prostate size in estimating treatment response. METHODS: In this retrospective study, 31 patients with previously untreated prostate cancer (Stage T1c to D2) who received hormonal therapy (flutamide, n = 18; flutamide plus castration, n = 13) were followed with serial estimations of prostate size by TRUS and by serum prostate-specific antigen (PSA). RESULTS: In both treatment groups, the major decreases in prostate size were noted within the first 6 months of therapy, whereas further follow-up examinations failed to show statistically significant changes. Prostate size decreased by 48% in men treated with flutamide, whereas those treated with flutamide plus castration showed a statistically significant greater decrease, mean of 56% (P < or = 0.01). Six patients (33%) in the flutamide group and 5 (38%) men in the total androgen deprivation group ultimately failed therapy as indicated by a rising PSA level. Only 55% (n = 6) of the patients who progressed showed an increase in prostate size. CONCLUSIONS: Total androgen deprivation in comparison to flutamide alone caused a larger reduction in prostate size. As a marker of hormonal failure, a rising PSA was more sensitive than an increase in prostate size.

Incidence of positive surgical margins after biopsy-selected nerve-sparing radical prostatectomy.

OBJECTIVES: The selection criteria for a nerve-sparing radical prostatectomy (NSRP) are not thoroughly investigated and are based mainly on preoperative digital rectal examinations and intraoperative findings. At our institution NSRP is performed only on patients whose preoperative systematic sextant biopsy of the prostate showed only unilateral cancer. To prove the safety of these criteria, we analyzed the incidence of positive surgical margins and tumor progression rate in patients who were selected for an NSRP only by the result of the biopsy. METHODS: Preoperative systematic sextant biopsies revealed unilateral cancer in 69 preoperatively potent men of 289 consecutive prostatic cancer patients (23.9%); contralateral NSRP was performed on these 69 patients. The prostate specimens were investigated by using a 3-mm step-section technique to identify positive surgical margins. Tumor progression was defined as a prostate-specific antigen (PSA) level greater than 0.4 ng/mL in the native and greater than 0.025 ng/mL in the suprasensitive postoperative blood test. Mean follow-up was 15 months (range 6 to 24). RESULTS: In 69 patients who underwent NSRP, 11 positive margins (15.9%) were found. Only 3 patients (4.3%) had a positive margin on the nerve-sparing side. In 220 patients who underwent non-NSRP 59 positive margins (26.8%) were detected. PSA recurrence rate after 12 months was similar in patients with NSRP and non-NSRP. Analysis of systematic sextant biopsies gives safe selection criteria because in approximately 95% the surgical margin on the nerve-sparing side will be negative. CONCLUSIONS: Basing the indication for an NSRP on the results of preoperative systematic biopsies was safe according to margin status and postoperative PSA, when all patients with tumor in one of the three biopsy cores of each side of the prostate were excluded from an NS technique on that side. Such a strict approach will exclude approximately 30% of patients from NSRP unnecessarily because of tumor findings on a prostate side where the cancer is still organ-confined. Less strict criteria, including patients with only well-differentiated cancer and a maximum of one positive biopsy on the evaluated side, seem to be as safe as the described selection. However, data on these patients need further evaluation.