Oncological outcomes after attempted nerve-sparing radical prostatectomy (NSRP) in patients with high-risk prostate cancer are comparable to standard non-NSRP: a longitudinal long-term propensity-matched single-centre study.

OBJECTIVE: To assess the long-term safety of nerve-sparing radical prostatectomy (NSRP) in men with high-risk prostate cancer (PCa) by comparing survival outcomes, disease recurrence, the need for additional therapy, and perioperative outcomes of patients undergoing NSRP to those having non-NSRP. PATIENTS AND METHODS: We included consecutive patients at a single, academic centre who underwent open RP for high-risk PCa, defined as preoperative prostate-specific antigen level of > 20 ng/mL and/or postoperative International Society of Urological Pathology Grade Group 4 or 5 (i.e., Gleason score ≥ 8) and/or ≥pT3 and/or pN1 assessing the RP and lymph node specimen. We calculated a propensity score and used inverse probability of treatment weighting to match baseline characteristics of patients with high-risk PCa who underwent NSRP vs non-NSRP. We analysed oncological outcome as time-to-event and calculated hazard ratios (HRs). RESULTS: A total of 726 patients were included in this analysis of which 84% (n = 609) underwent NSRP. There was no evidence for the positive surgical margin rate being different between the NSRP and non-NSRP groups (47% vs 49%, P = 0.64). Likewise, there was no evidence for the need for postoperative radiotherapy being different in men who underwent NSRP from those who underwent non-NSRP (HR 0.78, 95% confidence interval [CI] 0.53-1.15). NSRP did not impact the risk of any recurrence (HR 0.99, 95% CI 0.73-1.34, P = 0.09) and there was no evidence for survival being different in men who underwent NSRP to those who underwent non-NSRP (HR 0.65, 95% CI 0.39-1.08). There was also no evidence for the cancer-specific survival (HR 0.56, 95% CI 0.29-1.11) or progression-free survival (HR 0.99, 95% CI 0.73-1.34) being different between the groups. CONCLUSION: In patients with high-risk PCa, NSRP can be attempted without compromising long-term oncological outcomes provided a comprehensive assessment of objective (e.g., T Stage) and subjective (e.g., intraoperative appraisal of tissue planes) criteria are conducted.

Facklamia hominis bacteremia after transurethral resection of the prostate: a case report.

BACKGROUND: Transurethral resection of the prostate (TUR-P) is one of the most frequent routine procedures in urology. Because of the semisterile environment, postoperative infections, including sepsis, are a common complication, with Escherichia coli, Klebsiella spp., Proteus mirabilis or Enterococcus faecalis as frequently isolated pathogens. Facklamia hominis is a gram-positive, facultatively anaerobic, alpha-hemolytic, catalase-negative coccus that was first described in 1997. To date, only a few cases of infectious complications have been described. We report the first case of postoperative bacteremia due to Facklamia hominis after TUR-P. CASE PRESENTATION: An 82-year-old man developed fever only a few hours after elective TUR-P because of benign prostate syndrome. After cultivation of blood cultures, antibiotic therapy with ceftriaxone was intravenously administered and changed to oral cotrimoxazole before discharge of the afebrile patient. One anaerobic blood culture revealed Facklamia hominis. Under antibiotic therapy, the patient remained afebrile and showed no signs of infections during follow-up. CONCLUSIONS: Fever and bacteremia are frequent complications after TUR-P. This study is the first report of Facklamia hominis in a postoperative blood culture after TUR-P. To date, there are only a few reports of patients with infectious complications and isolation of Facklamia hominis in various patient samples. Because Facklamia hominis resembles viridans streptococci on blood agar analysis, this pathogen may often be misidentified. In this case identification of Facklamia hominis was possible with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. It has been postulated that Facklamia hominis might be a facultative pathogen and that its incidence will increase in the future.