Can prostate biopsies predict suitability for nerve-sparing radical prostatectomy?

Objective: The process for selecting patients suitable for nerve-sparing radical prostatectomy (NSRP) has been the source of much debate. In this study we analysed the use of prostate biopsies as the principal selection tool. Material and Methods: Patients undergoing radical retropubic prostatectomy (n = 133) were retrospectively categorized as having "unilateral" ( biopsy demonstrated malignancy confined to one side of the gland) or "bilateral" carcinoma. The accuracy and reliability of this categorization were determined by correlation with the final histopathology of the resected radical prostatectomy specimen. Results: Prostate biopsy suggested "unilateral" carcinoma in 30/58 (52%) and 45/75 (60%) patients diagnosed using transrectal ultrasound-guided (TRUS) and transperineal digital-guided (TP) routes, respectively. Subsequent analysis of the resected specimen, however, revealed "bilateral" malignancy in 50 patients (86%) in the TRUS group and in 63 (84%) in the TP group. Furthermore, positive surgical margins were identified on the "benign" side (by preoperative biopsy) in 6 (20%) patients in the TRUS subgroup whose biopsy had suggested "unilateral" carcinoma, and in 12 (27%) of the comparative TP subgroup. Conclusions: Biopsy-suggested "unilateral" carcinoma was associated with both a high incidence of "bilateral" disease on final histology following radical prostatectomy and an alarming incidence (24%) of positive surgical margins on the "benign" side where NSRP might be advocated.