Functional and oncological outcomes of men under 60 years of age having endoscopic surgery for prostate cancer are optimal following intrafascial endoscopic extraperitoneal radical prostatectomy.

Background: Endoscopic extraperitoneal radical prostatectomy (EERPE) is a well-established procedure for treatment of prostate cancer (PCa). Intrafascial nerve-sparing EERPE (nsEERPE) aims to preserve the neurovascular bundle and subsequently erectile function. This study assessed the functional and oncological outcomes of nsEERPE with particular regard to younger patients.

Methods: Data on 353 men undergoing EERPE between February 2006 and December 2009 was collected prospectively. Non-nerve-sparing EERPE was performed in men diagnosed with PCa with a Gleason score >6 and/or PSA >10 μg/l. nsEERPE was undertaken in men diagnosed PCa with PSA ≤10 μg/l and Gleason score ≤6. Biochemical failure (BF) was defined as PSA ≥0.2 μg/l after nadir or never reached nadir. Men were deemed continent if dry or using 1 confidence pad. Erections satisfactory for intercourse (ESI) or unsatisfactory for intercourse (EUI) were recorded.

Results: 102 Men (29%) had nsEERPE and 126 (36%) EERPE. pT2 positive surgical margin (PSM) rates were 20.5% for nsEERPE and 21.3% for EERPE (P = 1). Continence rates following nsEERPE were 59%, 86%, 97% and 52%, 76%, 86% following EERPE at 3, 6 and 12 months of follow-up respectively (P > 0.05). Erectile function rates for nsEERPE were 24%, 52%, 71% compared to 6%, 14%, 29% for EERPE at 3, 6 and 12 months respectively (P < 0.001). Erectile function in men <60 y having nsEERPE was 75% at 12 months.

Conclusions: Continence returned more rapidly and erectile function was improved following nsEERPE vs. EERPE. These results suggest that nsEERPE can be performed with particularly good oncological and functional outcome in <60 y men.