EXTENDED FOLLOW-UP OF THE INFLUENCE OF WIDE EXCISION OF THE NEUROVASCULAR BUNDLE(S) ON PROGNOSIS IN MEN WITH CLINICALLY LOCALIZED PROSTATE-CANCER AND EXTENSIVE CAPSULAR PERFORATION

Purpose: The effect of wide excision of the neurovascular bundles on d isease-free survival was determined in men with clinically localized p rostate cancer and pathological evidence of extensive capsular perfora tion in the region of the neurovascular bundle. Materials and Methods: We previously analyzed 107 men with clinically localized prostate can cer and pathological evidence of extensive capsular perforation in the region of the neurovascular bundles. Wide excision of the neurovascul ar bundle on the sides of palpable induration resulted in negative sur gical margins in 58% of patients compared to only 45% in whom the neur ovascular bundles were left intact (p = 0.03). At a mean followup of 2 0 months, median interval to disease recurrence as defined by a measur able PSA level was 33 months in patients whose neurovascular bundle(s) were widely excised versus 22 months in those whose neurovascular bun dle(s) were left intact (p = 0.03). However, by 43 months 75% of the p atients in both groups had a detectable prostate specific antigen and the Kaplan-Meier curves had converged, suggesting that wide excision o f the neurovascular bundle(s) did not confer a sustained survival adva ntage. Results: With an additional followup of 28 months, the probabil ity of having an undetectable prostate specific antigen level at 5 yea rs was 47% in patients with negative versus 6% with positive surgical margins (p < 0.001). Conclusions: Our extended followup suggests that some patients with extensive capsular perforation can be rendered free of disease with wide excision of the neurovascular bundle(s).