Intraoperative frozen section monitoring of nerve sparing radical retropubic prostatectomy

Purpose: We describe the clinical and pathological outcomes of intraoperati ve frozen sections performed on the posterolateral prostate margins during nerve sparing radical prostatectomy. Materials and Methods: We developed a technique of bilateral nerve sparing, inking the posterolateral prostate margins and obtaining frozen sections. When tumor was seen on frozen section, the fascia and neurovascular bundle were widely excised before completing the vesicourethral anastomosis. We re viewed 142 radical retropubic prostatectomies performed by a single surgeon between 1992 and 1997. Patients were divided into group 1-nerve sparing pr ocedure using our technique (48 patients), 2-planned unilateral nerve spari ng without frozen sections (46) and 3-planned bilateral nerve sparing witho ut frozen sections (48). Potency was measured implicitly by physician asses sment and explicitly with the UCLA Prostate Cancer Index. Group comparisons were made for positive margins, biochemical recurrence and potency. Mean f ollowup was 24.5, 43.8 and 39.4 months for groups 1, 2 and 3, respectively. Results: Of the 48 group 1 patients 9 (18%) had adenocarcinoma in the froze n section specimen, prompting wide excision of the bundles. None of these p atients had biochemical recurrence during a mean followup of 20.5 months. B oth bundles were spared in the remaining 39 patients (82%). There was no di fference in survival or time to biochemical recurrence between groups 1 and 2. Potency was significantly different between groups 1 and 2 (36 versus 1 3%, p = 0.001), even after age adjustment (p = 0.05). In contrast, potency did not differ between groups 1 and 3 (38 versus 40%). Preoperative stage, grade and prostate specific antigen level were similar among the 3 groups. Conclusions: We found a significant difference in potency rates adjusted fo r age between patients with and without frozen sections. Our results indica te that this technique can enhance the ability of the surgeon to monitor th e nerve sparing procedure without compromising cancer control.