Long-term function and oncologic outcomes following nerve-spare or wide resection during radical prostatectomy

Authors

  • Ameeta L. Nayak The Ottawa Hospital
  • Simon Pupulin University of Ottawa
  • Ahsas Nagee University of Ottawa
  • Luke T. Lavallée University of Ottawa
  • Ranjeeta Mallick Ottawa Hospital Research Institute
  • Anathea S. Flaman Ottawa Hospital Research Institute
  • Chris Morash Ottawa Hospital Research Institute
  • Ilias Cagiannos Ottawa Hospital Research Institute
  • Rodney H. Breau Ottawa Hospital Research Institute

DOI:

https://doi.org/10.5489/cuaj.9503

Keywords:

Radical prostatectomy, nerve-sparing, wide resection

Abstract

Introduction: Nerve-sparing during radical prostatectomy (RP) is associated with improved postoperative erectile function and urinary continence but may increase risk of positive surgical margins. This study sought to compare the long-term outcomes of patients treated with nerve-spare (NS) compared to wide resection (WR).

Methods: A historical cohort of consecutive patients was reviewed. A standardized surgical approach of lobe-specific NS or WR was performed. The primary outcome was treatment failure, defined as prostate-specific antigen (PSA) recurrence (PSA ≥0.2 ng/mL) or receipt of postoperative radiation. Secondary outcomes included time to metastases, urinary continence, and erectile function.

Results: Of 193 consecutive patients, 121 (62%) received bilateral NS, 37 (19%) received unilateral NS, and 35 (18%) bilateral WR. Patients undergoing any NS had lower preoperative PSA, tumor stage, and grade group compared to WR (all p<0.05). Adjusting for these variables, risk of treatment failure was increased in patients who underwent NS compared to WR (hazard ratio [HR] 3.08, 95% confidence interval [CI] 1.43-6.66). Continence recovered more quickly after NS, but by 24 months post-RP, this difference was not significant (relative risk [RR] 1.05, 95% CI 0.95-1.15). Postoperative erectile function was better in patients receiving unilateral or bilateral NS (unilateral: 21%, bilateral: 59%, WR: 0%).

Conclusions: NS during RP was associated with higher risk of treatment failure, but better functional outcomes compared to WR. These results indicate that NS presents a tradeoff of outcomes that must be matched to individual patient’s values and preferences.

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Published

2026-03-30

How to Cite

Nayak, A. L., Pupulin, S., Nagee, A., Lavallée, L. T., Mallick, R., Flaman, A. S., … Breau, R. H. (2026). Long-term function and oncologic outcomes following nerve-spare or wide resection during radical prostatectomy. Canadian Urological Association Journal, 20(8). https://doi.org/10.5489/cuaj.9503

Issue

Vol. 20 No. 8 (2026): CUAJ August

Section

Original Research

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