Impact of mpMRI targeted biopsy on intraoperative nerve‐sparing (NeuroSAFE) during robot‐assisted laparoscopic radical prostatectomy

Background The aim of our study was to evaluate the impact of prostate biopsy technique (transrectal ultrasound (US)—prostate biopsy (PBx) versus multiparametric magnetic resonance imaging (mpMRI) targeted prostate biopsy (MRI‐PBx) on intraoperative nerve‐sparing and the rate of secondary neurovascular‐bundle resection (SNR) in patients undergoing robot‐assisted laparoscopic radical prostatectomy (RARP). A real‐time investigation with a frozen‐section examination (NeuroSAFE) microscopically excluded or confirmed prostate cancer invasion of the nerve structures resulting in preservation of the neurovascular bundle or SNR. Additionally, we analyzed risk factors related to SNR, such as longer operation time and postoperative complications. Methods The total study cohort was stratified according to non‐nerve‐sparing versus nerve‐sparing RARP. Patients with nerve‐sparing approach were then stratified according to biopsy technique (PBx vs. MRI‐PBx). Further, we compared PBx versus MRI‐PBx according to SNR rate. Results We included a total of 470 consecutive patients, who underwent RARP for PCa at our institution between January 2016 and December 2019. Patients with a preoperative MRI‐PBx had a 2.12‐fold higher chance of successful nerve‐sparing (without SNR) compared to patients with PBx (p