중간위험도 전립선암 환자의 치료 편집하기 (부분)

== 근거표 ==
{| class="wikitable"
!KQ10
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!Reference
|1. David B.S., M. Francesca Monn, Liang Cheng, et al. Oncologic and quality-of-life outcomes with wide resection in robot-assisted laparoscopic radical prostatectomy. Urol Oncology 2015;33:9-14.
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!Study type
|Original article
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!Patients
|483 Patients undergoing RALP (2004-2013) for intermediate- or high-risk prostate adenocarcinoma 
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!Purpose of Study
|To assess urinary quality-of-life (QoL) and oncologic outcomes between wide resection (WR) robot-assisted laparoscopic radical prostatectomy (RALP) and non-WR (NWR) RALP in men with intermediate- or high-risk (Cancer of the Prostate Risk Assessment [CAPRA]-9 >2) prostate adenocarcinoma.
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!Study Results
|A total of 483 RALP cases met inclusion criteria—129 (26.7%) underwent WR and 354 (73.3%) underwent NWR-RALP. There were no demographic differences between groups. Burden of disease was greater in patients undergoing WR (P<0.001). There was no difference in+SM rates between WR and NWR (P=0.505). Adjusting for demographics and CAPRA-9 score, WR patients had a clinically relevant 27% decrease in posterolateral+SM (odds ratio=0.73; 95% CI: 0.38-1.41; P=0.351). WR was not associated with worse BCRFS (hazard ratio=1.24; 95% CI: 0.83-1.86, P=0.30). Adjusting for pathology, University of California, Los Angeles and Extended Prostate Cancer Index Composite urinary domain scores were similar between WR and NWR groups
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!Level of Study
|3
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!Reference
|2. R Deborah, M Eric, P Pavlovich, et al. Urinary outcomes are significantly affected by nerve sparing quality during radical prostatectomy. J Urology 2013;82:1348-54.
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!Study type
|Original article
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!Patients
|A total of 102 preoperatively potent men underwent laparoscopic or robotic radical prostatectomy
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!Purpose of Study 
|To assess the effect of nerve sparing (NS) quality on self-reported patient urinary outcomes after radical prostatectomy.
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!Study Results
|Patients with at least 1 neurovascular bundle spared completely, along with its supportive tissues (NS grade 4/4), noted significantly improved Expanded Prostate Cancer Index Composite urinary functional and continence outcomes as early as 1 month postoperatively and up to 12 months. Significantly less urinary bother was also noted in these men by 9-12 months postoperatively. Multivariate analysis revealed that bilateral or unilateral excellent NS (at least 1 bundle graded 4/4), increasing time from surgery, young patient age, and ower body mass index positively and significantly affected urinary functional outcomes, including pad use. Men who received excellent unilateral NS recovered urinary function about as well as men who had both neurovascular bundles spared in similar fashion.
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!Level of Study
|3
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!Reference
|3. Y Vette, Dubbelman, R Gert, et al. Sexual Function Before and After Radical Retropubic Prostatectomy: A Systematic Review of Prognostic Indicators for a Successful Outcome. Eur Urol 2006;50:711-20.
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!Study type
|Systemic review
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!Patients
|literature concerning sexual function after RRP and focused on prognostic indicators for a successful sexual outcome.
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!Purpose of Study
|Erectile dysfunction is common after surgery for prostate cancer. Potency rates after radical retropubic prostatectomy (RRP) vary widely among different studies. Since the introduction of the nerve-sparing technique potency rates have increased. Erectile function recovery rates for selected groups of patients are high. However, studies from community practices have shown less favourable outcomes after RP
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!Study Results
|Most important prognostic factors for the return of potency after RRP are preservation of the neurovascular bundles, age of the patient and sexual function before the operation. Neurogenic and vasculogenic factors seem to play an important role in the aetiology of the erectile dysfunction after surgery. The role of preserving the accessory pudendal artery is not certain, although some investigators found significant hemodynamic changes after sacrificing the accessory pudendal artery. Colour Doppler ultrasound studies in combination with intracavernous injection of vasoactive drugs or after PDE-5 inhibitors administration has shown to be a reliable test for vascular factors
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!Level of Study
|1
|-
!Reference
|4. Yang DY, Monn MF, Kaimakliotis HZ, et al. Oncologic and quality-of-life outcomes with wide resection in robot-assisted laparoscopic radical prostatectomy. Urol Oncol 2015;33:70. e9-14.
|-
!Study type
|Retrospective study
|-
!Patients
|483 patients
|-
!Purpose of Study
|To assess urinary quality-of-life (QoL) and oncologic outcomes between wide resection (WR) robot-assisted laparoscopic radical prostatectomy (RALP) and non-WR (NWR) RALP in men with intermediate- or high-risk (Cancer of the Prostate Risk Assessment [CAPRA]-9 >2) prostate adenocarcinoma.
|-
!Study Results
|A total of 483 RALP cases met inclusion criteria-129 (26.7%) underwent WR and 354 (73.3%) underwent NWR-RALP. There were no demographic differences between groups. Burden of disease was greater in patients undergoing WR (P<0.001). There was no difference in+SM rates between WR and NWR (P=0.505). Adjusting for demographics and CAPRA-9 score, WR patients had a clinically relevant 27% decrease in posterolateral+SM (odds ratio=0.73; 95% CI: 0.38-1.41; P=0.351). WR was not associated with worse BCRFS (hazard ratio=1.24; 95% CI: 0.83-1.86, P=0.30). Adjusting for pathology, University of California, Los Angeles and Extended Prostate Cancer Index Composite urinary domain scores were similar between WR and NWR groups. 
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!Level of Study
|3
|-
!Reference
|5. Karl A, Buchner A, Tympner C, et al. The natural course of pT2 prostate cancer with positive surgical margin: predicting biochemical recurrence. World J Urol 2015;33:973-9.
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!Study type
|Retrospective study
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!Patients
|956 patients with pT2R1N0/Nx tumors
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!Purpose of Study
|To predict biochemical recurrence respecting the natural course of pT2 prostate cancer with positive surgical margin (R1) and no adjuvant/neoadjuvant therapy.
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!Study Results
|Preoperatively intended omission of pelvic lymph node dissection had a protective effect on BCR in T2 tumors (p=0.002), suggesting that lower malignant potential as evidenced by R1 Nx cancers had lower preoperative PSA, a higher proportion of T1c cancers and smaller tumor volume. In multivariate analysis, GS of the regular prostatectomy specimen was the only statistically significant parameter for pT2R1 prostate cancer (Table 3, p=0.003). This observation remained stable even if data were analyzed respecting each center separately or if larger centers were compared versus smaller centers.
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!Level of Study
|3
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!Reference
|6. Suardi N, Moschini M, Briganti A, et al. Nerve-sparing approach during radical prostatectomy is strongly associated with the rate of postoperative urinary continence recovery. BJU Int 2013;111(5):717-22. 
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!Study type
|Retrospective study
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!Patients
|The study included 1,249 patients treated with radical prostatectomy between 2003 and 2010
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!Purpose of Study
|To demonstrate that nerve-sparing radical prostatectomy (NSRP) is associated with higher rates of urinary continence (UC) recovery compared with non-nerve-sparing procedures in patients with surgically treated organ-confined prostate cancer.
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!Study Results
|At a mean follow-up of 42.2 months (range 1-78), 993 patients (79.5%) recovered UC. Overall, UC recovery rate at 1 and 2 years was 76% and 79%, respectively. On univariable Cox regression analysis, age at surgery, preoperative risk group, medical comorbidities and nerve-sparing status were significantly associated with UC recovery (all P≤0.001). On multivariable analysis, age, risk group and nerve-sparing status were also independently associated with UC recovery (all P<0.003). Patients treated with bilateral NSRP had a 1.8-fold higher chance of full UC recovery
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!Level of Study
|3
|}