为了评估神经保留根治性前列腺切除术（NSRP）在高危前列腺癌（HR-PCa）患者中的长期安全性。HR-PCa与前列腺外疾病的发生率较高相关。这导致了避免进行NS以预防术后阳性切缘（PSM）的概念，因为它可能增加疾病复发的风险。关于是否应该在这些患者中尝试NSRP仍然存在争议。我们的目标是比较接受NSRP和没有进行任何NS的患者的生存结果、疾病复发、额外治疗的需要以及围手术期结果。我们纳入了在单一学术中心接受开放RP治疗HR-PCa的连续患者，其定义为术前PSA>20 ng/ml和/或术后ISUP分级组4或5（即Gleason评分≥8）和/或≥pT3和/或pN1评估前列腺切除和淋巴结标本。我们计算了倾向评分，并使用倒数治疗概率加权法将接受NSRP的HR-PCa患者的基线特征匹配到未接受NSRP的患者。我们将肿瘤学结果以时间为事件进行分析，并计算风险比（HR）。本分析共纳入了726名患者，其中84%（609名）接受了NSRP。没有证据表明NSRP组和非NSRP组之间的PSM有差异（47% vs 49%，p=0.64）。同样，接受NSRP的患者和没有神经干扰的患者之间接受术后放疗的需求也没有差异（HR 0.78，95% CI 0.53-1.15）。NSRP对任何复发的风险没有影响（HR 0.99，95% CI 0.73-1.34，p=0.09），并且没有证据表明接受NSRP的患者与未接受NSRP的患者的生存率有差异（HR 0.65，95% CI 0.39-1.08）。对于癌症特异性生存率（0.56，95% CI 0.29-1.11）和无进展生存率（H）0.99，95%CK 0.73-1.34）在两组之间也没有证据表明有差异。对于HR-PCa患者，只要进行了客观评估（例如T分期）和主观评估（例如术中组织平面评估）准则的全面评估，可以尝试NSRP而不影响长期肿瘤学结果。该文章受版权保护。保留所有权利。

To assess the long-term safety of nerve-sparing radical prostatectomy (NSRP) in men with high-risk prostate cancer (HR-PCa). HR-PCa is associated with higher incidence of extra prostatic disease. This has led to the concept that NS should be avoided to prevent positive surgical margins (PSM) as they may increase risk of disease recurrence. Whether NSRP should be attempted in these patients remains a matter of debate. We aim to compare survival outcomes, disease recurrence the need for additional therapy and peri-operative outcomes of patients undergoing NSRP to those without any NS.We included consecutive patients at a single, academic centre undergoing open RP for HR-PCa, defined as preoperative PSA>20 ng/ml and/or postoperative ISUP-grade group 4 or 5 (i.e. Gleason score ≥ 8) and/or ≥ pT3 and/or pN1 assessing the prostatectomy and lymph node specimen. We calculated a propensity score and used inverse probability of treatment weighting to match baseline characteristics of HR-PCa patients undergoing NSRP to those having non-NSRP. We analyzed oncological outcome as time-to-event and calculated hazard ratios (HR).A total of 726 patients were included in this analysis of which 84% (n=609) underwent NSRP. There was no evidence for the PSM being different between the NSRP and non-NSRP groups (47% vs 49%, p=0.64). Likewise, there was no evidence for the need for post-operative radiotherapy being different in men who underwent NSRP from those who did not have nerves spared (HR 0.78, 95%CI 0.53-1.15). NSRP did not impact the risk of any recurrence (HR 0.99, 95%CI 0.73-1.34, p=0.09) and there was no evidence for the survival being different in men who underwent NSRP to those who had non-NSRP (HR 0.65, 95%CI 0.39-1.08). There was also no evidence for the cancer-specific survival (0.56, 95%CI 0.29-1.11) nor progression-free survival (H) 0.99, 95%CK 0.73-1.34) being different between both groups.In patients with HR-PCa NSRP can be attempted without compromising long-term oncological outcomes provided a comprehensive assessment of objective (e.g. T-stage) and subjective (e.g. intraoperative appraisal of tissue planes) criteria is conducted.This article is protected by copyright. All rights reserved.