Does NS surgery affect the risk of PSM?
Since the surgical boundaries are reduced by performing an NS procedure, this may result in a higher rate of PSM, particularly in the posterolateral prostate. The region of the neurovascular bundle has been shown as the most common site of capsular penetration.15, 61 Using the NS procedure, Catalona and Bigg62 reported that all patients with extracapsular extension in the region of the neurovascular bundle had PSM.In spite of these premises, it is a fact that, irrespective of the widespread use of an NS approach, the overall rate of PSM has continuously declined over the last two decades.20 A shift in the prostate cancer population towards an intracapsular disease, together with refinements in surgical technique63 and improvement in surgical expertise,64 is the most likely explanation. In the presence of these confounds, it becomes difficult to interpret the potential negative impact of NS procedures.A few studies have addressed the question of whether NSRRP patients may have an increa
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