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Objectives: To evaluate the 1‐year efficacy of chitosan membrane (ChiMe) application on the neurovascular bundles (NVBs) after nerve‐sparing (NS) robot‐assisted radical prostatectomy (RARP) in potency recovery rate.To compare the results with those of a contemporary cohort of patients who did not benefit from chitosan use. Patients and Methods: Patients in the ChiMe group were enrolled at our institution from July 2015 to September 2016 in a preliminary phase II study. All of them underwent NS‐RARP with ChiMe applied on the NVBs and were followed over time to complete a 1‐year follow‐up. The control group was composed of patients who underwent NS‐RARP at our institution without the application of ChiMe from January 2015. The patients were further classified into two groups based on the amount of nerves spared: Group A, comprised patients who underwent a monolateral or bilateral full NS; Group B, comprised patients in which a full NS was not performed. The demographics, peri‐ and postoperative data, and complications were recorded and compared. Potency recovery was recorded for Group A vs Group B in both the ChiMe and the control groups. Results: In all, 136 patients were enrolled in the ChiMe group and 334 patients in the control group. There were no differences between groups in terms of baseline variables. Based on the amount of nerves preserved, 183 patients were included in Group A and 287 in Group B. Odds ratios at different time points showed that the only two factors influencing potency recovery were the amount of nerves preserved (Group A vs Group B) and the application or not of ChiMe on the NVBs spared. Comparing the ChiMe vs control groups at different time points, we found a statistically significant improvement in the potency recovery rate in the ChiMe group at 1 month (36.76% vs 25.88%; P = 0.02) and 2 months (52.2% vs 39.22%; P = 0.01) after surgery, showing a favourable trend at every time point of the entire follow‐up period, even if not significant after the second postoperative month. In Group A, the log‐rank test showed a statistically significant difference between the ChiMe vs control groups (P = 0.02), in particular at 1 and 2 months after surgery (P = 0.02 and P = 0.01, respectively). Conclusion: The application of ChiMe on the NVBs resulted in a higher potency recovery rate at 1 and 2 months after a bilateral or monolateral full NS‐RARP. A trend of a higher and shorter potency recovery rate showed it to be favourable to use ChiMe, even in the cohort of patients who did not undergo a full NS procedure. [ABSTRACT FROM AUTHOR]

Objective To assess the performance capabilities of multiparametric magnetic resonance imaging (mp MRI), the prostate health index ( PHI) and prostate cancer antigen 3 ( PCA3) in predicting the presence of pathologically confirmed significant prostate cancer ( PCSPCa), according to the European Randomized Study of Screening Prostate Cancer definition, in a single cohort of patients who underwent radical prostatectomy ( RP) but who were eligible for active surveillance ( AS). Materials and Methods An observational retrospective study was performed in 120 patients with prostate cancer ( PCa), treated with robot-assisted RP but eligible for AS according to Prostate Cancer Research International: Active Surveillance criteria. Blood and urine specimens were collected before initial prostate biopsy for PHI and PCA3 measurements, respectively. In addition, all patients underwent mp MRI, preoperatively and 6-8 weeks after biopsy, with a 1.5T scanner using a four-to-five-channel phase array coil combined with an endorectal coin. mp MRI images were assessed and diagrams showing the prostate sextants were used to designate regions of abnormality within the prostate. Prostate findings were assigned to one of five categories according to Prostate Imaging-Reporting and Data System guidelines ( PI- RADS) and considered positive for PCa if final PI- RADS score was >3 and negative if ≤3. Results Pathologically confirmed reclassification was observed in 55 patients (45.8%). mp MRI showed good specificity and negative predictive value (0.61 and 0.73, respectively) for excluding PCSPCa compared with the PHI and PCA3. On multivariate analyses and after 1 000 bootstrapping resampling, the inclusion of both mp MRI and the PHI significantly increased the accuracy of the base model in predicting PCSPCa. For the prediction of PCSPCa, in particular, the base model had an area under the curve ( AUC) of 0.71 which significantly increased by 4% with the addition of the PHI ( AUC = 0.75; P < 0.01) and by 7% with the addition of mp MRI ( AUC = 0.78; P < 0.01). Decision-curve analysis showed that the multivariable model with mp MRI had the highest net benefit. Conclusion In a single cohort of patients who underwent RP but who were eligible for AS, mp MRI and, to a lesser extent, the PHI, had an important role in discriminating the presence of PCSPCa; both measures could therefore be useful in the selection and monitoring of patients undergoing AS. [ABSTRACT FROM AUTHOR]