Eichelberg C et al. (2006) Frozen section for the management of intraoperatively detected palpable tumor lesions during nerve-sparing scheduled radical prostatectomy. Eur Urol 49: 1011–1018

In men scheduled to undergo nerve-sparing radical prostatectomy, intraoperative findings of palpable subcapsular tumor usually indicate that the ipsilateral neurovascular bundle should be resected. Eichelberg et al. used intraoperative frozen-section analysis to assess such tumors, and found that the ipsilateral neurovascular bundle can be spared in almost half of patients with palpable tumors, without sacrificing oncologic efficacy.

A single surgeon performed 608 consecutive nerve-sparing radical prostatectomies, during which 83 palpable tumors were detected (13.7%). Intraoperative frozen-section analysis revealed carcinoma in 77 of 83 (93%) tumors. In 48 (58%) tumors, frozen sections showed no capsular involvement, and the ipsilateral neurovascular bundle was spared. Final histopathology revealed positive surgical margins in 8 of 48 tumors: in 5 cases, the ipsilateral side had positive margins (equivalent to a false-negative rate of 6% for detecting capsular involvement), and in 3 patients, the contralateral margins were positive. Interestingly, in 30 of 35 (86%) cases in which the neurovascular bundle was resected because frozen-section analysis showed tumor contact with the capsule, final histopathology showed no tumor in the additionally resected tissues. Overall, positive-margin rates were similar in palpable versus nonpalpable tumors (15.7% versus 14.3%).

Although intraoperative frozen-section analysis would leave some patients with positive surgical margins, for some men, the improved continence and potency achievable with nerve-sparing surgery might outweigh the increased risk of recurrence associated with positive margins. These risks and benefits should be adequately discussed with the patient before surgery, say the authors.