Limited evidence exists about preserving neurovascular bundles during radical prostatectomy (RP) for high-risk prostate cancer (HRPCa) patients. Hence, we validated an existing algorithm predicting contralateral extraprostatic extension (cEPE) risk in unilateral high-risk cases. This algorithm aims to assist in determining the suitability of unilateral nerve-sparing RP. Among 264 patients, 48 (18%) had cEPE. The risk of cECE varied: 8%, 17.2%, and 30.8% for the low, intermediate, and high-risk groups, respectively. Despite a higher risk of cECE among individuals classified as low-risk in the development group compared to the validation group, our algorithm’s superiority over always/never nerve-sparing RP was reaffirmed by decision curve analysis. Therefore, we conclude that bilateral excision may not always be justified in men with unilateral HRPCa. Instead, decisions can be based on our suggested nomogram.

关于在高危前列腺癌 (HRPCa) 患者的根治性前列腺切除术 (RP) 过程中保留神经血管束的证据有限。因此，我们验证了一种预测单侧高风险病例中对侧前列腺外扩张 (cEPE) 风险的现有算法。该算法旨在帮助确定单侧神经保留 RP 的适用性。在 264 名患者中，48 名 (18%) 患有 cEPE。cECE 的风险各不相同：低风险组、中风险组和高风险组分别为 8%、17.2% 和 30.8%。尽管与验证组相比，开发组中被归类为低风险的个体的 cECE 风险较高，但决策曲线分析再次证实了我们的算法相对于始终/从不保留神经的 RP 的优越性。因此，我们得出结论，对于患有单侧 HRPCa 的男性，双侧切除可能并不总是合理的。相反，决策可以基于我们建议的列线图。