SS-ECE nomogram: Prediction of Side Specific Extracapsular Extension at Radical Prostatectomy
Preoperative prediction of the probability of side specific extracapsular extension (SS-ECE) is a useful aid for most surgeons performing radical prostatectomy (RP). For less experienced surgeons it might represent the main indication for neurovascular bundle (NVB) excision or preservation. Its importance may be more marginal for very experienced surgeons.

The SS-ECE nomogram was externally validated and was highly accurate in a RALP population. 

The SS-ECE nomogram is recommended in the EAU-guidelines to assess the risk of ECE to support decision making regarding NVB excision during RP. 
Research authors: Thomas Steuber, Markus Graefen, Alexander Haese, Andreas Erbersdobler, Felix K.-H. Chun, Thorsten Schlom, Paul Perrotte, Hartwig Huland, Pierre I. Karakiewicz
Version: 1.2
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Probability of positive ECE is:

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Nerve-sparing RP can be performed safely in most men with localised prostate cancer (PCa). Clear contraindications are patients in whom there is a high risk of extracapsular disease, such as any cT2c or cT3 PCa, and any Gleason score (GS) > 7 on biopsy.

This externally validated nomogram predicting side-specific extracapsular extension can help guide decision making.

Multiparametric MRI might be helpful in selecting a nerve-sparing approach.


If any doubt remains regarding residual tumour, the surgeon should remove the neurovascular bundle (NVB). Alternatively, the use of intra-operative frozen-section analysis can help guide these decisions. 

Resource: EAU guideline prostate cancer. 

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