Published Results Compared
A/Prof Gianduzzo’s results for robotic radical prostatectomy compared to the international literature
About Positive Surgical Margins
When the Prostate is removed it is covered in ink to mark where the surgeon has cut. It is then examined under the microscope.
If cancer cells
- Touch the ink, then this may indicate that not all of the cancer cells have been cleared and some has been left behind. This is termed a “positive margin”.
- Do not touch the ink then this is a “negative margin”.
The first aim of radical prostatectomy, before any other, is to achieve a negative margin.
If cancer has extended outside of the Prostate Gland into the adjacent tissue then the chance of a positive margin increases. However, in cases where the cancer is confined to the prostate gland, the positive margin rate should be very low.
Apart from some rare exceptions, it generally only occurs when the surgeon accidentally cuts into the prostate.
What Does Positive Surgical Margin Mean?
Positive Surgical Margin is an implied measure of cancer clearance.
A positive margin is where cancer cells are present at the very edge of the specimen that is removed. The lower the rate the better.
Stage 2 Prostate Cancer Margin
Some prostate cancers are contained within the prostate gland and are called pT2. In these cases, the positive margin rate should be very low.
Stage 3 Prostate Cancer Margin
In other cases, cancer has started to break out of the shell of the prostate into adjacent tissues and is known as pT3. The positive margin rates in pT3 disease in all series are higher than pT2 because cancer has gone further and is more aggressive.
Other Outcomes
Direct comparisons of potency and continence outcomes between series are difficult because of differences between
- patient groups,
- surgical techniques,
- degree of nerve-sparing and
- in definitions of potency and continence.
Erectile Potency
The potency rates listed for A/Prof Gianduzzo refers to those men who had good erections before surgery and who had both nerves preserved.
Continence
The measure of Continence means either not wearing any pads at all or just a small liner for “security” purposes. Six-month outcomes have been reported rather than 12 months as often many patients have been discharged back to their referring practitioner after 6 months.
References:
Novara, Ficarra, Mocellin, et al. (2012). Systematic Review and Meta-analysis of Studies Reporting Oncologic Outcome After Robot-assisted Radical Prostatectomy. European Urology, 62(3), 382-404.
Ficarra, Novara, Rosen, et al. (2012). Systematic Review and Meta-analysis of Studies Reporting Urinary Continence Recovery After Robot-assisted Radical Prostatectomy. European Urology, 62 (3), 405-417.
Ficarra, Novara, Ahlering, et al. (2012). Systematic Review and Meta-analysis of Studies Reporting Potency Rates After Robot-assisted Radical Prostatectomy. European Urology, 62(3), 418 430.
