Positive Margins and Robotic Prostatectomy
Dear OncoLink "Ask The Experts,"
My husband was recently diagnosed with prostate cancer. He was so sure the DaVinci prostatectomy was the way to go, but after reading more online, some doctors say that the prostate can be burnt or the capsule broken [during surgery], possibly leaving cancer behind and pathology margins not ideal. The one surgeon I was looking at does a minimum of 2 [robotic-assisted surgeries] a week. Do you have any thoughts to help our decision making?
David I. Lee, MD, Chief of the Division of Urology at Penn Presbyterian Medical Center, responds:
Positive margins occur with both the open (traditional retropubic) and robotic-assisted prostatectomies. The literature shows that there is a wide variation in surgical margins for surgeons performing open radical prostatectomy. Likewise, there is a wide variation for margins among surgeons who perform robotic prostatectomy. The trend seems to be, however, that surgeons who become more and more experienced at whatever technique they are performing tend to achieve better and better margin rates. Therefore, it is not the approach that matters. It is the experience of the individual surgeon. You should ask the prospective surgeon about his or her rates.
My personal margin rates continue to improve with experience. We have an overall rate of about 10-12%. This is even lower for men with organ-confined disease, where it can be as low as about 5%. These numbers are comparable to all numbers for open radical prostatectomy, and superior to many.