I'm going to have a prostatectomy in the weeks ahead and have seen two good surgeons. One has only done
open surgeries over his 20+ years and has done about
1,400 of them. The other has done about
open and then switched to daVinci eight years ago and has now done 700 of those.
When asked the question on what their positive margin rate was for organ-confined patients in my category (Gleason 6, 3+3, T1C, 1 core of 12 with cancer), the
open surgeon said 3% and the daVinci surgeon said 8%. The
open surgeon is passionate about
his statistics and has meticulously collected them for 20 years. He says he and only 1 or 2 others in the country have such statistics on their surgeries. I'm not sure the daVinci surgeon is that careful with his numbers although he is one of the best in my big city and very well-regarded.
I'd prefer to go the daVinci route due to the assumption that it will be less invasive for me though I'm not sure I believe these claims 100%. There are several well done studies (Univ. of Michigan, Vanderbilt) that show daVinci prostatectomies are not any easier to recover from than
open procedures, don't reduce blood loss, and are not less painful.
I'm going to get both these surgeons to clarify how they came up with their numbers and over what time period and exact patient demographics. But, if they turn out to really be 3% for the
open surgeon and 8% for the daVinci surgeon, doesn't it make sense to go with the
open surgeon who has a 5% less-chance of leaving cancer behind? Is an 8% positive margin rate for daVinci high? I know Walsh says across all surgeons at Hopkins and over 10K surgeries, the organ confined cases showed a 1.3% positive margin (pg. 295). He doesn't seem to clarify whether that includes
open and robotic as I believe they use daVinci at Hopkins as well.
April 2007 PSA: 2.9
July 2008 PSA: 3.2
Aug 2010 PSA: 4.3
September 2010 biopsy: Gleason 6 (3+3) T1C, 1 core positive out of 12
Post Edited (EdwardL) : 1/14/2011 6:46:38 PM (GMT-7)