In another thread, you wrote...
Definitely agree that Tewari is one of the 2-3 best RALP guys in terms of published hard numbers...
2.1% (4 of 188) for pT2a and 33.3% (7 of 21) for pT3+ which worked out to 5.3% (11 of 209) overall.
See http://www.ncbi.nlm.nih.gov/pubmed/20377582 (and those are from 2010 so he may have even improved since).
As far as the 10% risk he quoted to you, yes I assume it is based on your clinical staging and perhaps also other details like your positive core locations.
It is important to understand that even when a guy is clinical stage cT2, his pre-op estimated risk of PSM will be higher because there is always a chance of his pathological staging turning out to be pT3 or higher post-op. Nevertheless, for the purposes of comparing one surgeon to another I believe comparing their PSM rates for their actual pT2 patients is the best metric.
So a guy really has to ask the right questions... "What is my individual risk of PSM given my cT2 clinical stage and other risk factors (GS, pos. core counts / locations, PSA, MRI findings, etc.)? is a very different question than "What is your actual PSM rate for the subset of your patients who actually turned out to be pT2 post op?" Both are important questions.
Thanks for this. Is there a place you go on the internet to get published data by Dr on Positive Margins?
My increased chance of positive margins is one of the things that are weighing on me, and making me consider Brachy seriously. I go back and forth but right now am 50/50, maybe 60/40 surgery.