Cancer cells left behind: Rates of positive margins following different types of prostate surgery

This study examined the rates of positive surgical margins in both robot-assisted and open prostate removal surgeries.

Prostate cancer patients are often treated with radical prostatectomy (surgical removal of the prostate gland). In the standard, open approach an incision is made in the lower abdomen. In the robot-assisted method, much smaller incisions are made and the prostate can be removed using robotic arms that allow precise movements.

When cancer is removed from the body, some healthy tissue from around the tumor is also removed, in order to make sure that all of the cancer is removed. Positive surgical margins (PSM) indicate that following prostate cancer removal the outermost margins are positive for cancer and therefore it may be that not all of the cancer has been removed. It is not clear whether one type of surgery is more likely to lead to PSMs.

This study examined 6194 patients who underwent radical prostatectomy. 4404 underwent open radical prostatectomy and 1790 underwent the robot-assisted method. The patients were also subdivided based on the risk level of their cancer: low, intermediate and high. This was determined by factors such as tumor size. The surgical margins of each patient were examined for cancer cells.

PSMs were found in 21.6% of patients. The rate of PSMs was higher following open surgery for every risk group. In the high-risk patient group, the rate of PSMs in the robot-assisted approach was 19.7% versus 30.1% in the open approach. In the high-risk group, robot-assisted surgery deceased the odds of PSMs by 31% compared to open surgery.

This study concluded that the robot-assisted surgical method was associated with a lower rate of PSMs in patients with high-risk disease.

Discuss with your physician the use of the robotic approach the case of a radical prostatectomy, particularly if you are a high-risk patient.