Trifecta Outcomes of Robot-Assisted Radical Prostatectomy: The “Balancing Act” of Achieving Cancer Control and Minimizing Collateral Damage
摘要
Positive surgical margins (PSMs) is a serious conundrum in need of improved understanding for both the surgeon and patients. PSMs modestly increase the risk of a Biochemical recurrence (BCR) as it has been shown that in low grade patients, a PSM leads to BCR in less than 15%. So in 100 PSMs only 15 will develop BCR. Reinforcing this thinking is the rare risk of prostate cancer death associated with PSMs. There is a growing body of literature in that Gleason grade group and stage drive prostate cancer specific mortality (PCSM). This is the primary mortality driver and questions the relevance of PSM rates as a metric of surgical efficacy.