Re: What is T2 Margin Status?

[Guest guest]

Welcome ,

Clearly you are starting to do your homework

early – I hope you will have read up about the basics of PSA to realize that,

since it is not prostate cancer specific the rise in PSA level you highlight

may have nothing to do with prostate cancer. If you haven’t found it yet,

this piece http://www.yananow.net/PSA101.htm

may be of interest

As I am sure you will discover, there is a

good deal of information on the Internet which can be confusing and misleading.

This is especially true of sites where the site owner/sponsor is “selling”

a specific form of therapy. The site you refer to is “selling” RALP

(Robotic Assisted Laparoscopic Prostatectomy) – the Da Vinci way and they

have therefore selected from the plethora of studies big and small information

that suits their case.

You ask specifically about the T2 margin

status. This refers to the percentage of men who have positive margins (which

is to say that there is evidence that the disease may have escaped from the

gland before surgery) discovered after surgery and who were staged T2 –

most men are staged T1 at diagnosis ( see http://www.yananow.net/Staging.htm

) They claim a rate of 2.5% for these men, but looking at the Abstract of the

study from which the figures are extracted we see that it says in part <snip>

The positive margin rate was 9.4% for all patients; i.e. 2.5% for T2 tumours,

23% for T3a and 53% for T4. <snip>

So, the first question is this –

does the comparison compare apples and apples or chalk and cheese. I can’t

access the paper from which the second column figure was extracted, but the

abstract of the paper from which the third column is extracted is available. It

compares the outcomes of procedures where T2 glands were removed prior to the instigation

of a quality control program and the results after this program was running. The

relevant extract says <snip> The 2 groups were comparable in regard to

preoperative cancer characteristics and total tumor volume. In patients who

underwent bilateral nerve sparing the positive margin rate was 10.6% in group 1

and 5.4% in group 2 (p = 0.18). <snip> The body of the report may show

where the figure of 7.7% occurs, but it isn’t in the abstract. It would

appear that a better figure for comparative purposes in this study would be

5.4% - still a little higher than the 2.5% claimed for the Da Vinci result, but

significantly different.

No doubt similar anomalies could be shown

for each of the figures shown – and of course the period over which the

results were measured, the experience of the surgeons and similar factors are

all in the mix.

There have been many studies comparing Open

RP (Radical Prostatectomy) and RALP (Robotic Assisted Laparoscopic

Prostatectomy) and there is no clarity as to which is ‘better’ than

the other. Below is the abstract of one such typical study:

J Urol. 2008 May;179(5):1811-7; discussion

1817. Epub 2008 Mar 18.

Comprehensive

prospective comparative analysis of outcomes between open and laparoscopic

radical prostatectomy conducted in 2003 to 2005.

Touijer

K, Eastham

JA, Secin

FP, Romero

Otero J, Serio

A, Stasi

J, -Salas

R, Vickers

A, Reuter

VE, Scardino

PT, Guillonneau

B.

Department of Surgery, Service of Urology,

Memorial Sloan-Kettering Cancer Center, New York, New York

10021, USA.

touijera@...

PURPOSE: In a nonrandomized prospective

fashion we compared the oncological, functional and morbidity outcomes after

laparoscopic and retropubic radical prostatectomy. MATERIALS AND METHODS:

Between January 2003 and December 2005 a total of 1,430 consecutive men with

clinically localized prostate cancer underwent radical prostatectomy, laparoscopic

in 612 and retropubic in 818. The surgical approach was selected by the

patient. Preoperative staging, respective surgical techniques, pathological

examination and followup were uniform. Functional outcome was measured by

patient completed health related quality of life questionnaire.

RESULTS: Positive surgical margin rates

(11%) and freedom from progression (median followup 18 months) were comparable

between laparoscopic and retropubic radical prostatectomy (HR 0.99 for

laparoscopic vs retropubic radical prostatectomy, p = 0.9). We found no

significant association between operation type and time to postoperative

potency (HR 1.04 for laparoscopic vs retropubic radical prostatectomy; 95% CI

0.74, 1.46; p = 0.8). Patients who underwent laparoscopic radical prostatectomy

were less likely to become continent than those treated with retropubic radical

prostatectomy (HR 0.56 for laparoscopic vs retropubic radical prostatectomy;

95% CI 0.44, 0.70; p <0.0005). Laparoscopic radical prostatectomy was associated

with less blood loss (mean ml +/- SD 315 +/- 186 vs 1,267 +/- 660) and lower

overall transfusion rate (3% vs 49%). No significant difference was noted in

cardiovascular, thromboembolic and urinary complications. Emergency room visits

and readmissions were higher after laparoscopic radical prostatectomy (15% vs

11% and 4.6% vs 1.2%, respectively).

CONCLUSIONS: At our institution and during

the study period laparoscopic radical prostatectomy and retropubic radical

prostatectomy provided comparable oncological efficacy. Laparoscopic radical

prostatectomy was associated with less blood loss and a lower transfusion rate,

and higher postoperative hospital visits and readmission rate. While the

recovery of potency was equivalent, that of continence was superior after

retropubic radical prostatectomy.

PMID: 18353387 [PubMed - indexed for

MEDLINE]

Good luck on your voyage of discovery!!

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of the

decisions we make with regard to prostate cancer are made with inadequate data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Bzh

Sent: Saturday, 27 February 2010

2:39 PM

To: ProstateCancerSupport

Subject:

What is T2 Margin Status?

Hello, I am a new member of this group. My PSA

level went from 1.7ng (2 years ago) to 4.3ng (recent test). I have been

scheduled for an initial consultation with a urologist, possibly followed by

a biopsy in April.

Meanwhile, I am reading about the treatment options

for prostate cancer. There is a comparison chart of Da Vinci vs. Open vs.

Laparoscopy: http://davinciprostatectomy.com/treatment-options/dvopenlap.aspx

In the comparison of " Cancer Control " outcome, Da Vinci has the

lowest number among the three (2.5 vs. 5.9 vs. 7.7). Does that mean Da

Vinci has the best outcome if a prostatectomy is done? Or is it the

opposite?

Thanks in advance for any answers!

[Guest guest]

,

I agree with Terry about everything he said. I believe that he's

exactly right that the website you are looking at is a sales

site, not an information site, and the studies have been picked

for the purpose of selling you their service.

Da Vinci machines cost a bundle. Searching Google for costs, the

first page I found said a hospital just paid $1.9 million for

one. There's big bucks involved in selling this to the public,

and it's not surprising that there's big hype around it. The

same is true for all the other expensive therapies - proton beam,

IMRT, Cyberknife, etc.

I'm not saying that robotic surgery, or any of the other

therapies mentioned above, is worse than other kinds of

treatment. It may be as good. It may be worse. It may be

better. But I know of no studies that really establish the

relative merits in a way that has garnered any consensus among

experts.

All of the cited studies appear to be single treatment studies.

For example, a study claiming that positive margins are X with

robotic surgery is purely a study of robotic surgery, probably

done by a single team at a single clinic on a non-random patient

population, with a particular pathology lab reporting the

results. That is then compared to another study done by a

different treatment team on a different patient population

(possibly one with more serious disease characteristics), and

evaluated by a different lab that might have different criteria

for what constitutes a T2 positive margin.

As Terry says, it's chalk and cheese, not apples and apples.

If and when you are actually diagnosed with cancer, and if and

when you decide you do need treatment (not everyone with PCa

needs immediate treatment), you need to find the best, most

experienced, most trustworthy doctors you can and consult with

them about treatment options. I'm not sure that I would want to

pick a treatment modality and then find someone who can do it.

You might well be better off finding someone really good, and

seriously considering what he can offer you. I personally

believe that a great doctor offering treatment X is going to do

a way better job than a mediocre doctor offering treatment Y.

Also, if I were seeking treatment, I would want to consult at

least one radiation oncologist as well as at least one surgeon.

Best of luck,

Alan

[Guest guest]

Thanks Terry and Alan for you answers! They make a lot of sense. If my biopsy turns out to be positive, I will try to find the best doctor I can to discuss about treatment options. I am doing my homework now, so I can understand the discussion better when the time comes.

Wishing everyone a great weekend!

[Guest guest]

Hello ,

In your quest, remember that most all Dr. will try to convince you to

use their method. After all you are a customer that is not to be turned

away or sent somewhere else.

When the dust settles you will find that most all methods of treatment

are close as to a "cure" rate.

Then go look at the quality of life after treatment.

Since you are on a yahoo forum, go look at other forums dealing with

Pca. One that was not mentioned in the previous exchange is Proton

therapy. I will not expand on it but a forum site to look at is

protoninfo at Yahoo.

Do not get in a hurry, but look at all of your options.

d.

Thanks Terry and Alan for you answers! They make a lot of

sense. If my biopsy turns out to be positive, I will try to find the

best doctor I can to discuss about treatment options. I am doing my

homework now, so I can understand the discussion better when the time

comes.

Wishing everyone a great weekend!

[Guest guest]

A study was just published in the Journal of Urology, by the Memorial Sloan

Kettering group, comparing " open " and " laparascopic " (including robotic)

prostatatectomy.

The best summary I've seen is here:

http://tinyurl.com/yernbxy

You may need a free subscription to " Nexcura " to open the page. " Nexcura "

doesn't send spam or advertising.

>

> Thanks Terry and Alan for you answers!  They make a lot of sense.  If my

biopsy turns out to be positive, I will try to find the best doctor I can to

discuss about treatment options.  I am doing my homework now, so I can

understand the discussion better when the time comes.

>  

> Wishing everyone a great weekend!

>

>