Factors Involved with Recurrence After Prostate Cancer Surgery

The risk of recurrence after prostate cancer surgery explained.

Recurrence After Prostate Cancer SurgeryThe most important factors for determining risk of recurrence after prostate cancer surgery are the advancement of the disease and the skill level of the surgeon. During prostate cancer surgery, which is referred to as a prostatectomy, the prostate is removed and surgeons try to cut as close to the prostate as possible to preserve the neurovascular bundle. It is of the utmost importance to any surgeon to reduce the risk of recurrence after prostate cancer surgery.

The closer the surgery site is to the prostate, the higher the risk of recurrence after prostate cancer surgery. It also will help with the outcomes of continence, one that will help with the outcomes of potency, and one that will cure the patient. The disease itself plays an important part in recurrence after prostate cancer surgery. The goal of an surgeon is negative margins, to contain the disease within the prostate, thereby reducing the risk of recurrence after prostate cancer surgery.

David Albala MD:  What is the risk for recurrence after surgery?

Well, if one looks at the literature, the most important factor are what is the disease that the patient has when he comes to the table and how good is the surgeon.  For example, when we do a prostatectomy, we take the prostate gland out, we typically try to stay as close to the prostate as we can to try to preserve the neurovascular bundle.  The neurovascular bundle are the nerves that supply the penis for erection, when right along side the prostate and as surgeons, we peel those nerves off much like peeling an onion skin off an onion to preserve those nerves to allow men to have erections after surgery.

The closer you are to the prostate, higher the risk of recurrence can be, for example if the disease is all contained within the prostate, a good surgical procedure is one that has negative margins which preserve the neurovascular bundle that will help with the outcomes of continence, that will help with the outcomes of potency, and one is cure the patient.

Now in some cases, disease may be outside the prostate.  After surgery, the specimen that’s removed by your surgeon is sent to the pathologist, it is dipped in a bucket of ink, and then it is put in formaldehyde and then section stained and looked under the microscope.  What the pathologist looks for is to see if tumor cells go right up to the edge or the cut edge of the prostate.  If we see tumor cells at the cut edge, we have to assume that the disease, some disease was left in the bed of the prostate in the patient and those patients, if they have a positive margin or advanced disease outside the prostate, some of those patients will require radiation therapy to get a cure.

So, the disease itself does play an important part in the recurrence rates in individuals, but the surgical technique also plays an important role.  As surgeons, we want to get negative margins, we want the disease contained within the prostate and ultimately, that’s going to give the patient the best outcome.

 

Dr. David Albala
Dr. David M. Albala is Chief of Urology at Crouse Hospital in Syracuse, New York and Medical Director for Associated Medical Professionals. He is considered a national and international authority in laparoscopic and robotic urological surgery and has been an active teacher in this area for over 20 years.


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