Tell your surgeon you want TWO incisions

​Surgeons always operate from one side of the patient. They make an incision on one side and start cutting the prostate capsule away from its fossa from that side. Then they reach across the prostate to cut away the rest of it. This seems to lead to a better quality of dissection on the incision side compared to the other side. What this study indicates is that the point of view they have while dissecting makes a difference in the oncological outcome​ of the surgery.

They suggest a bilateral approach instead - starting the dissection from an incision on one side, and then flipping to the other side to complete the dissection. There will always be positive surgical margins because sometimes the tumor has already penetrated into surrounding tissue (T3a), but if they're right, this change in technique would greatly reduce the number of positive margins - up to 59% of them - caused by not adequately cutting the prostate away ("iatrogenic").

So if you're going under the knife soon, show this to your surgeon.

Wrong to be Right: Margin Laterality is an Independent Predictor of Biochemical Failure After Radical Prostatectomy.

- Allen

I believe I would say it came from a peer-reviewed study that was published in a professional medical journal. Which, of course, has the added benefit of being true.

Sheepguy - what a strange attitude!

I often bring journal articles for discussion with clinicians, and sometimes email them. Sometimes, they will have seen them and have an opinion, but often (as is most likely for an article like this that has only been published online in the last week), they may not have seen it. Clinicians have a full patient load and they don't always read the latest journal articles. I have never had a clinician object. Remember that they are very intelligent people who usually value medical research. Now admittedly, most doctors I visit with are at some of the top teaching hospitals in the US, and many are professors who enjoy being engaged in discussions about medical research. It may be that doctors in community practice are less receptive - but then again, those are not the doctors we should be getting prostatectomies from.

It's all part of being an empowered patient - which is something I very much encourage. Doctor/patient relationships have changed markedly in the last 20 years. Bringing in info from good sources can be a stimulant to fruitful discussions.

- Allen

Allen, I agree. I would want no part of being treated by a Dr. Who was not open to at least answer questions about a study we may come across, if he's seen it. And no part of a Dr who wouldn't be willing to read something I've found, that may be applicable to my case, which he hasn't come across.

No room for ego in treating this disease.

Pratoman said...
Allen, I agree. I would want no part of being treated by a Dr. Who was not open to at least answer questions about a study we may come across, if he's seen it. And no part of a Dr who wouldn't be willing to read something I've found, that may be applicable to my case, which he hasn't come across.

No room for ego in treating this disease.

Amen!

halbert,

I'm not sure, but I don't think it applies to RALP because the surgeon is at a console and I think he can approach the cutting from any side or both sides.

I think most surgeons would be more than amused, perhaps even seriously annoyed, by having a patient tell them how they are to operate on them. Sorry, I feel this is way over the line of being informed.

I would hope we all have enough social savvy and tact to discuss the issue without raising ego barriers. As I said in my post: "show this to your surgeon." I have never had a doctor bridle, and I have talked to a LOT of doctors. If anyone wants some pointers, here are some suggestions:

Managing the Doctor/Patient Relationship

This is kind of a moot discussion as it's getting difficult to find surgeons who still perform "open" Prostatectomies..85% to 90% of them are now performed roboticly..Even if you DID have open surgery, surgeons might be sure to balk at opening a second pathway to the prostate because of all the extra and duplicate tissue damage such a procedure would entail...

I had only one incision. Most doctors, being also human, are open to information patients share with them as part of a conversation about their treatment. Some patients don't want to engage their physicians at all, but then complain when they don't get the answers they want to questions they didn't ask.

Some docs do balk at being asked about things found on the internet. One of my husband's docs told me to stay off the internet. He actually told me that all the information I needed could be found on the American Cancer Society website and that I didn't need to concern myself with trying to read complicated study material. We don't see this doctor anymore.

Tall One and halbert
"I'm not sure, but I don't think it applies to RALP because the surgeon is at a console and I think he can approach the cutting from any side or both sides."
My wife drove me to the first meeting after my DaVinci surgery and, when asked if any questions, said "how many holes did you make?" I found that a touch strange, but as a result I can add to this discussion the answer: Seven
And Tall One: Thanks for this and so much more, and even if, in the future and I doubt it, I have occasion to disagree with you, that will not diminish my gratitude.

Allen,
Did you read the full article? It cost $ to read other than the abstract, which only says "RP", but maybe you already subscribe? I think the main article will tell us if this only applies to open or also RRP. But I can't quite picture how it applies to RRP.
"Patients and Methods: We reviewed 226 RP patients between 1991 and 2013 with PSM. Data includes operation type............"