Robotic Prostate Cancer Surgical Outcomes
There are three factors by which primary prostate cancer treatments are usually evaluated. These are often referred to as the “trifecta” outcomes. They include cancer control, preservation of urinary continence, and preservation of sexual functioning. The Advanced Robotic Technique (ART™) prostatectomy, developed by Dr. Ashutosh (Ash) K. Tewari, Chairman of the Department of Urology at Mount Sinai, offers prostate cancer patients, who are candidates for the procedure, an opportunity to achieve trifecta outcomes with minimal disruption to their everyday lives.
With access to an unparalleled, multidisciplinary team of experts and the most advanced imaging and testing all under the same roof, patients are likely to receive the right treatment recommendation. Not all prostate cancer patients are candidates for robotic prostate cancer surgery, nor is robotic prostatectomy recommended in all cases. After careful evaluation and consultation with Dr. Tewari, active surveillance or other treatments (including radiation or focal therapy) may be the recommended treatment course.
"Cancer control" refers to the ability of the surgeon to remove all the cancerous tissue from the body. This is measured by surgical margins (the rim or border of the tissue removed in cancer surgery). After surgery, the prostate is sent for evaluation by Mount Sinai’s Department of Pathology. Slides are made to determine the cancer grade and margin status. If no prostate cancer cells are seen at the margin, the operation was a success and cancer control is achieved.
Over the course of 5,500 robotic radical prostatectomy surgeries, Dr. Tewari has achieved full cancer control in 95 percent of his patients who had localized prostate cancer (cancer confined to the prostate) – cancer control results that are among best in the class in published data. In published long-term, follow-up studies performed by Dr. Tewari, this translates to a greater than 95 percent, 10-year cancer-specific survival rate in select patients.
Dr. Tewari has one of the lowest tumor-free margin rates even as he continues to operate on more and more aggressive cancer cases. Since the establishment of one of the most innovative and imaging and genomic-based active surveillance programs in 2012, many more patients who come to Mount Sinai are also able to avoid surgery while patients with aggressive cancers get appropriate treatments.
Urinary continence outcomes are determined by the surgeon’s ability to preserve and restore the pelvic male anatomy in such a way that the bladder and surrounding anatomy are unaffected by the removal of the prostate. Dr. Tewari has standardized a unique procedure that restores the urinary support structure following prostate removal. This procedure allows for faster continence recovery.
Loss of sexual functioning is a chief concern of men undergoing prostate cancer treatment. Potency outcomes are often determined by the ability to spare nerves related to the sexual functioning during surgery. The nerves envelop the prostate like a hammock. Dr. Tewari pioneered the technique of neural-hammock sparing, a nerve-sparing technique with outstanding results.
Fully 87 to 93 percent of patients who experienced normal sexual functioning before surgery and were candidates for the nerve-sparing technique, regained sexual function and were able to achieve intercourse after ART surgical treatment.