Dr James Thompson is an experienced robotic, laparoscopic, endoscopic and open urological surgeon. He has sub-specialty training in (and passion for) the treatment of prostate, bladder and kidney cancer using the latest robotic surgery techniques and for high-impact cancer research that has the ability to immediately improve quality of life and cancer cure rates for the community.
Positive surgical margins
Positive surgical margins are a key indicator of surgical quality and surgeon skill for robotic radical prostatectomy.
This refers to the proportion of cases where the cancer reaches all the way to the edge of the tissue removed at surgery, indicating that microscopic cancer cells may have been left behind. A ‘positive’ margin means that cancer was present at the edge of tissue removed, which increases the chance of the cancer ’growing back’ at that location.
A/Prof Thompson is one of the few surgeons who publicly reports his positive margin rate, which was 8% for the last audit period (Jan 2020 - September 2022). All of these margins were in the context of a shared decision with the patient to perform complete nerve sparing and bladder neck sparing surgery to achieve sexual and urinary function preservation, all margins were tiny ( ‘focal’ i.e. 1-3mm) and none has resulted in a PSA recurrence requiring further treatment to date.
For comparison, reported positive margin rate in recently published large studies were:
26% for all NSW prostate surgeons according to a major pathology provider who reports surgical margins for the largest number of private radical prostatectomies in Australia (2020-2022 period)
17% for robotic prostatectomy by an experienced, high-volume robotic prostate surgeon (see here )
16% in a recent audit of 3,000 laparoscopic cases by 5 prominent Australian prostate cancer specialists (see here );
20-22% for robotic prostatectomy & 17-25% for laparoscopic in 5,500 cases by international experts (see here );
14-23% in a large global study of expert prostate surgeons from Australia, USA, UK and Europe (click here )
Urinary Continence (control)
Recovery of urinary continence (control of urine) is another a key indicator of surgical quality and surgeon skill for robotic radical prostatectomy.
This refers to the proportion of men who regain full control of their bladder, such that they ‘rarely or never’ leak urine and do not need to wear a pad.
A/Prof Thompson is one of the only surgeons who publicly reports his urinary continence recovery outcomes for robotic surgery: 97% of men were pad-free by 3 months following robotic surgery for the most recent audit period (Jan 2020 to October 2021).
Over the past 3 year period (2018 to 2021), 91% of men were pad-free by 3 months and 95% by 6 months following robotic surgery.
For comparison, reported pad-free continence rates in recently published large studies were:
50% for older men (>75 years) and 86% for young men (< 55 years) at 12-months in an Australian study of 8,100 men;
60% at 6 months for robotic prostatectomy by an experienced, high-volume robotic prostate surgeon (see here );
80-91% at 6 months in a recent audit of 3,000 laparoscopic cases by 5 Australian prostate cancer specialists (see here ).
Sexual (erectile) Function
Unlike surgical margins and urinary control, reporting figures for the recovery of erections is complex, making comparisons between surgeons difficult.
This is because the extent to which a man’s erections will recover depends upon:
The age of the man (older men have less recovery of erections)
How strong the erections were before surgery (any pre-existing weakness dramatically reduces recovery)
Other medical conditions (diabetes, smoking, vascular disease, heart disease eg stents, neurologic conditions)
Time since surgery
The number of nerve fibres spared (on a 5 point scale between none, partial on one or both sides and full nerve sparing on both sides)
this depends in turn on how close the cancer is to the nerves and how aggressive it is;
Whether a man is sexually active and how much he pursues erectile rehabilitation with tablets, pumps and injections.
The need to use special questionnaires to collect ‘scores’ that enable accurate comparisons between men
Given all these factors, comparisons between surgeons and studies is very difficult.
A/Prof Thompson does perform careful nerve-sparing wherever it is safe to do so without compromising cancer cure. He is able to perform both complete and partial nerve sparing on each side, depending on each man’s unique situation.
The bottom line is that for younger men (e.g. below 65 years of age) who have good erections, are otherwise healthy and are suitable for nerve sparing on both sides, Dr Thompson is able to achieve good recovery of erections (Adequate for satisfactory sexual intercourse, possibly requiring the use of a Viagra) in most men, i.e. around 80%.
For healthy men with good erections who have complete nerve sparing on one side or partial nerve sparing on both sides, the chance of recovering erections adequate for intercourse (with or without Viagra) is lower but still possible, i.e. around 40-50%.