‘Primary vs Definitive’ or ‘Radical vs Total’ which denotes correct Terminology in P Ca
We use terminologies frequently which are not clear. It adds to the confusion which could be avoided where possible. Many could ask what is wrong in this. Mark Soloway has written 2 Editorials, one in 2010 and the other 10 years later, wherein he has suggested that the word ‘Definitive’ should not be used but the word ‘Primary’ should be used for treatment offered especially in the context of P Ca. He has explained the reasons behind this succinctly. I tend to agree with the observations made by Soloway. More often we use terminologies to suit our convenience and it does not reflect what we really offer.
Today many oncological surgeons believe that the age old wide excision surrounding the cancer has no evidence and as mentioned by some of our own that the need is excision is to be as close to the cancer as possible and it is a safe oncological principle. This has been exemplified more than Prostatectomy in Partial (nephron sparing) Nephrectomy where some mention that the excision could be very close to the lesion leaving a margin of even an mm. I somehow do not have the will to purchase this. PSM is considered as an important cause for probable recurrence and studies have shown that PSM increases the closer we are to the cancer that we are excising. There are many articles addressing this issue and claim that that Local recurrence is a problem when performing NSS for complex Lesions. But do the present day Uro-oncologists take this into consideration.
On a similar vein, Soloway has in 2008 mentioned that we should not use the word ‘Radical’ for prostatectomy as we are not implementing what the word ‘radical’ Implies. As we dissect the prostate closer to the prostate in our pursuit for nerve preservation ‘Intrafascial’, Soloway opines that the correct terminology is ‘Total’. Studies have demonstrated that more closely our dissection to the prostate more is the likelihood for PSM. Are we compromising on our dissection for better outcomes for Incontinence and ED?
How many of us will think that such usages have no real meaning and presume ‘word is a word’ as long as it conveys some meaning, it is right to use wrong words and we should not over emphasize on Semantics.
With warm Regards,