BEWARE OF INEXPERIENCED PROSTATE CANCER SURGEONS

//BEWARE OF INEXPERIENCED PROSTATE CANCER SURGEONS

[From physorg.com. All emphasis, e.g., boldface or italic typeface, is mine.]

“Prostate Cancer Surgery Performed by Many Surgeons with Little Experience”

November 19, 2009

(PhysOrg.com) — A new study from researchers at Memorial Sloan-Kettering Cancer Center has found that the majority of surgeons treating prostate cancer in the United States have extremely low annual caseloads,

“The research was published in the December issue of The . Andrew Vickers, PhD, Associate Attending Research Methodologist in the Department of Epidemiology and Biostatistics at Memorial Sloan-Kettering Cancer Center, led an analysis of data on radical prostatectomy, the surgical removal of the prostate for men with . Of US treating patients in 2005, more than 25 percent performed only a single radical prostatectomy that year and approximately 80 percent of surgeons performed fewer than ten such procedures.

“It is known that surgical volume is associated with improved patient outcomes, and fewer complications.  Previous work from this team has indicated that a surgeon’s lifetime experience with radical prostatectomy is strongly associated with cancer control;  patients treated by experienced surgeons had a 40 percent lower risk of a cancer recurrence than patients treated by inexperienced surgeons. The importance of experience in cancer outcomes has been termed the “learning curve.”

“We have previously shown that a surgeon needs to conduct an average of 250 radical prostatectomies to give patients the best chance of cure,” said Dr. Vickers, “so we decided to look at how long it would take a typical surgeon to reach that number of procedures. While the learning curve is not the only factor in determining surgical skill, we found that the majority of surgeons who treat prostate cancer patients will not achieve that number of procedures in their entire career.”

“A high-volume surgeon is defined as one who performs 50 cases a year or more. According to Dr. Vickers and colleagues’ research, only 2 percent of surgeons nationally and 4 percent of New York State surgeons fall into this category. Nationally, only about one in five prostate cancer patients are treated by high-volume surgeons; this rises to 40 percent in New York .

. . . The study included radical prostatectomies that were performed laparoscopically and with robotics as well as more traditional open surgery.

On the basis of this research, Dr. Vickers said that, “prostate cancer patients considering surgery should be aware that most surgeons have very little experience treating this disease. They are likely to have a reduced risk of complications, and better chance of cure, if they are treated at a specialist cancer center by a surgeon who focuses on treating prostate cancer.”

Provided by Memorial Sloan-Kettering Cancer Center


By | 2009-11-20T11:23:23+00:00 November 20th, 2009|Postings|2 Comments

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  1. Alvin Chin November 21, 2009 at 7:50 pm

    I realized the side effects were bad in surgery and that is why I chose brachytherapy. I also didn’t particularly like the game played by my diagnosing urologist who I felt was not up front with me on how many procedures he had done and was doing per year. It didn’t take me too long to conclude that I was not going to let this relatively inexperienced, but mid-career urologist, operate on me. I’ve always said that one of the reasons that I chose brachytherapy was the “learning curve” need not be that great and you have the help of a whole team to make sure that the doses are done correctly. The simple fact that you have to cut a closed system invites leakage and that was not necessarily the case in radiation, as the side effect rates bear out. There are times when surgery truly is the gold standard but in most run of the mill cases, it is not necessary and radiation, (preferably brachy), will do fine.

    This leads one to wonder if the over treatment caused by the over diagnosis of PCa is not solely due to the inability of surgeons to provide a clean operation. That is, too many inexperienced surgeons are leaving the impression that there is over treatment because of the detritus that is invariably left behind. It always causese one to wonder whether the treatment was worth it when one is left with incontinence, impotence, and a less than perfect internal system.

    The final question is why can’t they train their surgeons better or require them to obtain special licenses or experience to perform mass prostatectomies just as they require of specialized cardiac surgeons. I suspect that there are still surgeons out there not practicing Nerve-sparing RRP even though Johns Hopkins/Walsh circulated the procedure in the major professional journals a few years ago. Over treatment is a problem caused by the professional gate keepers, not the patients. All they need is more honesty and a will to improve the results. But, evidently is takes more than a desire to make our professionals, more professional.

  2. Sal February 1, 2012 at 3:13 am

    Wow, this is an eye opener!

    Ironically, the dr who would have probably done surgery (ha hubby code it), is not board certified in anything at all, no urology, not surgery.

    It was not why hubby did not close surgery, but… scary in retrospect.

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