Experience Tells in Prostate Surgery

Researchers in New York tracked success rates of a procedure to remove the prostate gland in men with prostate cancer and documented the 'learning curve' doctors face as they perform operations over and over.

The prostate is a walnut-sized gland that makes fluid for semen. In the operation, a surgeon takes out the prostate and some surrounding tissue while trying to spare muscles and nerves that control urination and sexual function in an effort to remove the cancer entirely and prevent it from spreading.

Previous research has shown a surgeon's level of experience can be important in influencing an operation's success. In this study, experience was measured not by age or years as a surgeon but by the number of times doctors performed this operation.

'Advice for patients is to try to seek out experienced surgeons, and they're likely to be ones who specialize in the procedure,' Andrew Vickers of Memorial Sloan-Kettering Cancer Center in New York City, one of the researchers, said in a telephone interview.

The researchers followed 7,765 prostate cancer patients who underwent an operation called radical prostatectomy performed by 72 surgeons at four U.S. academic medical centers in New York, Texas, Michigan and Ohio from 1987 to 2003.

As the number of times a doctor performed it increased, the number of patients who remained cancer-free five years after the surgery also rose, the researchers wrote in the Journal of the National Cancer Institute.

But at a certain point the improvement in surgical outcome topped out and stabilized regardless of how many more times a surgeon did the procedure.

'The learning curve for prostate cancer recurrence after radical prostatectomy was steep and did not start to plateau until a surgeon had completed approximately 250 prior operations,' the researchers wrote.

Men whose doctors had performed the surgery only 10 times in their careers were about 70 percent more likely to suffer a recurrence of prostate cancer within five years than men whose surgeons had performed it 250 times, the study found.

The researchers said 17.9 percent of patients of these less experienced surgeons had their cancer return, compared to 10.7 percent of patients of the more experienced doctors.

The researchers attributed the findings to improvement in technique by the doctors who did the operation repeatedly.

'It's a very, very difficult, complex operation to do. So it's not surprising that it takes a large number of surgeries to get good at it,' Vickers said.

The American Cancer Society forecasts that there will be about 219,000 new cases of prostate cancer in the United States in 2007 and about 27,000 men will die of it.

Source-Medindia
GPL/C