A significant problem with cancer is that, in spite of the best efforts of your surgeon, it has a nasty habit of recurring in a number of cases. In the case of prostate cancer following the removal of the prostate by radical prostatectomy recent studies have revealed that, while the likelihood of a recurrence are approximately 18 percent where surgery is performed by a fairly inexperienced surgeon, this figure falls to under 11 percent in more experience hands. So exactly what do we mean when we talk about 'experienced hands'?
A recently conducted study examined just under 8,000 prostate cancer patients who underwent radical prostatectomy surgery in the United States between 1987 and 2003 involving a total of 72 surgeons from 4 major academic cancer centers around the country.
The study showed that there is an extremely steep learning curve when it comes to performing prostate surgery and that it takes considerable practice to master this particular surgical technique. Indeed, the study revealed that it was not until surgeons had performed a minimum of 250 operations that a marked improvement in recurrence rates was witnessed.
So exactly what can we learn from this study if we are facing the possibility of requiring prostate surgery?
First and foremost it is very important that patients choose a surgeon who frequently performs this form of surgery. Indeed, it may well be advisable to choose a surgeon who specializes exclusively in prostate surgery, or whose work involves a significant proportion of such surgery. In most general settings surgeons will carry out such surgery infrequently, perhaps as rarely as just one or two times a year, and this is not sufficient to provide them with the expertise necessary to provide you with the best possible change of a low recurrence rate.
In the light of this therefore your first choice should without doubt be that of a specialist cancer treatment center and of a surgeon whose work involves exclusively, or very largely, prostate surgery.
The study also revealed however that there is a significant improvement in recurrence rates not only for specialist cancer centers, but also for teaching establishments. This is because, within the academic environment, a great deal of emphasis is placed on supporting mechanisms to evaluate the outcome of procedures as well as to provide feedback in an effort to create an environment in which continuous improvement is seen. This is not always the case in non-academic environments. Also, academic centers have a tendency to attract people who are particularly interested not simply in the outcome of their work but in correcting their errors and improving their technique.
So, if you find yourself in the unfortunate position of requiring prostate surgery then you would be well advised to elect to undergo surgery at the hands of an experienced surgeon who is employed in a specialist cancer center housed within a major teaching facility.
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