Before you sign up for prostate cancer surgery, find out if your surgeon has enough of the right sort of experience. This may seem obvious, but many patients get distracted by institutional reputations, the latest gizmo the hospital is promoting, or where their neighbor had his operation. Don’t let yourself get distracted. Focus on what you want from your surgeon.
A recent study looked at data from nearly 8,000 prostate cancer operations called radical prostatectomy. This study used rising PSA test results as the definition of treatment failure. (Successful operations cause PSA test results to drop to very low levels.) Using this definition it found that the number of operations the surgeon had done was associated with the likelihood of success. It actually quantified the surgical “learning curve” at approximately 250 operations, the point at which surgeon experience began to matter less.
A second study looked at data from less than 200 patients who had so-called “robotic” prostate cancer surgery. This study found that the chances of leaving a lot of cancer behind by the edge of the prostate (what they called “extensive” positive margins; a margin is simply the edge of the prostate) was directly related to surgeon experience. It also found that there was no drop in the overall risk for cancer left behind, even tiny amounts. Overall the chance of any amount of cancer left behind remained more than 20 percent. Compared with rates of 5 percent or lower in the hands of experienced surgeons doing non-”robotic” conventional surgery, this was a bad result. The authors suggest that it takes more than 200 operations to become proficient with “robotic” prostate cancer surgery.
We do not know how experience increases the chance of success with prostate cancer surgery. We only know that it does. These two studies suggest that you should be very careful about using a surgeon who has done less than 200-250 prostate cancer operations. They also suggest that experience, not gizmos, brings the results you want. If your objective with your cancer operation is to get rid of your cancer, focus on your surgeon’s experience.