BEWARE OF INEXPERIENCED PROSTATE CANCER SURGEONS
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[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 Journal of Urology. 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 prostate cancer. Of US surgeons treating prostate cancer 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
NOTE: I ADDED INFORMATION TO THIS STORY AFTER I INITIALLY PUBLISHED IT. PLEASE CONSIDER THIS NEW INFORMATIONIT CAREFULLY.
The Wall Street Journal Health Blog entry today (Surgery for Prostate Cancer: Comparing Different Techniques, by Jacob Goldstein) concerns the results of a study recently reported in the Journal of the American Medical Association which compared the results of traditional, open radical prostatectomy (RP) with the newer minimally-invasive techniques such as laparascopic RP (LRP) and robotically assisted RP (RALP).
http://jama.ama-assn.org/cgi/content/short/302/14/1557?home
The new study did not address the comparative rates of “oncological efficacy” (i.e. cancer control), as determined by the rates of positive post-surgical margins in the two groups. But previous studies have found that cancer control is *worse* in patients who have minimally invasive RP, *unless the surgery is performed by an exceptionally skilled laparascopic surgeon* — part of an elite clique who have at least 500 surgeries under their belt (no pun intended). Obviously, for a cancer patient, NOTHING is more important than the actual results of his surgery, regardless of the technique used.
CORRECTION: The study found that cancer control was the same in both groups.
With regard to side effects, the study found that minimally invasive surgery resulted in shorter hospital stays and fewer transfusions. But the researchers also found that patients who underwent LRP or RALP had a higher incidence of incontinence and impotence than those who had open surgery. I was aware of previous findings of more “urinary bother” in men who had had minimally invasive RP, but this study went *even further* by adding the ED results to the picture.
[ADDED]
The disparity in reported side effects of genitourinary problems, incontinence and impotence was dramatic: only 2% of traditional RP patients reported persistent side effects versus 5% of MIRP patients.
The researchers stressed that the men who had minimally invasive surgery tended to be of a higher socio-economic class, so perhaps the increased rate of reported side effects had something to do with higher expectations, or maybe it’s that people who are better off complain more.
[ADDED]
Interestingly, there were differences in outcomes based on geographical areas and ethnic groups. In spite of the fact that black men were far less likely than whites or Asians to have minimally invasive surgery, the struggling city of Detroit was at or near the top of the list. My guess is this is because a famous minimally invasive prostate cancer surgeon practices in the Motor City, and the patients are mostly “medical tourists”.
The ultimate meaning of this is that, if RP is in your future, ALWAYS CHOOSE THE MOST EXPERIENCED SURGEON YOU HAVE ACCESS TO, ONE WHO HAS HIGH LEVELS OF PATIENT SATISFACTION, REGARDLESS OF TECHNIQUE. THAT’S HOW YOU WILL ACHIEVE THE BEST RESULT. As Dr. Arnon Krongrad, a well-regarded laparascopic RP surgeon who also founded the New Prostate Cancer Infolink (www.prostatecancerinfolink.net) wrote in this blog, “Find your Tiger Woods and don’t micromanage the clubs.” So if the most experienced surgeon in your area happens to use the open technique, do not despair — in the hands of a competent surgeon it’s not the barbaric picture that some partisans portray it to be. A day or two extra at the hospital, at most.
[ADDED]
BASED ON NEW INFORMATION, I RECOMMEND RECONSIDERING MINIMALLY INVASIVE RP UNTIL MORE OR BETTER INFORMATION BECOMES AVAILABLE.
I know it’s hard to absorb the concept that the newest technology is not necessarily the best one for you. But as the authors of the above study put it, the adoption of the high-tech, minimally invasive approach to RP may just “be a reflection of a society and health care system enamored with new technology that . . . had yet to uniformly realize marketed or potential benefits during early adoption.”
To read the complete story from the WSJ blog, cut and paste the following URL:
http://blogs.wsj.com/health/2009/10/13/surgery-for-prostate-cancer-comparing-different-techniques/
Wish You’d Been Here
By · CommentsAs a follow-up to my previous post, here are a few pictures from my recent vacation (click on image to see full size): (1) a lighthouse at Halifax, Nova Scotia; (2) Cormorants at the Bay of Fundy, St. John, New Brunswick; (3) Acadia National Park in Maine; (4) Thunderhole, also at Acadia; and (5) Sunset off the coast of Maine.
A Note from Your Blogress
By · CommentsI want to thank you all for the comments, letters and other ways you have kept in touch with me. This feedback is what we bloggers live for! But I have to share with you that it might take me a little more time than usual to respond because, although my mind is willing, my body is not. By that I mean that I am having back and shoulder aches from spending so much time on the computer, and I will have to take a little break to let my body heal — even if it means cutting my hands off! I will still post. Dear husband has offered to help in any way he can, even if it means typing and posting what I scribble in long-hand.
I also just got a teensy-weensy “netbook” computer which requires little arm motion, and I think it will be easier on my body. I got the wrong cord with it, but in a day or two I should be good to go with it.
In the meantime, I want to share with you some photos from my recent vacation to Canada and New England. We hopped on a cruise ship right here from New York City and spent a week visiting Halifax, Nova Scotia, CA, St. John, New Brunswick, CA, Bar Harbor, Maine (and Acadia National Park), Boston, MA and Newport, Rhode Island. What made this trip particularly enjoyable was that the guests hailed from all over the world. Lots of folks from different parts of the US and “Old Europe” 
)
Enjoy the pics and keep in touch.
Leah