Surgeon's Experience Affects Cancer Recurrence

Prostate cancer reappearance after surgery is not only influenced by the nature of the tumor but also by the skill and experience of the surgeon, according to a recent study.

The study results are based on 7,535 men who had radical prostatectomy by one of 65 surgeons at four institutions between 1987 and 2003. After an average follow-up of 50 months, 17% experienced a recurrence of prostate cancer as indicated by a rising PSA level. The rate of recurrence was associated with several tumor characteristics such as higher stage, grade, degree of tumor invasiveness, prostate-specific antigen (PSA) level, and the extent of cancer cells left around the tumor site after surgery.

However, after taking these tumor characteristics into account, the rate of recurrence was also independently associated with the surgeon's expertise. Five-year progression-free survival was 88% for surgeons who had performed 250 or more operations, compared to 79% for those who had performed only 10. There were significant variations among surgeons who had performed over 40 procedures, and among the 17 surgeons who had performed over 100 procedures. The authors concluded that the learning curve rises up to 250 procedures, but they emphasized that the exact number is less important than the principle that the more the surgeon has done, the better. The findings were reported at the annual Prostate Cancer Symposium held in February 2006 in San Francisco (California, USA). Lead author of the study was Dr. Fernando J. Bianco, a urologic oncology fellow at Memorial Sloan-Kettering Cancer Center (New York, NY, USA).

"The study suggests that in surgery for prostate cancer, surgeons with more experience who've done at least 250 cases in their lifetime are more likely to get rid of the cancer permanently,” said Dr. Peter Scardino, chairman of the department of urology at Memorial Sloan Kettering Cancer Center.



Related Links:
Memorial Sloan Kettering Cancer Center