Surgeon’s skill affects prostate cancer relapse

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Prostate cancer recurrence after surgery to remove the prostate is not only influenced by features of the tumor but also by the skill or level of experience of the surgeon, according to a study presented at a medical conference in California.

“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,” Dr. Peter Scardino of Memorial Sloan Kettering Cancer Center in New York told Reuters Health.

“That is, the chances of curing a patient’s cancer increase measurable until a surgeon has done more than 250 cases or so.”

Patients faced with a surgical procedure should not be shy about asking their surgeon about their level of experience, Scardino said.

The findings, reported at the 2006 Prostate Cancer Symposium in San Francisco, are based on 7535 men who had their prostates removed—a procedure called radical prostatectomy—by one of 65 surgeons at four institutions between 1987 and 2003. After an average follow-up of 50 months, 1,281 patients (17 percent) 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, 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—that is, the cumulative number of surgeries he or she had performed.

“The learning curve looks like it continues to rise up to 250 procedures,” Scardino said. “But the emphasis,” he cautioned, “should not be on the exact number but on the principle that the more the surgeon has done the better.”

This principle, Scardino said, fits well with several studies that have looked at things like complications of surgery and it also fits with studies of surgery for cancer in other organs.

Scardino also noted that there is growing emphasis on laparoscopic and robotic-assisted laparoscopic surgery, and while his team didn’t specifically look at this, he’s confident that the same principle applies. “There is probably a similar learning curve with these new procedures, although we won’t know how steep that learning curve is for another few years,” he said. 

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