Experience Counts

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Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4149
   Posted 11/13/2008 8:12 AM (GMT -6)   
I subscribe to John Hopkins health alerts on "Prostate Disorders".  The following is quoted from today's bulletin and emphasizes what many veteran HW members have advised re surgical experience:
 

The importance of surgeon's experience as it relates to prostate cancer outcome is underscored by the results of a study reported in the Journal of the National Cancer Institute (volume 99, page 1171).

Researchers analyzed the outcomes of 7,765 radical prostatectomies performed by 72 surgeons between January 1987 and December 2003 at four major academic medical centers. "Biochemical" recurrence was defined as a postsurgery PSA level greater than 0.4 ng/mL followed by a subsequent higher PSA level. The analysis took into account patient and tumor characteristics, such as pre-operative PSA level and Gleason grade. The men's PSA levels were measured every three to four months in the first year after surgery, twice in the second year, and annually during the following years.

The researchers found that surgical outcomes improved along with the number of radical prostatectomies a surgeon had performed, leveling off only after about 250 surgeries. The five-year probability of experiencing a recurrence of prostate cancer was 18% for surgeons who had performed only 10 operations compared with 11% for surgeons who had performed at least 250 surgeries.

Bottom line on prostate cancer surgery: The results suggest that you can improve your odds of a successful outcome from radical prostatectomy by taking time to find a surgeon with extensive experience.


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
27cc
Brachytheraply volume study 11/14/08; brachytherapy to be scheduled in early December


Lungman
Regular Member


Date Joined Jan 2008
Total Posts : 276
   Posted 11/13/2008 11:33 AM (GMT -6)   
That data is not surprising at all, the surgery itself is a very delicate procedure done in very close quarters, I would think that the skill and dexterity needed for success is attained only through practical experience. I know new urologists have experience is real world settings, much of it is spent as a senior resident. They may actually perform the procedures, often times they assist a senior/attending surgeon, occasionally doing the procedures under supervision. I can see instances where a new surgeon would be superior to an older, complacent one though.
Randy
46 you when diagnosed, now 48
Pre-Op PSA 9.9
1 of 12 cores positive, Gleason 3+3
DaVinci on 9/5/2007
Post-Op Gleason 3+6, Negative Nodes and Margins
Less than 1% of prostate involved with CA
3 Month PSA 0.01, 6 Month PSA 0.01, 9 Month PSA 0.01
One Year PSA 0.01
Incontinence resolved 9/15/2007, one day after cath removal
ED showing significant improvement.
Occasional Success with Oral Meds
Success with BiMix

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