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Prostate Problem Guide
Experience Is Important When It Comes To Prostate Cancer Surgery
With the majority of things in life it is fair to say that the more practiced and experienced you are the better your performance will be and this would certainly seem to be the case when it comes to prostate cancer surgery.
A major problem with cancer is that, despite the best efforts of your surgeon, it has a bad habit of returning in a number of cases. In the case of prostate cancer following the total removal of the prostate by radical prostatectomy recent studies show that, while the likelihood of a recurrence are approximately 18 percent where surgery is carried out by a relatively inexperienced surgeon, this figure falls to less than 11 percent in more experience hands. So exactly what do we mean when we talk about 'experienced hands'?
A recent study examined 7,800 prostate cancer patients who underwent radical prostatectomy in the United States between 1987 and 2003 involving a total of 72 surgeons from 4 major academic cancer centers around the country.
Interestingly enough the study showed that there is an extremely steep learning curve when it comes to carrying out prostate surgery and that it requires considerable practice to master this particular surgical technique. Indeed, the study revealed that it was not until surgeons had carried out a minimum of 250 operations that a marked improvement in recurrence rates was evident.
So exactly what can we learn from this study if we are faced with the prospect of requiring prostate surgery?
First it is extremely important that patients choose a surgeon who regularly performs this type of surgery. Indeed, it could well be advisable to choose a surgeon who specializes exclusively in prostate surgery, or whose work revolves largely around such surgery. In many general settings surgeons will carry out such surgery infrequently, perhaps as rarely as just one or twice a year, and this is not sufficient to give them the expertise necessary to provide you with the best possible change of a low recurrence rate.
In the light of this therefore your first choice should without doubt be a specialist cancer treatment center and of a surgeon whose work involves exclusively, or very largely, prostate surgery.
The study also showed however that there is a marked improvement in recurrence rates not merely for specialist cancer centers, but also for teaching facilities. This is because, within the academic setting, a good deal of emphasis is placed upon supporting mechanisms designed to assess the outcome of procedures and to provide feedback in an effort to create an environment in which continuous improvement is seen. This is not always the case in non-academic facilities. In addition, academic centers tend to attract people who are particularly interested not only in the outcome of their work but in correcting their errors and improving their technique.
So, if you find yourself in the position of needing prostate surgery then you would be well advised to choose to have surgery at the hands of an experienced surgeon who works in a specialist cancer center within a major teaching facility.
COWPER'S GLANDS: a pair of pea-sized glands that lie beneath the prostate gland, named after the English surgeon William Cowper (1660-1709). Cowper's glands secrete an alkaline fluid that forms part of the semen. This fluid neutralizes the acidic environment of the urethra, thereby protecting the sperm.
DEXA (DUAL ENERGY X-RAY ABSORPTIOMETRY): a type of bone mineral density radiologic examination using x-ray absorption.
ISODOSE CONTOUR: a two or three-dimensional shape that contains the volume receiving a dose greater than or equal to a specified amount.
SALVAGE: a procedure intended to 'rescue' a patient following the failure of a prior treatment; for example, a salvage prostatectomy would be the surgical removal of the prostate after the failure of prior radiation therapy or cryosurgery.
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