A recent study published in The Journal of Urology suggests that prostate cancer patients treated by more experienced urologic surgeons achieve improved results.
Prostate cancer is the most common non-skin cancer in American men, who have about a 1 in 6 chance of being diagnosed with this disease in their lifetime. Radical prostatectomy, performed either through a standard incision, or more recently through a robotic-assisted minimally invasive approach, is a surgical procedure in which the surgeon attempts to remove the cancer-containing prostate gland, without damaging the surrounding structures that control sexual and urinary function.
According to the study, "Low Annual Caseloads of United States Surgeons Conducting Radical Prostatectomy", conducted by Caroline Savage and Andrew Vickers from Memorial Sloan-Kettering Cancer Center, a surgeon needs to have completed a minimum of 250 prostatectomies to reach the "learning curve plateau" at which point cancer cure is maximized and surgical complications minimized. After adjusting for tumor severity, a typical patient treated by a surgeon who reached the learning curve plateau had a 10.9 percent risk of recurrence at 5 years compared to 17.7 percent for those treated by a less experienced surgeon. Similarly, surgical complications were decreased by 20 percent in patients treated by the highest versus the lowest volume surgeons studied.
Furthermore, for the 75 percent of patients diagnosed today with cancers still confined to the prostate gland, the most highly experienced surgeons, those who had performed at least 1,500 prior surgeries, achieved recurrence rates of less than 1 percent, suggesting that recurrence is largely dependent on surgical technique.
Despite these findings, the study authors found that approximately 25 percent of United States surgeons performing radical prostatectomy surgery perform only a single procedure per year, while about 80 percent of surgeons performed fewer than 10 procedures per year. Nationally, only 1.8 percent of surgeons perform more than 50 prostatectomies per year. The study also concluded that most surgeons will never reach the key threshold of 250 radical prostatectomy cases in their surgical careers.
"Practice patterns in which the majority of prostate cancer patients undergoing surgery are treated by surgeons performing fewer than 10 procedures a year suggest that better results may be achievable for many of these men. The study provided data that supports what common sense suggests; that a more experienced surgeon will likely produce more positive results for patients undergoing a procedure as technically complex and challenging as radical prostatectomy," said Kevin Slawin, M.D., director of urology at Memorial Hermann-Texas Medical Center and the Vanguard Urologic Institute.
During the course of his career, Dr. Slawin, a nationally renowned urologist and prostate specialist, has performed more than 1,700 prostatectomies, consistently averaging between 100 - 150 cases per year for more than a decade. This makes him a member of a small, select group -- among the top 1.8 percent -- of surgeons in the country that are true experts in the field.
Since joining Memorial Hermann-Texas Medical Center in 2007, Dr. Slawin has continued his high volume practice in early stage prostate cancer, and has broadened his focus to patients with more advanced disease, spearheading the clinical development of a novel cancer vaccination technology for metastatic, castration resistant prostate cancer.
Just this month, Dr. Slawin was recognized as one of America's Top Doctors in Urology & Cancer for 2009 - 2010 by Castle Connolly Medical Ltd. Dr. Slawin has consistently been recognized as one of America's Top Doctors for over a decade as a leader in his field.