Prostate cancer surgery often performed by surgeons with little experience

The majority of surgeons treating prostate cancer in the United States have extremely low annual caseloads, potentially leading to increased rates of both surgical complications and cancer recurrence, according to a recent study.

Andrew Vickers, PhD, of Memorial Sloan-Kettering Cancer Center, New York, led an analysis of data on radical prostatectomy. Of U.S. surgeons treating prostate cancer patients in 2005, more than 25% performed only a single radical prostatectomy that year, and approximately 80% of surgeons performed fewer than 10.

"We have previously shown that a surgeon needs to conduct an average of 250 radical prostatectomies to give patients the best chance of cure, so we decided to look at how long it would take a typical surgeon to reach that number of procedures," Dr. Vickers said. "While the learning curve is not the only factor in determining surgical skill, we found that the majority of surgeons who treat prostate cancer patients will not achieve that number of procedures in their entire career."

A high-volume surgeon is defined as one who performs 50 cases per year or more. According to the research by Dr. Vickers and colleagues, only 2% of surgeons nationally and 4% of New York state surgeons fall into this category. Nationally, only about 20% prostate cancer patients are treated by high-volume surgeons; this rises to 40% in New York state.

Results from the study appeared online in the Journal of Urology (Jan. 16, 2010).