Risk of prostate cancer recurrence after RP varies even among experienced surgeons
MedWire News: The risk for prostate cancer recurrence after radical prostatectomy (RP) for localized disease varies greatly between experienced surgeons, researchers report.
Fernando Bianco (Memorial Sloan-Kettering Cancer Center, New York, USA) and colleagues say in the Journal of Urology that “surgical randomized trials are imperative to determine and characterize the roots of these variations.”
Bianco et al analyzed data from 7725 patients with clinically localized prostate cancer treated with open RP at four major US academic medical centers from 1987 to 2003 by 54 different surgeons.
The researchers defined biochemical recurrence as serum prostate-specific antigen (PSA) of 0.4 ng/ml or greater followed by a higher level. Multivariate random effects models were used to evaluate prostate cancer recurrence variation among surgeons after adjusting for PSA levels, pathologic stage and grade, surgery year, and surgeon experience.
Bianco et al found great variation in the rate of recurrence between different surgeons. Seven experienced surgeons had an adjusted 5-year prostate cancer recurrence rate of less than 10%, while five otherss had a rate that exceeded 25%.
The researchers comment: “A 15% absolute difference in biochemical recurrence rates is higher than that of adjuvant chemotherapy for colon or breast cancer, and comparable to that of adjuvant radiation therapy after RP in high risk cases.”
They add: “What aspects of surgical technique explain the different results among surgeons? Systematic research is required to identify the critical aspects of RP associated with cancer control.”
The researchers recommend that undesirable variability in surgical outcomes could be addressed by continuing practical education including, for example, using surgical simulators or having surgeons observe each other operate in person.
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By James Taylor