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CHOOSING AN EXPERT PHYSICIAN CAN MAKE ALL THE DIFFERENCE

Posted by Dr. Stephen Scionti on Apr 23, 2014 12:31:56 PM

Practice makes perfect, as the saying goes. This especially rings true when it comes to choosing a doctor to treat your prostate cancer. Prostate cancer support groups repeatedly advise members to find an expert, no matter which treatment they have.

There are numerous published studies that point to the importance of physician expertise.

For example, a 2007 article published by the Journal of the National Cancer Institute analyzed the results of 72 surgeons who treated a total of 7,765 patients.  Experience level was determined by the number of previous surgeries each doctor had done prior to treating the patient. Results showed that for patients whose surgeons had performed only 10 prior prostatectomies, recurrences at five years were nearly 18%, whereas recurrences were reduced to 10.7% for patients treated by surgeons who had performed approximately 250 prior prostatectomies.[i]

Authors of a similar article reporting on 7,683 patients found that recurrence-free probability for low-risk disease approached 100% for the most experienced surgeons.  "Excellent rates of cancer control in patients with low risk disease treated by the most experienced surgeons suggest that the primary reason that recurrence develops in such patients is inadequate surgical technique. The results have significant implications for clinical care."[ii]

What about side effects of treatment? In this regard, more experienced surgeons appear to have lower morbidity (side effect) rates. The treatment location may also make a difference, with high volume centers showing better results than low volume hospitals.[iii]  In fact, academic centers with a teaching faculty tend to have excellent treatment outcomes. This may be due not only to the large volume of cases treated, but also to the ongoing search to repeat, improve and excel.

When it comes to selecting a HIFU physician for prostate cancer treatment, the same principles apply. In responding to a Medscape article by Dr. Gerald Chodak (Jan. 12, 2011), Dr. Herbert Lepor (Professor and Martin Spatz Chairman, Department of Urology, NYU Langone Medical Center) wrote, "It is therefore not surprising that experienced HIFU surgeons achieve superior results, no different than experienced surgeons who perform radical prostatectomy and any complex surgical procedure." In other words, choosing a HIFU expert who has done hundreds of procedure and is a faculty member at an academic center may offer the best likelihood of cancer control with high quality of life after treatment.

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[i] Vickers A, Bianco F, Serio A, et al. The surgical learning curve for prostate cancer control after radical prostatectomy. Journal of the National Cancer Institute [early on-line publication]. July 24, 2007. DOI: 10.1093/jnci/djm060
[ii] Klein E, Bianco F, Serio A, et al. Surgeon experience is strongly associated with biochemical recurrence after radical prostatectomy for all preoperative risk categories. Journal of Urology, 183:4; 1366-1372, April 2010
[iii] Begg C, Riedel E, Bach P, et al. Variations in morbidity after radical prostatectomy. The New England Journal of Medicine. 2002:346;1138-1144

[1] Vickers A, Bianco F, Serio A, et al. The surgical learning curve for prostate cancer control after radical prostatectomy. Journal of the National Cancer Institute [early on-line publication]. July 24, 2007. DOI: 10.1093/jnci/djm060
[1] Klein E, Bianco F, Serio A, et al. Surgeon experience is strongly associated with biochemical recurrence after radical prostatectomy for all preoperative risk categories. Journal of Urology, 183:4; 1366-1372, April 2010
[1] Begg C, Riedel E, Bach P, et al. Variations in morbidity after radical prostatectomy. The New England Journal of Medicine. 2002:346;1138-1144

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