Prostate Cancer Recurrence Linked to Surgeon's Skill

SAN FRANCISCO—The 5-year incidence of biochemical recurrence (BCR) of prostate cancer decreases with increased experience of the surgeon performing the prostatectomy, Fernando Bianco, MD, reported at the 2006 Prostate Cancer Symposium (abstract 272).

Dr. Bianco, a urologic oncology fellow at Memorial Sloan-Kettering Cancer Center, and his colleagues analyzed the incidence of BCR in 7,849 men who had a radical prostatectomy performed by one of 74 surgeons at four institutions between 1987 and 2003. A meta-analysis that controlled for PSA, Gleason score, positive margin, stage, and surgical expertise was performed, using the I2 statistic to determine the proportion of the variation that was due to true differences rather than chance alone.

The 5-year probability of freedom from BCR was 79% and 88% if the surgeon had previously performed 10 or 250 prostatectomies, respectively, he said.

There was also significant heterogeneity in BCR rates between individual surgeons (P < .0005), independent of experience. The I2 analysis indicated that 54% of the difference in BCR rates between high-volume surgeons (at least 40 lifetime surgeries) was due to differences in surgical technique and approach.

"While the rate of recurrence is largely determined by tumor stage, grade, and PSA level, surgical technique and decision-making in the operating room also play a role in patient outcome," he said. He called the existence of heterogeneity between surgeons "undesirable," and recommended that prospective randomized trials be designed to account for these effects "either by equality in randomization or showing no significant heterogeneity among providers."