With the majority of things in life it is fair to say that the more experienced and practiced you are the better your performance will be and this is most certainly true with prostate cancer surgery. A significant problem with cancer is that, despite the best efforts of your surgeon, it has a nasty habit of returning in a number of cases. In the case of prostate cancer following the total removal of the prostate by radical prostatectomy recent studies have revealed that, while the chances of a recurrence are around about 18 percent where surgery is performed by a relatively inexperienced surgeon, this figure falls to less than 11 percent in more experience hands. So just what do we mean when we talk about 'experienced hands'? A recently conducted study looked at just under 8,000 prostate cancer patients who underwent radical prostatectomy in the United States between 1987 and 2003 involving no fewer than 72 surgeons from 4 major academic cancer centers around the country. The study showed that there is a very steep learning curve when it comes to performing prostate surgery and that it takes a significant amount of practice to master this particular surgical technique. Indeed, the study showed that it was not until surgeons had performed at least 250 operations that a marked improvement in outcomes was seen. So just what can we learn from this study if we are faced with the possibility of requiring prostate surgery? First it is very important for patients to select a surgeon who regularly undertakes this form of surgery. Indeed, it could well be advisable to select a surgeon who specializes exclusively in prostate surgery, or whose work revolves largely around such surgery. In many general settings surgeons will carry out such surgery infrequently, perhaps as rarely as just one or two times a year, and this is simply insufficient to give them the expertise needed to provide you with the best possible change of a low recurrence rate. Against this background therefore your first choice should without doubt be a specialist cancer treatment center and a surgeon whose work involves exclusively, or at least very largely, prostate surgery. The study also demonstrated however that there is a significant improvement in recurrence rates not simply for specialist cancer centers, but also for teaching hospitals. This is undoubtedly because, within the academic environment, a great deal of emphasis is placed on supporting mechanisms designed to evaluate the outcome of procedures as well as to provide feedback in an effort to create an environment in which continuous improvement is seen. This tends not always to be the case in non-academic environments. In addition, academic centers tend to attract people who are especially interested not only in the outcome of their work but in both correcting their errors and improving their technique. So, if you find yourself in the position of requiring prostate surgery then you would be well advised to elect to undergo surgery at the hands of an experienced and practiced surgeon working in a specialist cancer center within a major teaching facility.
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