European Journal of Cancer Supplements vol:1 issue:5 pages:S31-S32
ECCO edition:12 location:Copenhagen date:21-25 September 2003
Radical prostatectomy is performed by many urologists and the quality of the surgeon and the surgery itself should be optimal. The question is whether surgical quality can indeed be assessed.
We have made an attempt to evaluate the quality of the surgical act in a number of EORTC GU Group centers and showed that the duration of surgery, the blood loss, the postoperative continence, the margin positivity and the rate of undetectable PSA after surgery are highly variable and that this cannot be absolutely related to the caseload as was shown in other cancer surgeries. A standard radical prostatectomy can be defined by a rather limited number of parameters that can even be collected retrospectively.
Large single center studies have been reporting their results on surgical, urological and oncological aspects of surgical treatment for prostate cancer. Single surgeon results have only been presented scarcely and then mostly reflect high quality and probably not the standard quality achieved in all centers.
The intersurgeon variability of surgical skill can be translated not only in peri- or postoperative complications but also in statistically significant differences as concerned to PSA progression.
Therefore it is clear that the surgeon who performs radical prostatectomy matters. The surgeon must inform his patients about his own outcomes and not about the results of high standard centers that have reported their experience. Indeed, there can be a relevant difference in morbidity and cancer cure.