Picking the Right Hospital for Prostate Cancer Surgery

Each year, it is estimated that more than 240,000 men will be newly diagnosed with prostate cancer, with one out of six men being diagnosed in their lifetime.

Prostate cancer is not only a prevalent disease, but also potentially deadly – making it one of the leading causes of cancer-related death in men, second only to lung cancer.  With that in mind, how to manage the disease after detection is of great interest to researchers, as well as patients.

Prostatectomy has been the mainstay of prostate cancer therapy.  According to the Centers for Disease Control and Prevention, approximately 156,000 prostatectomies were performed in 2007 alone, and over the past four years this number has steadily increased.

For example, in 2007, at Mount Sinai Medical Center in New York City, 358 prostatectomies were preformed, while just two years later the number of cases per year grew to 410 in 2009.

With the growing number of prostatectomies preformed each year and increased scrutiny regarding health care outcomes and cost, many have focused on the efficacy and impact of prostatectomy on cancer, as well as side effect control.

Past studies have found the volume of cases preformed annually impacts surgical outcomes like erectile function, urinary control and cancer control.

In line with the practice makes perfect hypothesis, hospitals and surgeons who log more cases have decreased instances of death and complications from surgery. Additionally, long-term continence, potency, and disease-free survival were found to be superior at high-volume centers and with high-volume surgeons.

Although academic institutions tend to have higher case volumes, the importance of an academic affiliation on surgical outcomes was examined for the first time, last month in a report published in the Journal of Urology.

The authors examined data from the Nationwide Inpatient Sample, which is a database comprised of inpatient discharges and associated charges for approximately 20 percent of the U.S. population.

Using this data set, the authors were able to isolate patients who had a prostatectomy and patient experiences between academic and non-academic centers. The authors concluded that prostatectomies performed at academic institutions resulted in less overall complications.

This is not the first report to demonstrate a benefit to being treated within an academic institution.  Deaths from heart failure, heart attack and stroke were reduced at major teaching institutions.

Being a patient at a teaching hospital however, can be frustrating. Due to the fact that there are students at various points in their training, patients are examined multiple times by medical students, residents and attending physicians. However, with this process comes greater attention and critical analysis of every clinical decision made.

Throughout my career, I have seen the benefit of working within academia. It is in this environment that one is pushed to learn and develop the best technique with which to treat patients. When meeting with a new patient, I stress my one-team method: One surgeon, one anesthesiologist and one surgical team makes for better outcomes. At the same time, I emphasize the importance of resident participation in post-operative care -- not for their education but for the benefit of the patient.

Before undergoing any procedure, I advise taking an active role in selecting a physician. It is vital to ask how many times the surgeon has done the procedure before, whether they are doing research to improve their technique, what side effects could be expected after surgery and what the rates of these side effects are.

Dr. David B. Samadi is the Vice Chairman of the Department of Urology and Chief of Robotics and Minimally Invasive Surgery at the Mount Sinai School of Medicine in New York City. He is a board-certified urologist, specializing in the diagnosis and treatment of urological disease, with a focus on robotic prostate cancer treatments. To learn more please visit his websites RoboticOncology.com and SMART-surgery.com. Find Dr. Samadi on Facebook.