COMMENTARY

Urologists Should Disclose Prostatectomy Volume, Experience

Gerald Chodak, MD

Disclosures

April 20, 2016

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Hello. I'm Dr Gerald Chodak from Medscape. Today I want to talk about important information that is needed by patients who decide that radical prostatectomy is the way they want their cancer treated.

Oberlin and colleagues[1] conducted an analysis of more than 6500 doctors who submitted their 6-month surgical logs as part of their recertification process. They found that 41% of the prostatectomies were performed by 10% of the urologists. So, a portion of physicians are having a very high volume of surgery.

However, the number of prostatectomies performed by the majority of doctors was quite low. In fact, the median number of open prostatectomies was two, and the median number of robotic prostatectomies was eight. This means that more than half the doctors are performing fewer than these numbers during a 6-month period. Even if we double up for the yearly amount, we can see that a significant proportion of doctors undergoing recertification are having extremely low volumes of surgery.

Why is this important? A number of studies have looked at the importance of experience in terms of outcomes. Some studies have suggested that several hundred robotic prostatectomies are needed to really become proficient in terms of complication rates and in terms of cancer control. This study would suggest that a vast proportion of doctors may not be anywhere near the number needed for that level of proficiency until many years have gone by.

Now we come to the patient. A patient comes in who has been diagnosed with his disease and he has decided that surgery is right for him. He may ask his doctor important questions before proceeding. For example: How many do you do per year? How many have you done in total? What are your complication rates?

All too often, patients may be reluctant to question their doctors about their proficiency. I'd like to suggest that, as part of the consent process, urologists have an obligation to provide that information even if patients don't ask them. They should volunteer the information of how many they've done in total, how many they do per year, what the complication rates are based on validated surveys, and what the likelihood is that patients of similar cancer grade and stage need additional therapy after undergoing radical prostatectomy.

That information is critical so that patients can decide whether the results sound good enough or they would like to try out another doctor, or at least interview another doctor to see if different information is available.

I am hopeful that one day there will be a more regimented way to assess this information and make it available, much in the way that we've got Yelp and other websites where you can read reviews. Doctors' records should be available for the patient to see so that they can make an intelligent decision about whether their doctor has enough experience to let them undergo that procedure or whether they should seek out a high-volume surgeon to do the operation.

I look forward to your comments. Thank you.

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