UK radical prostatectomy outcomes and surgeon case volume: based on an analysis of the British Association of Urological Surgeons Complex Operations Database

UK radical prostatectomy outcomes and surgeon case volume: based on an analysis of the British Association of Urological Surgeons Complex Operations Database

In an article by Vessey et al published in BJUI (2012) it was shown that surgeons with high case loads had better results than lower volume surgeons when doing radical prostatectomy. The study included a total of 8032 radical prostatectomy entered on the BAUS database and follow-up data was available on 4206 cases. Analysis of annual surgeon caseload revealed that 54% of surgeons performed an average of less than 10 procedures per annum and 6% of surgeons performed an average of 30 or more procedures per annum. When individual outcome variables where examined against surgeon case activity it was demonstrated that outcomes are clearly improved beyond 20 cases and there is a trend to continued improvement up to the series maximum of 40 cases per annum. There was an overall positive surgical margin rate of 38%.

A critical analysis of the long term impact of radical prostatectomy on cancer control and functional outcomes

In an article by Boorjian et al (Eur Urol 61 (2012) 664-675) the literature published between 1980 and 2011 was reviewed. Less than 10% of all men treated by radical prostatectomy died from prostate cancer within 15 years of surgery. The authors comment that radical prostatectomy has been associated with a 40% decrease in risk of death from prostate cancer compared to watchful waiting quoting Bill-Axelson et al in NEJM (2011). They also comment on slack of evidence directly comparing the results of surgery versus radiotherapy, although they quote Abdollah et al in Eur Urol (2011), who reported on 404,604 patients treated for low and intermediate risk prostate cancer recorded by the SEER database, with surgery having the lowest risk of cancer and all cause mortality (3.6% at 10 years compared to 6.5% for radiotherapy).

Systematic review of oncological outcomes following surgical management of renal cancer

In an article by MacLennan et al (Eur Urol 61 (2012) 972-993) 4580 abstracts and 389 full text articles were assessed. The evidence base suggests that localised renal clear cell carcinoma <4cms is best managed by nephron sparing rather than radical surgery where technically feasible. Results for tumours >4cms are equivalent. Open and laparoscopic surgery achieved equivalent survival.

Monotherapy with Tadalafil or Tamsulosin similarly improved LUTS suggestive of BPH

In an article by Oelke (Eur Urol 61 (2012) 917-915) mono therapy with Tamsulosin or Tadalafil resulted in significant and numerically similar improvements in LUTS, but only Tadalafil improved ED. However, the study was not powered to directly compare these agents. A systematic review by Gacci et al (Eur Urol 61(2012) 994-1003) assessed 107 articles suggests PDE5I can significantly improve LUTS.

PSA and long term prediction of prostate cancer

4383 men were followed for 28 years in a study Orsted et al from Denmark (Eur Urol 61(2012) 865-874). Patients with a baseline PSA under 1ng/ml had a very low risk of future prostate cancer diagnosis and mortality. Indeed, an editorial suggested that if PSA<2 and age>64, no further screening is required and if age <65 PSA screening may not need to be repeated for 10 years. If PSA=2-4 then a further PSA screen could be left for 2-4 years. A PSA>4 required a detailed examination for prostate cancer.

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