Many of my friends and patients have asked me what to look for in a prostate cancer surgeon. I have always told them that the right surgeon will become very apparent if you ask him or her the right questions. Below are what I feel are the 5 most important questions to ask:
1. How many of these surgeries do you perform every year?
This question is extremely important because studies have shown that the most important factor in outcomes of surgeries for prostate cancer appears to be surgeon experience. If a surgeon performs 2-3 surgeries per year, it can mean a less than great result regardless of how knowledgeable he or she is. This question is particularly important for surgeons performing robotic prostatectomy surgeries. Because robotic surgery is a new technology, many surgeons have not had enough experience to have mastered the surgery. Studies demonstrate the surgeons usually perform at least 50 robotic surgeries before they can really be comfortable with the procedure.
2. What is your rate of positive margins?
“Positive margins” is the technical term for not getting all of the cancer out. If the prostate is removed incompletely, cancer may be left behind, making the chance of cure substantially less. Some patients do have very aggressive cancer which extends out of the prostate. This situation occasionally makes avoiding positive margins nearly impossible. But overall, a surgeon’s positive margin rate should be less than 20-30%.
3. What is your potency rate?
Approximately 50% of all men undergoing prostate surgery for cancer have problems with erections following surgery. Older men and those with weak erections prior to surgery are much more likely to lose their erections following surgery. Most prostate surgeons currently try to spare the nerves responsible for erections during surgery. These nerves, which are located on the sides of the prostate, are very delicate and can be easily torn or damaged during surgery. Some surgeons have better success than others when it comes to preserving these critical nerves and that is reflected in a higher potency rate. If you are sexually active and have good erections, you should definitely ask your surgeon about his or her success with preserving erections.
4. What is your continence rate?
One of the more devastating potential side effects of prostate cancer surgery is leakage of urine or incontinence. The two main muscles responsible for controlling urination are located above and below the prostate. During surgery, the muscle above the prostate is usually removed with the prostate. This leaves only the muscle below the prostate to control urination. If this muscle is damaged during surgery, incontinence can occur. Most men will leak urine immediately following surgery. However, about 85-90% of men will regain their continence within 3-6 months. At most, they may place a small pad in their underwear in case they have to do strenuous activity. For the remaining 10-15% of men who do leak urine, they may need anything from pads to diapers to keep dry. Some may also need a second surgery to better control their continence. Asking your surgeon his or her continence rates can give you a better understanding of what the chances of you leaking will be in the future.
5. What percent of your patients require a blood transfusion?
Prostate surgery has been historically thought of as a bloody operation which often required blood transfusions. Fortunately, with refined techniques the transfusion rate has fallen to 5-10% for open surgery and a much lower rate for robotic surgery. Make sure to ask your surgeon how often he or she needs to give blood to their patients following surgery. A high transfusion rate may indicate outdated or flawed surgical techniques.
I hope that these 5 questions will serve you well in deciding whether a particular surgeon is right for you. Choosing the right surgeon could be the most important decision you make during your prostate cancer treatment. The right decision could protect you from recurrent cancer, impotence, incontinence, and unnecessary blood transfusions. Make sure that your surgeon is qualified before agreeing to proceed. Of course, also make sure that you feel comfortable with the surgeon as you will be embarking on a relationship with him or her that will most likely last for decades.
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