ANAHEIM, CA (UroToday.com) - Claudio Jeldres, MD and a large group of international researchers presented “The Effect of Surgical Volume on the Rate of Seconday Treatment After Radical Prostatectomy” (ABST#556 - Localized Prostate Cancer II). They state that surgical volume (SV) defined as the number or radical prostatectomies (RP) performed within one calendar year may represent an important determinant of cancer-control. They assessed the relationship between SV and the rate of use of secondary therapies after RP.

The study population consisted of 7,937 men treated with RP between 1989 and 2000. Median follow-up was 6 years. All patients were treated by 130 surgeons who had an average individual annual treatment volume of 16.7 cases (median 11, range 1-57). Secondary treatment was defined as radiotherapy or hormonal therapy or orchiectomy. Univariable and multivariable Cox regression analyses targeted the rate of secondary treatment after RP.

Secondary treatment was delivered to 1,982 (25%) of 7,937 patients. The median failure-free survival was not reached (mean 12 years). The average SV was 16.7 (median 11) RP. SV was indirectly related to the use of secondary treatment and represented independent predictor of secondary treatment use after RP (p=0.02). Multivariate analyses showed that the rate of secondary treatment sharply decreased with increasing SV. This trend persisted up to a SV of 24 RPs per year. They conclude that surgical volume is a determinant of treatment-failure when evidenced by the use of secondary therapies. Surgeons performing 24 RPs per year had the lowest rate of secondary treatment use.

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Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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