Dear OncoLink "Ask The Experts,"
I am considering nerve-sparing radical prostatecomy and radiation therapy. For the prostatecomy, I have found it difficult to find any "guidelines" to suggest what minimum number of prostatecomies annually and years of experience could contribute to a better outcome, and would minimize impotence and incontinence. What would you suggest?
Alan J. Wein, MD, Professor and Chair of the Division of Urology at the University of Pennsylvania School of Medicine, responds:
In my opinion, the more experience, in general, the better the outcome, and the better equipped an individual surgeon is going to be in dealing with any and all problems that might occur post-operatively. Every surgeon, regardless of how experienced, has cases of incontinence and impotence following nerve sparing prostatectomy. My personal opinion is that 50 per year is the number that an operating surgeon should have to assure the patient of maximum experience in this area. This is not to say that there are not some surgeons who do less than this number who are absolutely terrific at this procedure. Mind you, this is just an educated guess, based upon experience. These cases should be as the lead surgeon and not part of the team.