Abstract
BackgroundRadical prostatectomy (RP) is a common treatment for prostate cancer (PCa). Morbidity, mortality and pathological outcomes may be superior in academic institutions. One explanation may be the involvement of oncology fellowship trained urologists within academic institutions. The literature examining pathological outcomes often lacks individual surgeon data. The objective of this study was to compare pathological outcomes following RP between fellowship trained and non-fellowship trained urologists.MethodsPopulation-based, retrospective chart review of men diagnosed with PCa between 2003 and 2008, the majority treated with open approach RP (>99%). Pathological outcomes were compared between oncology fellowship trained academic (FTA), non-fellowship trained academic (NFTA) and non-academic (NA) urologists. Relationships with pathological outcomes were examined utilizing multivariable logistic regression.Results83.1% of eligible patients were included in our analysis resulting in 1075 patients. In multivariable analysis, surgeon group was an independent predictor of positive surgical margin (PSM) (p < 0.0001). NFTA and NA urologists were more likely to have PSM compared to FTA urologists (OR 2.50; 95% CI: 1.44 - 4.35 and OR 2.10; 95% CI: 1.53 - 2.88, respectively). However, the proportion of PSM between NFTA and NA urologists was not significant (p = 0.492). In addition, pathological stage (p = 0.0004), Gleason sum (p < 0.0001), and surgeon volume (p = 0.017) were associated with PSM. Limitations include retrospective design and lack of clinical and functional outcomes.ConclusionsUro-oncology fellowship trained surgeons had significantly lower rates of PSM than non-fellowship trained surgeons in this population based cohort. This study demonstrates the importance of surgeon-related variables on pathological outcomes and highlights the value of additional urologic oncology fellowship training.
Highlights
Radical prostatectomy (RP) is a common treatment for prostate cancer (PCa)
It has been shown in a small prospective, cohort study, that fellowship training can abbreviate the learning curve associated with RP [21]
To the authors’ knowledge there have been no studies investigating the impact of oncology fellowship training on pathological outcomes following RP in a population-based cohort
Summary
Radical prostatectomy (RP) is a common treatment for prostate cancer (PCa). Morbidity, mortality and pathological outcomes may be superior in academic institutions. One explanation may be the involvement of oncology fellowship trained urologists within academic institutions. This study was limited by lack of individual surgeon data and information on clinic-pathological outcomes. Another potential reason for superior outcomes may be the involvement of urooncology trained clinicians within these institutions. Urologic oncology fellowship programs provide intensive training with a concentrated surgical experience focusing on oncological theory and skills. It has been shown in a small prospective, cohort study, that fellowship training can abbreviate the learning curve associated with RP [21]. To the authors’ knowledge there have been no studies investigating the impact of oncology fellowship training on pathological outcomes following RP in a population-based cohort
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