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From the Johns Hopkins Prostate Bulletin, 2004

Surgery to completely remove the prostate for treatment of prostate cancer (radical prostatectomy), or to remove only the prostate tissue blocking the bladder for treatment of benign prostatic hyperplasia (simple prostatectomy), involves some complex and intricate techniques that require a skilled surgeon. Moreover, the risk of side effects—including incontinence and erectile dysfunction (ED)—is influenced by both the experience of the surgeon and the hospital where the surgery is performed.

A recent study showed that patients treated by experienced surgeons in high-volume medical centers had fewer complications after radical prostatectomy, compared with those who underwent surgery in centers where surgical volumes were lower. When considering surgery, therefore, you should be sure to seek out a competent and highly skilled, trained, and experienced surgeon.

How do you find one?

The process involves both research and recommendations of other specialists in the field. The following are some basic guidelines for choosing a surgeon and questions to ask that will help you make a confident choice.

Questions to Ask
Is the surgeon a board-certified urologist? What training has he/she had? How many times has he/she performed the surgery? How many operations does he/she do a year? The goal here is to find a surgeon with plenty of experience. As a general rule, an experienced surgeon will have performed at least 150 procedures like yours. Preferably, he should perform the procedure every day, or several days a week.
Does the surgeon keep a record of patient outcomes? What is the surgeon's success rate in preserving continence and potency? For radical prostatectomy, does he/she use the nerve-sparing technique? For prostate cancer, what percentage of patients requires further treatments after radical prostatectomy? These types of questions should help to reveal the surgeon's experience. Don't be shy about asking for figures: Surgeons expect potential surgical patients to ask for statistics and should have no problem offering this information. If a surgeon is not able to provide numbers or percentages with which you are comfortable, you may want to look elsewhere.
Is the surgeon a specialist in the particular operation you need? Does he/she keep updated with the latest in medical technology and research? Does he/she make an effort to refine older techniques as well as master new ones? How does he/she handle specific complications that may arise after surgery? You want to make sure that your surgeon, even if highly experienced, is keeping abreast of advances in his or her field of specialty. You want to make sure that your surgeon has enough experience to have encountered the possible complications that may occur after surgery and can clearly outline a plan for managing incontinence, erectile dysfunction, bladder outlet scars, etc. that may occur after surgery.
Does the surgeon screen patients carefully so that those patients who cannot be cured with surgery undergo other treatments?
 Radical prostatectomy should not be performed if cancer has already spread. You want to make sure your surgeon operates only in appropriate situations, such as when the tumor is still thought to be confined to the prostate. Here, information about the percentage of patients who need further treatments after surgery may be beneficial. If a surgeon is operating only on patients who are most likely to benefit from the operation, less than 30% to 40% of his/her patients should need further treatment after surgery.
Is the medical center where the operation will be performed an accredited and high-volume institution? Centers that specialize in prostate surgery will generally have more experienced doctors, the latest technology, and more resources.
Do you feel comfortable with your doctor? Can you ask questions and get satisfactory answers? Is the doctor personable and sympathetic? Do not underestimate the importance of comfort. For the least stressful experience, you must have basic trust in your surgeon. Patients should be involved in their medical treatment and have confidence in their doctors.

page last updated July 2004

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