Does a surgeon's annual radical prostatectomy volume predict the risk of positive surgical margins and urinary incontinence at one-year follow-up? - Findings from a prospective national study

Abstract

Objective. This study aimed to assess the prevalence of positive surgical margins (PSM) and urinary incontinence (UI) in relation to surgeons' annual radical prostatectomy (RP) volume. Material and methods. This national study prospectively assessed 521 preoperatively continent patients with prostate cancer (PCa), scheduled for RP by surgeons with high (>50), medium (20–50) or low annual volume (<20) at 14 urological departments in Norway. Patients responded to UI questions from the Expanded Composite Prostate Cancer Index (EPIC-50) before and 1 year after RP. UI was defined as “use of pad(s)” and/or “a moderate or severe urinary leakage problem (ULP)”. Preoperative prediction of PSMs and UI was explored in multivariate regression analyses with the following independent variables: surgeons' annual RP volume, type of hospital (university versus community), patient's health, sociodemographic features and PCa characteristics. Results. Based on histopathological reports, the overall PSM rate was 26%, with differences between the high- (18%), medium- (28%) and low-volume (44%) groups. Increasing PSM rates were predicted by surgeons belonging to the low- and medium-volume categories, prostate-specific antigen> 10 µg/l, Gleason score >7, patient age >65 years and <12 years of education. At 1-year follow-up 40% reported UI, without significant differences between the volume groups. Only 46% of those who used pad(s) experienced ULP. UI was predicted by clinical category ≥T2 and community type of hospital, but not by surgeons' annual RP volume. Conclusions. Preoperative counselling should take into account the relationship between surgeon's annual RP volume and PSM rate and the current knowledge about UI and ULP.

Key Words::

• prostate cancer
• radical prostatectomy
• surgeon volume
• surgical margins
• urinary incontinence

Acknowledgements

This study was funded by the South-Eastern Health Board of Norway and the Norwegian Cancer Society. The authors gratefully acknowledge the skilful support from all the contributors to NUCG study VII at each of the participating urological departments collecting data. In particular we acknowledge: Brennhovd, Hammer, Frydenlund, L.N. Berge, Hoff, V. Berge, Schmitt, Knutsen, Ludvigsen, Stokkan, Wold, Fauskanger, Tasdemir, Bernardsen, Haukaas, Nygård, Frugård, H.O. Beisland, Servoll, Halvorsen, Kvan, Devold Steinsvik, Sæter, Zasada, Halse, Hals, Hunderi, Zare, Hauglien, Nagelhus, Løffler, Bøe, Sebakk, Larsson, Øverland and Mjell. We also acknowledge Gullan and Svaboe (proof-reading), the NoPCR and Småstuen (statistical analysis).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.