Read about what questions to consider when picking your prostate cancer surgeon.

Is there a way for men to find the best surgeon possible? I wish there was an impartial and objective database that could simply tell us who was the best. If I were the patient, I would love to use such an incredible resource. Unfortunately, the reality is that it does not exist. However, I can advise you what to look for in your prostate cancer surgeon. 

 

My professional experience tells me that a patient cannot just settle for, “well, he/she seems like a nice guy, I’ll let him do my surgery.” This sentiment can doom your chances for a good outcome from prostate cancer surgery. I have trained dozens of urologists in robotic prostate surgery. The robot is an amazing tool, but it does not do anything by itself. In fact, it is completely controlled by the surgeon. When I watch other surgeons perform robotic prostatectomy, I understand why many patients have such variable and sometimes scary outcomes.

 

So, what are some things you should be looking for with an expert robotic prostate surgeon? 

Obviously, I am bias and I have patterned my practice as to what I think is best for me in giving the best outcomes for my patients. With that said, I would like to share my thoughts on what you should consider before choosing your surgeon.

 

Surgeon experience is key. No one can claim they are the best prostate cancer surgeon. However, experience should be a good indicator, as many research studies show this over and over again. How many cases are enough? I want my surgeon to have done thousands of cases. As of 2019, there are probably a few dozen surgeons who have completed thousands of robotic prostatectomy cases. 

 

Private practice may be better than academic. Every urologist trains in an academic center, as this is how we learn. Teams are in constant transition as trainee surgeons and nurses come in new, learn what they can, and proceed to move on to the next team. The attending surgeons often farm out parts of the case to the trainee surgeons. You might have the best surgeon in the world, but he may not do your entire case. I would not go to an academic center for a routine type of surgery such as a robotic prostatectomy. Academic centers are great for cases that are more involved or rare.

 

The urologist needs a team supporting him. This is a very important and often skimmed-over detail many patients fail to consider. If your surgeon does robotic prostate surgeries at more than one hospital, each team will be different. There will be a different robot, a different scrub tech, a different OR nurse, etc. I have the same team for my cases. My surgical first assistant has done over 2000 cases. These details reduce variability and help keep your surgeon calm and focused. Ask your robotic surgeon if they use the same team and the same hospital.

 

Is my urologist current? Your urologist should go to the American Urology Association (AUA) annual meetings or the Society for Urologic Oncology meetings. Until 2018, I had been to every annual meeting since I was a resident. This allows us to see what other urologists are doing, share our experiences as well as potentially adopt new and more valuable skills with our patients in mind. I’ve had the opportunity to do live surgery at the AUA meeting. However, for me, it is way more valuable to see how other surgeons approach treatment for prostate cancer. Going to meetings and keeping up with the journals can be difficult, but that is part of being current.

 

Find someone who is confident in their abilities. Urologists see a vast amount of conditions. As much as a surgeon would love to be an expert in everything, it’s simply not possible. My philosophy to find the best, which sometimes leads me to refer my patients to another surgeon if I believe another provider is more experienced in that field. For example, if a patient has extensive testicular cancer, I will refer them to a surgeon who has more expertise than me. I want my patients to have the best possible outcome. Our patients will be provided information on what they can do prior to surgery to optimize results. “Plain talk” is important, complicated jargon is where patients begin to feel uncomfortable. The patient should feel confident in their surgeon and should understand what is at stake concerning cancer control, urinary control and sexual function. No surgeon can make guarantees, but an experienced surgeon can give you a very good idea of what to expect. I would expect to hear statistics regarding transfusion rates, length of stay, foley catheter duration, and urinary control. Cancer outcomes and sexual outcomes are harder variables to give expectations for because everyone’s case is unique.

 

In summary, robotic surgery for prostate cancer can be one of the best treatment options for prostate cancer. The prostate is removed and no bridges are burned for any future therapies, if necessary. Most cancer cases do better if the primary tumor is removed, and I believe prostate cancer is no different. Finding the best surgeon for you is a fundamental key in ensuring the best possible outcome.