Introduction: Prior work suggests that <5% of urologists performing radical prostatectomy (RP) in the U.S. have adequate annual surgical volume to achieve expertise with 250 cumulative surgeries by 10 years in practice. We sought to characterize modern-era urologists’ cumulative volume and time to surpassing 250 radical prostatectomy cases using real-world population-level data.
Methods: We identified urologists performing RP for prostate cancer from 2010-2015 in the New York (NY) Statewide Planning and Research Cooperative System (SPARCS) database during the modern robotic era and assess their cumulative RP volume from 2000-2015. NY medical license numbers were cross-referenced with the state physician licensing database and online profiles to obtain urologist training data. We limited our analysis to urologists who completed terminal training and graduated medical school =1990. Kaplan-Meier estimates of time from initiation of independent practice to surpassing 250 cases were computed as well as a Cox proportional hazards model assessing the impact of fellowship training status.
Results: We identified 25,093 RP surgeries performed by 193 urologists with median follow-up of 8 years (IQR: 4-15 years) and median years of independent practice 6 years (range 0-18). Seventy-one (37%) completed an oncology or robotics fellowship. Twenty-three urologists (12%) surpassed 250 cumulative RP during observation within a median of 7 years. Kaplan-Meier estimates revealed at 10 years of independent practice 12% of urologists surpassed 250 cumulative RP; at 18 years 39% surpassed this threshold. Among fellowship trained urologists, 35% surpassed 250 RP at 10 years and half surpassed 250 RP at 15 years. Fellowship trained urologists had a 10.7-fold higher hazards (p<0.001) of achieving 250 RP compared to non-fellowship trained surgeons (Fig 1).
Conclusions: Thirty-nine percent of urologists performing radical prostatectomy surpass a rigorous learning curve threshold of 250 cumulative surgeries during their first two decades in practice with a median time of 7 years. Fellowship trained urologists are far more likely to achieve this learning curve plateau and half achieve this goal around 15 years into independent practice. Source of
