Men who undergo radical prostatectomy (RP) for localized prostate cancer (PCa) live longer after surgery if they have the procedure at facilities with a high annual PCa caseload, both in terms of overall encounters and the number of RPs performed, according to a new study.

However, facility caseload measured by all PCa encounters is a better predictor of survival than the number of RPs performed.

Using the National Cancer Database, a team led by Sarmad Sadeghi, MD, PhD, of the Norris Comprehensive Cancer Center at the University of Southern California in Los Angeles, examined survival outcomes among 488,389 men who underwent RP in the United States as they relate to facility annual caseload (FAC) for all PCa encounters and facility annual surgical caseload (FASC) for RP cases.

The investigators classified facilities into 4 volume groups (VGs) based on caseload: less than 50th percentile (VG1); 50th to 74th percentile (VG2); 75th to 89th percentile (VG3); and 90th percentile or higher (VG4). With regard to FAC, VG1, VG2, VG3, and VG3 facilities had less than 63, 63 to 115, 116 to 207, and more than 207 annual PCa encounters overall, respectively. For FASC, the annual numbers of RP cases were less than 22, 22 to 53, 54 to 111, and more than 111, respectively.

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Based on FAC, median overall survival was 13.2 months longer among men who underwent RP in VG4 vs VG1 facilities, Dr Sadeghi and his colleagues reported in Cancer. For FASC, median overall survival was 11.3 months longer for those who underwent RP at VG4 vs VG1 facilities.

Compared with VG4 patients (reference), VG1 patients had a significant 30% and 25% increased risk of death by FAC and FASC, respectively, on multivariable analysis.

“In conclusion,” the authors wrote, “this study of a large population of patients with prostate cancer reveals a significant and clinically important survival advantage from performing radical prostatectomies at highly experienced centers. These data support the regionalization of radical prostatectomy in an effort to improve oncologic outcomes for this patient population.”


Barzi A, Lara PN, Tsao-Wei D, et al. Influence of the facility caseload on the subsequent survival of men with localized prostate cancer undergoing radical prostatectomy. Cancer. 2019. doi: 10.1002/cncr.32290