title: High surgical volume is associated with a lower rate of secondary therapy after radical prostatectomy for localized prostate cancer.
abstract: OBJECTIVE
  To assess the relationship between surgical volume (SV), defined as the number of radical prostatectomies (RPs) within a calendar year, and the time to secondary therapy (ST) after RP, as this might represent an important determinant of cancer control.
  
  
  METHODS
  The study included 7937 men treated with RP by 130 urologists between 1989 and 2000. Radiotherapy or any form of hormonal manipulation represented ST. Univariable and multivariable Cox regression analyses was used to evaluate the time to ST after RP.
  
  
  RESULTS
  SV was an independent (P = 0.02) predictor of ST-free survival after RP, and the multivariable rate of ST sharply decreased with increasing SV.
  
  
  CONCLUSIONS
  The use of ST is inversely proportional to SV of up to 24 RPs per year. A higher annual SV might be indicative of less restrictive use of RP in high-risk patients who eventually require combined treatments.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Francois
authors.initials: F
authors.lastname: Peloquin
authors.forename: Daniel
authors.initials: D
authors.lastname: Pharand
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000592:standards*; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011468:Prostatectomy / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011792:Quebec / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome; D016526:Workload