Prostate Cancer

Prostate cancer is cancer that occurs in the prostate, a small walnut-shaped gland that is part of a man's reproductive system. The gland wraps around the urethra, the tube that carries urine out of the body.

Prostate cancer is one of the most common types of cancer in men. Treatment of prostate cancer depends on several factors: how fast the cancer is growing, how much it has spread, the patient's overall health and potential side effects of treatment. Some types of prostate cancer grow slowly and remain confined to the prostate gland and may need minimal or no treatment. Other types are aggressive and can spread quickly and may require treatment, such as radiation or surgery.

The University of Michigan Health System treats many prostate cancer patients with radiation and surgery. The following information focuses on surgical treatment. The graphs demonstrate that UMHS has considerable experience in performing radical prostatectomy, a procedure that removes the prostate, in patients with cancer that has not spread beyond the gland.

Procedure volume is the number of times a procedure was performed and is used to assess clinical experience and expertise. Studies have linked higher volumes with more successful outcomes for some types of procedures. The following graphs display the number of radical prostatectomy operations (removal of the prostate gland) performed at the University of Michigan Health System.

Number of Radical Prostatectomy Operations

Details

Why is This Measure Important?

Studies show that hospitals that perform a higher volume of radical prostatectomy operations have better outcomes, such as lower rates of complications and shorter hospitalizations. One study defined high volume as more than 60 operations in a year. This graph displays the number of radical prostatectomy operations performed at the University of Michigan Health System from 2004 - 2009. It also displays the way in which the operation was performed:

a) Open - an open procedure involves an incision in the abdomen or the groin
b) Laparoscope - the surgeon makes small incisions in the abdomen and uses a tube with a camera at the end to guide surgical instruments
c) Robotic laparoscope - instruments are attached to a mechanical device (robot) and the surgeon sits at a console and uses hand controls to guide the robot to move the instruments. The robot can allow the surgeon to make more precise movements

How is UMHS Performing?

The University of Michigan Health System performs a very large and increasing number of radical prostatectomy operations. Our urology surgeons have considerable experience treating prostate cancer patients and are performing more operations using robotic laparoscope. In 2012, 99% were robotic-assisted operations.

UMHS Source: Hospital administrative data and chart review.

Radical prostatectomy carries a risk of urinary incontinence and erectile dysfunction. It is important to reduce these outcomes in men with cancer that is confined to their prostate since the likelihood of a long-term cure is high. The following graphs display the rates of urinary incontinence, urinary irritation and sexual function compared to rates from a published study of outcomes from multiple institutions, at the time of operation and then at 3-, 6-, 9- and 12-months after the operation. Separate rates are presented for patients undergoing nerve sparing and non-nerve-sparing operations. Note that outcomes are better in men whose cancers permit nerve-sparing surgery, which keeps nerves intact and improves chances the patient will recover sexual function.

Urinary Incontinence
Higher Value = Better Performance

Details

Why is This Measure Important?

Radical prostatectomy carries a risk of urinary incontinence. The prostate gland sits just below the bladder and completely encircles the urethra (the tube that carries urine out of the body) at the point where it leaves the bladder. Surgery to remove the prostate affects both the urethra and urinary sphincter (muscles that control the flow of urine from the bladder) causing incontinence. However, patients often regain continence over time. This measure describes the percentage of patients who are continent at the time of operation (baseline) and at 3-, 6-, 9- and 12-months after nerve-sparing or non-nerve-sparing radical prostatectomy. The measurement results do not take factors that influence recovery of urinary continence and sexual function such as age, tumor stage, weight and desire for sexual recovery into account. So, the results are influenced by the types of patients who undergo radical prostatectomy. For this measure, higher percentages are better.

How is UMHS Performing?

For patients undergoing radical prostatectomy at the University of Michigan Health System in 2011, recovery of urinary continence is equal to or better than the benchmark after 12 months.

UMHS Source: Survey of patients undergoing radical prostatectomy in 2011 using the Expanded Prostate cancer Index Composite (EPIC) survey instrument.
Comparison Group Source: 2008 study of quality of life and satisfaction for men undergoing radical prostatectomy in multiple centers, published in the New England Journal of Medicine.

Sexual Function
Higher Value = Better Performance

Details

Why is This Measure Important?

Radical prostatectomy carries a risk of erectile dysfunction because removal of the prostate can sever nerves that initiate an erection. Nerve-sparing operations are performed to preserve these nerves, but cannot be performed in some men with large or high-grade tumors. The risk of erectile dysfunction is lower for younger patients, patients with small, low grade tumors, patients with sexual function before surgery and patients who can undergo a nerve-sparing operation. This measure describes the percentage of patients who have sexual function at the time of operation (baseline) and at 3-, 6-, 9- and 12-months after nerve-sparing or non-nerve-sparing radical prostatectomy. The measurement results do not take factors that influence recovery of urinary continence and sexual function such as age, tumor stage, weight and desire for sexual recovery into account. So, the results are influenced by the types of patients who undergo radical prostatectomy. For this measure, higher percentages are better.

How is UMHS Performing?

For patients undergoing radical prostatectomy at the University of Michigan Health System, recovery of sexual function is better than benchmark institutions in both nerve-sparing and NON-nerve sparing procedures.

UMHS Source: Survey of patients undergoing radical prostatectomy in 2009 using the Expanded Prostate cancer Index Composite (EPIC) survey instrument.
Comparison Group Source: 2008 study of quality of life and satisfaction for men undergoing radical prostatectomy in multiple centers, published in the New England Journal of Medicine.

Urinary Irritation
Higher Value = Better Performance

Details

Why is This Measure Important?

Radical prostatectomy carries a risk of urinary irritation symptoms such as urgency and frequency of urination. This measure describes the percentage of patients who do not experience urinary irritation at the time of operation (baseline) and at 3-, 6-, 9- and 12-months after NON-nerve-sparing radical prostatectomy. The measurement results do not take factors that influence recovery of urinary continence and sexual function such as age, tumor stage, weight and desire for sexual recovery into account. So, the results are influenced by the types of patients who undergo radical prostatectomy. For this measure, higher percentages are better.

How is UMHS Performing?

Urinary continence for patients undergoing radical prostatectomy at the University of Michigan Health System in 2011, is better than the benchmark in nerve-sparing procedures; results are mixed for non-nerve sparing procedures.

UMHS Source: Survey of patients undergoing radical prostatectomy in 2009 using the Expanded Prostate cancer Index Composite (EPIC) survey instrument.
Comparison Group Source: 2008 study of quality of life and satisfaction for men undergoing radical prostatectomy in multiple centers, published in the New England Journal of Medicine.