Good Help, Close to Home
But Trinity Health System, the major source of hospital care for the area, had recently geared up a state-of-the-art seed implant, or brachytherapy, program. Trinity's radiation oncologist, Mark Trombetta, was affiliated with Allegheny General, a major medical center in Pittsburgh, and had assembled valuable new technology: ultrasound scanners to image the prostate and an advanced computer program to instruct Trombetta while he was in the operating room exactly where to place the seeds to hit the cancer but spare normal tissue.
"Boy, did I pray," says McMahon. "And I decided on radiation. Prostatectomy is routine, but it's still major, and there's some potential for incontinence and impotence afterwards. And I had great, great confidence in Trombetta."
A good team. McMahon knew Trombetta's record. By now, he has done over 200 brachytherapy cases at Trinity, with just one disease recurrence. That's identical to the rate at Allegheny General. And Trinity does about 25 a year, enough volume to produce good outcomes.
McMahon went in the morning of Oct. 22, 2003, went home that afternoon, and was back at work a few days later. His PSA gradually fell from 4 to a healthy 1. "I trusted in God, and I trusted in my doctors, and that's truly a good team," says the friar.
If McMahon had opted for surgery instead, he would have had to mull over Trinity's record of only two prostatectomies per year. For an operation in which more means better, that's low for any hospital. A typical urologist does 11 to 12 a year, says Peter Carroll, chair of urology at the University of California-San Francisco. "I think that doing between 20 to 30 of these each year makes you an experienced surgeon," says James Eastham, who researches prostatectomy outcomes. In several studies by Eastham and others, patients of surgeons who do fewer than 20 operations per year have a 10 percent to 30 percent higher rate of incontinence or impotence than do those whose surgeons do more than 33. "Those are real big differences," Eastham says.
Patients who elect surgery don't always need a Sloan-Kettering or a UCSF, where urologists do three or more a week. Paul Sieber, chief of urology at Lancaster General Hospital in Pennsylvania, averages about 50 a year. "We participate in a national database of more than 100 urologists," he says, "and our outcomes--continence, potency, and cancer recurrence--are at or above the average."
Still, advanced prostate disease or other challenging conditions may overmatch even good community hospitals. The more rare the diagnosis or the more difficult the procedure, the better off you'll be at a major referral center. Most of the time, however, your best choice could be just up the road.
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