Mel, you are wise to seek out the top-notch centers/doctors for your treatment...
Consider the distribution of cases which vary. On one end of the spectrum, some procedures are so standard that it probably shouldn’t make any difference where you go. On the other end, some cancer cases are so advanced, perhaps so “helpless,” that even the best centers cannot make much difference.
Then there are the millions of cancers cases in the middle—those that are neither hopeless nor straightforward (or as straightforward as cancer can be). Here is where differences in outcomes based on where you are treated were most noteworthy.
The quality-of-care differences have been found to be, interestingly, not related to who has the newest, coolest multi-million dollar machine, in which case one could forgive small community hospitals for lagging behind. Instead, it comes down to such basics as experience; to getting the correct diagnosis; to whether doctors address holistic aspects of diet, exercise, and psychological health; to whether doctors routinely test tumors for molecular markers that can guide therapy; to whether multi-disciplinary care is coordinated or haphazard; to how well doctors monitor patients (after surgery, radiation, or chemical treatment) in order to minimize the chance that the cancer will recur.
You’ve already been down the surgical route. But just to note, outcomes for complex surgeries have significantly disparities between top cancer centers and community hospital settings. For tough surgeries, you want the doctor who’s been around the block, so to speak; surgeons at the top centers have generally sharpened their teeth elsewhere first. You'll never know how big your issues might have otherwise been right now if you had selected a less experienced surgeon…you’ll just never know.
Likely of more interest to you now is the noted general differences between the approaches of oncologists in the two settings. Doctors in the community setting (generally) report that there is a lot of art in the treatment of cancer, whereas oncologists at top centers say it’s a science. “Art” might sound desirable and even personal—my oncologist spends time with me, is friendly and compassionate, and isn’t blindly following a recipe in treating me!—but it covers a lot of sins, notably the tendency of some doctors to pick treatments that worked for other patients, even though those results might have been statistical flukes. The “recipes” are well established (see the Clinican's Guidelines for Prostate Cancer which I have previously provided to you) by the National Comprehensive Cancer Network (NCCN).
I think you are on the right path, Mel. I'll close by copying/pasting one from one of my earlier posts:
Is very good care also found elsewhere [i.e., in community hospital settings or at private generalists]? Absolutely. Will there be people who feel that they had unfavorable experiences at these centers [the CCCs]? Absolutely. But taking the broad view, these centers [the CCCs and the private expert specialists] would absolutely be considered the cream of the crop.