News
WSJ Investigates Robotic Surgery
May 15th, 2010
A recent article in the Wall Street Journal investigated the use of robotic surgery and reports of patient injuries from inexperienced practitioners.
ACS Prostate Screening Guidelines
March 6th, 2010
The American Cancer Society’s (ACS) latest pronouncement on prostate cancer screening has them pulling back from their past recommendations. They are no longer recommending yearly PSA and digital rectal examinations (DRE) but instead stressing that the patient should make an informed consent in consultation with his physician.
ACS guideline:
Beginning at age 50, asymptomatic average-risk men with at least a 10-year life expectancy should receive information that allows them to make an informed decision, in collaboration with their healthcare providers, about prostate cancer screening
Despite the clear fact that PSA is the most accurate single cancer detection test in oncology, recent complaints about false positive test results (as occurs with all tests) and an inability to differentiate the most dangerous prostate cancers has the ACS backtracking on its prior pronouncements. The America Urological Association (AUA) and the ACS are no longer in agreement about who should be screened. This is a complex issue that even the experts do not agree, making it even more puzzling that the ACS is abdicating its leadership role and now wants to leave this controversy up to the patient. Read more…
ProstRcision® – What is it?
March 5th, 2010
Patients have asked me, “What is ProstRcision®?” A new ad has hit the Louisville radio airwaves and billboards touting “the highest documented cure rate* of any prostate cancer treatment”. It appears that the Radiotherapy Clinics of Georgia (RCOG) have trademarked a clever word “ProstRcision®” to designate a well know treatment option, that is combination radioactive seed implantation followed by external beam radiation therapy. Read more…
NY Times - Robotic Surgery - Results Unproven
February 15th, 2010
Yesterdays New York Times had a front page article on robotic surgery for prostate cancer. It rightly points out the lack of evidence that robotic surgery claims can be substantiated. Worse still, some of the evidence suggests inferior results compared to standard open surgery. Despite this, they point out that the majority of patients are being sold on a procedure which takes twice as long and costs twice as much due to heavy marketing by doctors, hospitals and the company that makes the robot. Read more…
NYT Articles - The Radiation Boom
February 1st, 2010
Two recent articles in the New York Times about the Radiation Boom discuss the problems which can result from new high energy high-tech radiation such as IMRT when there is insufficient training and supervision of the advanced technology.
Radiation Offers New Cures, and Ways to Do Harm
NCI - Open prostatectomy remains “gold standard” over Robotic surgery for prostate cancer
November 2nd, 2009
The National Cancer Institutes (NCI) bulletin reports on a recent article in JAMA reviewing results of robotic prostatectomy compared to open surgery. The only advantages for robotics in this study was shorter hospital stay (2 days vs 3 days) and fewer blood transfusion. Robotic surgery was found to have more than twice the risk of genitourinary complications including a 30% increased risk of incontinence and a 40% increased risk of erectile dysfunction. The NCI concluded that open surgery should remain the “gold standard” for men who opt for surgery to treat localized prostate surgery. The rapid increase in the robotic approach is because of aggressive marketing from hospitals, doctors and the company who makes the device.
Status of Radical Prostatectomy in 2009
August 27th, 2009
Status of Radical Prostatectomy in 2009: Is There Medical Evidence to Justify the Robotic Approach?
Herbert Lepor, MD
New York University School of Medicine, New York, NY
This article presents the evolution of open radical retropubic prostatectomy (ORRP) into a minimally invasive procedure and reviews the literature to provide a legitimate comparison between ORRP and robotic-assisted laparoscopic radical retropubic prostatectomy (RALRP). The article is limited to manuscripts cited in the peer-reviewed literature, and an effort was made to identify those articles that fulfilled the highest level of medical evidence. In centers of excellence, ORRP is performed with no mortality, extraordinarily low technical and medical complications (1%), the rare need for blood transfusions, 1 to 2 day hospital stays, urinary catheters that are routinely removed in a week, the majority of men returning to work in 2 weeks, and up to 97% of men regaining urinary continence. Return of potency remains a challenge, especially for older men with marginal erections. RALRP is now the most common approach for the surgical removal of the malignant prostate. A critical review of the literature fails to support the marketing claims that RALRP is associated with shorter hospitalization, less pain, better cosmetics, shorter catheter time, lower transfusion rates, or improved continence and potency rates. The highest level of medical evidence suggests that RALRP may significantly compromise oncologic outcomes and that men undergoing this approach have higher regret rates than men undergoing ORRP.
[Rev Ural. 2009;11 (2}:61-70]
Is Robotic Radical Prostatectomy Ready for Prime Time?
August 21st, 2009
Dr. William J. Catalona
Chicago, Illinois
Patients contemplating radical prostatectomy for prostate cancer want the answers to many important questions. Will I be cured of my cancer? Will I be continent? Will I be able to have spontaneous erections? What is my risk for other complications? How long will it take to return to my regular activities? Open nerve sparing radical retropubic prostatectomy is the gold standard for the surgical treatment of prostate cancer, and the answers to these questions are well documented for open prostatectomy. The results have shown that high volume surgeons usually achieve excellent outcomes. Recently largely due to hype and aggressive marketing, there has been increasingly widespread use of robot assisted laparoscopic radical prostatectomy in the United States.1 Reports directly comparing open and laparoscopic procedures are just beginning to be published because of the relatively recent use of laparoscopic operations to treat prostate cancer. However, during the last year several highly credible studies on comparative data have indicated important disadvantages of these minimally invasive approaches in terms of achieving cancer control, urinary continence and patient’s satisfaction.2-4 Furthermore, recent studies have called into question whether robotic surgery offers any material advantage in terms of side effects or recovery time.5,6 These comparative studies are more informative than reports merely claiming that laparoscopic or robotic surgery has significant advantages compared to open surgery.
New Prostate Cancer Vaccine Promising
July 16th, 2009
The American Society of Clinical Oncology recently reported favorable results of a Phase 2 therapeutic trial of a vaccine called Prostvac-VF in the treatment of men with metastatic hormone-refractory prostate cancer. Men who received the vaccine had a median overall survival that was 8.5 months longer than the placebo group. Note that this data will need to be verified in Phase 3 trials.
AUA - Start Offering PSA Test at Age 40
July 15th, 2009
The American Urological Association (AUA) Best Practice Statement has recently updated its prior recommendation from 2000 now suggesting that urologists start offering patients PSA testing beginning at age 40 years. This is in contrast with a number of other medical organizations who disagree.