SARASOTA, Fla., June 24 FL-Diagnostic-Center
SARASOTA, Fla., June 24 /PRNewswire/ -- The following statement was issued
today by Diagnostic Center for Disease --
"There is currently no convincing evidence that early screening, detection,
and treatment improve mortality. Limitations in prostate cancer screening
include potential adverse health effects associated with
false-positive and negative results, and treatment side effects."
Policy Statement from the American College of Preventive Medicine,
published in the American Journal of Preventive Medicine, February 2008
There were an estimated 50,000 robotic prostatectomies performed in
2007(1). It is projected that the number could double in 2008. Robot
assisted laparoscopic prostatectomy (RALP) is now generally accepted by
Urology as the "gold standard" of curative treatment for Prostate Cancer.
Like conventional laparoscopic surgery to remove the prostate gland, "robotic"
prostatectomy is presented and described as a "minimally invasive" procedure.
Robotic surgery is possible due to some amazing technology. One excellent
example is the "da Vinci" system manufactured by Intuitive Medical, Inc. The
device is remotely operated by the surgeon. Television cameras inserted into
the abdomen provide multiple views and simulate three-dimensional vision. The
robot consists of small, articulating arms which can perform multiple tasks.
Operating tools include suture, scalpel, cauterizing tool, etc. This is a
laparoscopic surgical process and is considered to be minimally invasive.
Promoters of robotic prostatectomy routinely use the term "promising" in their
expectation that this device and procedure will eventually demonstrate
improvement in the cure rate for prostate cancer. Their enthusiasm is
generated by the awareness that other curative treatments have a poor track
record to cure prostate cancer. This procedure is also accompanied in far too
many cases, by other negative side effects such as incontinence and permanent
erectile dysfunction.
Robotic surgical technology and the procedure is still fairly new. There
is as yet nothing dramatically different in performing the procedure or the
results compared to traditional laparoscopic surgery. However, armed with
hope for improved results, the urology community has increased the rate of
these surgeries, and their search for cancer at alarming rates. In 2000,
there were 1500 robotic prostatectomies performed. Last year, 2007, it is
estimated that 50,000 robotic prostatectomies were performed.(1) The rate of
procedures is still climbing, with projected 80,000 or more robotic
prostatectomy procedures in 2008. The number is staggering when you add
robotic surgeries to all other curative procedures performed which include
open prostatectomy, conventional laparoscopic prostatectomy, radiation in all
forms, radiation seed implantation, cryosurgery, thermometry, focused
ultrasound ablation, etc. The significant cost of the robotic system may be
driving the search for new cancers in addition to an increase in the number of
surgeries. A typical robotic surgery device costs $1.2M with annual
maintenance of approximately $120,000.00 per year.(2) In spite of the
popularity of this procedure, robotic prostatectomy has yet to deliver any
results or evidence that it will provide any improvement over other treatments
to cure prostate cancer.
A great number of urologists and academic centers promote early detection
and early curative treatment, citing a better cure rate.
"These technical improvements would lead one to believe that improved
results with continence, potency and oncologic outcomes should logically
follow. Ultimately, long-term outcomes and possibly financial impact will
determine the role of robotic-assisted laparoscopic prostatectomy.(1)"
Published results of several studies simply do not support this supposition:
"Cancer cure rate, measured by presence of cancerous cells at the surface of
the removed prostate, and by PSA levels following surgery, was nearly
identical for all three procedures (open, laparoscopic and robotic
prostatectomy).(2)"
Concurrently, the leadership in Urology and academic institutions have for
several years expressed concern regarding "over treatment" of prostate cancer.
Retrospective studies have revealed that a very high percentage, exceeding
30%, of surgeries were performed for "insignificant" cancers.(3) In addition,
physicians promote cure rates for robotic prostatectomy using statistics with
only five years of data. The failure rates for treatments of all prostate
cancers become quite significant by 7 to 10 years. Without any evidence for
improvement in the rate of cure, surgeons are wagering on the hope that this
new approach will deliver better results. As the numbers of treatments
escalates, so will increased numbers of treatment failures and the devastating
side effects that accompany them. A seemingly incongruous announcement in a
policy statement released by the American College of Preventive Medicine last
year recommended against routine prostate screening. Does this announcement
have any connection to the alarming escalation of treatment? Their policy
statement details concern regarding the PSA blood test as cause for false
positive and false negative diagnoses. However, it also recognizes concern
over the inability to improve outcomes, to cure cancer predictably, or improve
upon the negative side effects.
The increasingly aggressive search for cancer by repeated needle biopsies
will inevitably lead to more and more unnecessary surgeries, more failures to
cure and a growing number of men and their families suffering from the
devastating side effects of incontinence and sexual dysfunction. There exists
no compelling evidence at this time that robotic prostatectomy will deliver
any improvement whatsoever over the current poor rate of cure for all other
radical, curative treatments. What is truly alarming is that the effort to
find more cancers by more than doubling the rate of biopsy, will only serve to
increase the devastation that exists today. Ironically, increasing number of
insignificant cancers included for treatment, will only serve to (falsely)
indicate better cure rates for robotic prostatectomies. Of course, this will
only incentivize urologists to treat even more cancers. Also of concern is
the trend is to treat more aggressive cancers, Gleason 8 and above. In far
too many cases, it is not confirmed prior to actual surgery that the cancer is
organ-confined. The number of failures, exceeding 1,000,000 men, could easily
double within the next few years. What of these men and these families? The
only reasonable conclusion is to discontinue curative treatments such as
robotic prostatectomy, for the majority of positively diagnosed men until
proof exists that these treatments can successfully cure prostate cancer.
There is a real concern that the cure may become more dangerous than the
disease. To read the full article, "Robotic Prostatectomy - A Race to
Failure?," go to http://www.mrisusa.com.
Reference
1. Minimally Invasive Surgery in Urology, Current Opinion in Urology.
18(2):173-179, March 2008, Box, Geoffrey N; Ahlering, Thomas E
2. Robot-Assisted Prostate Surgery Has Possible Benefits, Higher Costs,
By Lisa Esposito, Editor, Health Behavior News Service, August 29, 2005
3. Clinically Insignificant T1 Stage Tumors Of The Prostate, Konstantinos
Stamatiou, Vassilissa Karanassiou, Kavouras Nikolaos, Makris Vasilios, Lebren
Fred, Emmanuel Agapitos: Clinically Insignificant T1 Stage Tumors Of The
Prostate. The Internet Journal of Urology. 2007. Volume 4 Number 2.
SOURCE Diagnostic Center for Disease
