PROSTATE CANCER SURGERY? Lies, lies and more damned lies.
Bert Vorstman, MD,MS,FAAP,FRACS,FACS
http://www.urologyweb.com
“Choosing prostate cancer surgery was the worst decision of my life” patient
There is no creditable scientific evidence for significant curative life extension in men treated for prostate cancer through radical prostate surgery/robotics alone.
In addition, this one surgery is associated with more permanent complications than probably any other operation ever, performed on humans.
It’s an operation that is often treated as an emergency, is without merit and is
probably without equal in providing false hope. Unbelievably, this high-risk
surgical technology for prostate cancer treatment was simply given a pass by
the FDA without being rigorously and scientifically evaluated for risk or reward.
The current lack of progress towards a sincere and definitive resolution to
determining which of the few prostate cancers demand treatment, and which
treatment if necessary, is confounded by a preponderance of short term (5-15
years) clinical studies hopelessly jaundiced by treatment philosophies, egos and money. For many men, their small area of prostate cancer (which was never going to behave like a cancer we normally think of) never required treatment.
For many other men, their prostate cancer treatment with surgery/robotics was a journey to hell and back.
The absence of any real significant scientific validation for prostate cancer surgery/robotics in bringing about curative life extension or reduction in prostate cancer-specific mortality, is an indictment against prostate cancer surgeons worldwide and should stop every man in his tracks.2
Lost in all the years of so-called “data” gathering from a multitude of nonscientifically run clinical studies around the world since the radical surgery was first described by Young in 1905, has been the most basic and fundamental issue of whether prostate cancer surgery/robotics actually extends the life of a man afflicted with prostate cancer in a curative manner. That there is no evidence to support surgery for treatment of prostate cancer has not tamed the proponents of surgery from disseminating opaque prostate cancer information where sensationalism, half truths, downright lies, bias, obvious conflicts of interest, use of the word “data” to imply real results and use of marginal statistical significance to misconstrue real benefit has been spun, distilled and re-spun. Much of this socalled “scientific” prostate cancer surgery information now belongs in the category of junk science.
To date, we have no robust supporting scientific evidence from long term randomized trials using validated pathology and imaging (to diminish significant observer error) to say that radical surgery/robotics for prostate cancer results in curative life extension. In place of answering that most fundamental question of “are we doing any good at curing a man from prostate cancer with surgery?”, we have countless articles on the ignorant preoccupation with PSA testing for prostate cancer, along with endless papers on the latest imaging techniques, each desperately attempting to show how they can identify even smaller, probably meaningless areas of prostate cancer. Along with discussions on other mindless trivia, we see a nauseatingly long list of “how to” articles on surgical technique for prostate cancer removal with each egotistical surgeon trying to outdo the previous “gifted” surgeon. At the very pinnacle of these stupefying discussions however, is the apparently serious debacle questioning the relevance of positive margins (cancer left behind) in a prostate cancer operation! This is an unbelievable example of medical defensive posturing and pseudo scientific rationalization.
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