Prostate Cancer Surgery Myths and … Lies, Lies and More Damned Lies
CORAL SPRINGS, Fla., Jan. 31, 2012 /PRNewswire/ — Dr. Bert Vorstman, a urologist with nearly 30 years expertise in prostate cancer diagnosis and treatment, is challenging the validity of curative life extension claims promoted by manufacturers and surgeons employing radical prostate surgery/robotics.
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Dr. Vorstman addresses these inconsistencies in an extensive treatise on prostate surgery at http://www.urologyweb.com/urology/mens-health/prostate-cancer/prostate-cancer-surgery.html and responds to common myths and mis-statements involving diagnosis and "junk science" applied to promoting this surgical treatment.
Top 10 Prostate Cancer Myths, Misconceptions and Outright Lies
1. I’ve been diagnosed with prostate cancer and I’ve got to act quickly before it spreads.
Dr. Vorstman: The first order of business is to take a deep breath, relax and then review and evaluate all treatment options. Cancer is an emotionally charged word causing anxiety and an inappropriate rush to judgment. Due to a generally slow growth and indolent nature, MOST prostate cancers are unlikely to impact most men during their lifetime. Though the second leading cause of cancer related deaths for men, only some 7% of men will actually die from prostate cancer. Clearly, prostate cancer is not going to "spread" while a man enters a period of active surveillance (AS) seeking out second opinions and empowering and educating himself on treatment options. In particular, many small volume low risk cancers can often be followed for several years.
2. My PSA (Prostatic Specific Antigen) test is abnormal and my doctor has suggested evaluation.
Dr. Vorstman: Never take any action based upon just one abnormal PSA.
Fundamentally, the PSA is a flawed screening test for prostate cancer as it screens more for benign prostatic disease and is not an accurate validation for early prostate cancer detection. Its value is in post prostate cancer treatment monitoring. Furthermore, if you have significant co-morbidities such as heart disease or diabetes, or have a life expectancy of 10 years or less, PSA evaluation is unlikely to be of any benefit to you as you are very likely to outlive any existing prostate cancer.
3. A digital rectal examination shows indication of an irregularity, lump or nodule. A blood screening shows a normal PSA. Should I agree to a biopsy as a next step?
Dr. Vorstman: A digital exam’s accuracy, much like a typical PSA blood test, is like tossing a coin—a 50 percent chance. Men should understand that:
- You can have a prostate nodule that is cancerous but your PSA is "normal",
- 15-20% of men with a normal PSA under 4ng/ml can have prostate cancer, and
- Some 30% of men with a PSA between 4-10ng/ml will have significant prostate cancer. Although a needle biopsy of the prostate might carry its own complications for the patient, it is the only way to determine if cancer exists.
4. My doctor wants to discuss my biopsy results and next steps.
Dr. Vorstman: Firstly, you need to send your biopsy slides out to a nationally recognized reference laboratory so your diagnosis, benign or malignant, can be validated. Unfortunately, there is a huge discordance rate amongst pathologists on reading the same slides and patients should only consider further actions on their diagnosis based on a consensus of reliable pathology results. Secondly, you should know exactly where your cancer was found in your prostate as significant cancer at the base or apex can mean that the cancer is no longer confined to the prostate and that only radiation would be a reasonable treatment option. Thirdly, you should realize that CAT scan and bone scan studies are of no value in determining the status of your cancer if your PSA is less than 15ng/ml.
5. Prostate cancer surgery/robotics, an often recommended and "cutting" edge treatment, is offered by many urologists with curative intent.
Dr. Vorstman: Although offered with curative intent, it is known that there is NO scientific validation for significant curative life extension after radical surgery/robotics for prostate cancer. In fact, this one surgery is associated more with permanent complications (especially incontinence and impotence) than probably any other operation ever performed on humans. Unfortunately, this radical surgery is often treated as an emergency, but is a heavy-handed approach without merit and probably without equal, in providing false hope. Surgery has also been shown to have a high rate of inadequate cancer control (residual cancer) in some 20-40% of patients. These negative quality of life issues should be considered before submitting to an invasive and irreversible surgical procedure.
6. My friend, who underwent radical surgery, says he is fine and he has no complications.
Dr. Vorstman: I’m sure that there are some men who claim no complications following radical surgery/robotics for their prostate cancer. However, in addition to shortening of the penis and a high rate of residual cancer in men after radical surgery/robotics, many men are often too embarrassed to admit to post operative urinary leakage and issues of a sexual nature. These quality of life issues clearly underscore the fact that surgery/robotics is no panacea for prostate cancer treatment. Surgeons as well as marketers continue to promote robotic technology for radical prostatectomy by a creative spin, using such terms as "advanced", "minimally invasive", and "superior outcomes." The sad truth is that prostate cancer surgery is solely responsible for the worldwide increase in urinary incontinence and impotence but without the benefit of curative life extension.
7. But they say surgery is the "Gold Standard" in prostate cancer treatment and it is FDA approved.
Dr. Vorstman: The term "Gold Standard" is a very unfortunate, self-anointed, self-serving term, which implies established and proven benefits for radical surgery/robotics in the treatment of prostate cancer when the truth is far from it. Surgery is simply the oldest treatment modality for prostate cancer, and because of this history, is deemed as the "Gold Standard".
Yes, robotic surgery for prostate cancer is FDA approved but the technology was simply given a "pass" by the agency without the benefit of rigorous scientific evaluation for risk or reward. There is no other high-risk surgical technology for prostate cancer to be so approved.
8. I’m conflicted about treatment options as most prostate cancer is currently treated by either surgery/robotics or radiation. What about Cyroablation or HIFU?
Dr. Vorstman: First let me say that it is absolutely the patient’s prerogative as to what treatment modality he chooses, if at all, to treat his prostate cancer. After any diagnosis—especially when cancer is suspected—it is imperative for the patient to empower himself and seek out several opinions. Most of the information given by physicians will be skewed with bias, but often, a patient can work around this issue by researching and seeking second and third opinions. Most men are offered either surgery or one of the several radiation options as most urologists have no experience in the minimally invasive options of Cryoablation (Outpatient percutaneous placement of cyroprobes into prostate for freeze-thaw cycles to iceball prostate) or HIFU (high intensity focused ultrasound of the prostate gland). Since all of the treatment options have similar survival benefits, it is important for men and their partners to be sure that they understand the various complications that may be associated with the different treatment modalities.
9. Prostate cancer is prostate cancer—all are the same.
Dr. Vorstman: NOT true and patients need to be wary of following the treatment experienced by a friend, who may have a different Gleason grade, tumor location and tumor volume. Because of these differences, not all treatment modalities may be suitable for every prostate cancer. And, as a general overview, it should be clearly understood that most men will die with and not from prostate cancer, so the disease if far from a "death sentence."
10. My urologist tells me that I’ve been "successfully treated" through radical robotic surgery. Does that mean I’m cancer free and can I expect my leakage and erections to improve to the same quality of life I had before the surgery?
Dr. Vorstman: Every man expects curative life extension after treatment of his prostate cancer, no complications and with a full return of normal daily activities and the quality of life he had before surgery. This happens rarely, if ever, after radical surgery/robotics for localized prostate cancer. It’s a naive dream propagated through marketers and pursued by many surgeons. Furthermore, because the prostate cancer cell is generally quite slow growing, survivorships of 10-15 years after surgery are meaningless as metastases may present 20-30 years after surgery.
