Prostate Cancer Surgery:
Even A Robot Can Do It, But Is That Necessary
By
Leonard Zwelling
It made the NY Times
(http://well.blogs.nytimes.com/2016/07/28/robotic-surgery-for-prostate-cancer-may-offer-no-benefits-over-regular-surgery/?_r=0).
In
an article published in The Lancet (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30592-X/fulltext) surgeons in
Australia and New Zealand have reported that for patients with early stage
prostate cancer who opt for surgery as initial therapy, the use of robotic
laparoscopic surgery proved no better than conventional open surgery in preserving
urinary function or sexual function at 6 or 12 weeks after surgery. Surgical
margin positivity was the same in both groups. Longer term follow-up is
pending.
The point is that just because it is
new and cool, doesn’t mean that it is better and that a large investment in
novel equipment prior to its superiority having been tested, may not be a wise
deployment of resources.
This study also raises the hope that a
similar examination of the relative efficacy and safety of radiotherapeutic
techniques in the treatment of primary prostate cancer may also be published in
the near future so the benefits of proton therapy in this disease can also be
assessed.
As if this needs to be said, it is
always important to ask the question in a scientifically valid study to
ascertain the risks and benefits of any new medical procedure, technology or
drug. Just as high dose chemotherapy with cell rescue proved to be unhelpful,
if not harmful, in primary breast cancer, this case illustrates that the newest
does not need to be the best or even better.
At every juncture in cancer medicine,
it will be necessary to test whether what appears to be an advance really is
one. We all like to think that the newest and the coolest is the best, but it
is not necessarily so, as this study shows.
The last line of the article is
telling:
“In the interim, we encourage patients
to choose an experienced surgeon they trust and with whom they have rapport,
rather than a specific surgical approach.”
Not a bad plan for all medical choices.
Now if we only had studies comparing the quality of the doctors…
