Interesting article in NY Times today from Dana Jennings reviewing a book called "Invasion of the Prostate Snatchers". (Yeah, that's really the title---I suspect publishers nowadays are contractually obligated to come up with the most outrageously sensationalistic titles possible prior to shipping them off to Borders.) Jennings is a prostate cancer survivor who underwent a radical prostatectomy. His particular tumor was a highly aggressive variant. Surgery probably added years to his life. But according to a recent NEJM study, only 1 out of 48 patients with early prostate cancer who undergo a prostatectomy realize any survival benefit compared to non-operative treatment.
Here's a line that jumped off the page at me:
“Out of 50,000 radical prostatectomies performed every year in the United States alone,” Dr. Scholz writes, “more than 40,000 are unnecessary. In other words, the vast majority of men with prostate cancer would have lived just as long without any operation at all. Most did not need to have their sexuality cut out.”
That quite an astounding proclamation. 80% of the prostatectomies done in this country are arguably unnecessary? Whatever are we going to do with the million dollar DaVinci robotic machines that every private hospital is clamoring to buy and market?
Admittedly, I'm a no expert in prostate cancer. I'd love to hear a rebuttal from any urologists and medical oncologists out there.
Here's a nice review on early stage prostate cancer from the NCI. It seems that men with prostate cancer younger than 65 years old probably benefit from a more aggressive surgical approach. The older patients don't see a statistically significant benefit from radical prostatectomy.