Tuesday, August 31, 2010

Prostate Snatchers?

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.


Anonymous said...

I believe an ounce of self abuse is worth a pound of prostrate...
PREVENTION!! and is there a more useless specialty than "Preventative Medicine"???

and I'm not usually an article quoter but check out "Sexual Factors & Prostrate Cancer" from the British Journal of Urology vol 92, page 211, 2003 at
Basically the more you jerk off, the less chance you get Prostrate Cancer.
Wish I'd have known that in 1974, would have saved my mom a fortune in gym socks...

Frank "you'll take my Prostrate when you pry my cold dead fingers off my cold dead..."

Sarada Kakinada said...

Craziness!! Actually, I buy it. It goes hand in hand with not checking PSA levels after 75. There is probably an argument for reducing this age to 70 or even 65, depending on the number of co-morbid conditions that a given patient might have. My understanding of PSA is that it is great for tracking progression, but you can't just look at the number and declare it as high. In younger men, you track it because a lower number that jumps up still stays in the "normal" range. (And who did they base the normal range on, anyways??)

On a more personal note, my 82 year old grandfather has prostate cancer, and we are very happy that his doctor is treating it conservatively. A prostatectomy still carries so much risk, and he doesn't need that kind of morbidity.

(On the other hand, the da Vinci prostatectomy is pretty freaking cool.)