Diagnostic Center for Disease: Robotic Prostatectomy - A Race to Failure?
There were an estimated 50,000 robotic prostatectomies performed in2007(1). It is projected that the number could double in 2008. Robotassisted laparoscopic prostatectomy (RALP) is now generally accepted byUrology as the "gold standard" of curative treatment for Prostate Cancer.Like conventional laparoscopic surgery to remove the prostate gland, "robotic"prostatectomy is presented and described as a "minimally invasive" procedure.Robotic surgery is possible due to some amazing technology. One excellentexample is the "da Vinci" system manufactured by Intuitive Medical, Inc. Thedevice is remotely operated by the surgeon. Television cameras inserted intothe abdomen provide multiple views and simulate three-dimensional vision. Therobot consists of small, articulating arms which can perform multiple tasks.Operating tools include suture, scalpel, cauterizing tool, etc. This is alaparoscopic surgical process and is considered to be minimally invasive.Promoters of robotic prostatectomy routinely use the term "promising" in theirexpectation that this device and procedure will eventually demonstrateimprovement in the cure rate for prostate cancer. Their enthusiasm isgenerated by the awareness that other curative treatments have a poor trackrecord to cure prostate cancer. This procedure is also accompanied in far toomany cases, by other negative side effects such as incontinence and permanenterectile dysfunction.
Robotic surgical technology and the procedure is still fairly new. Thereis as yet nothing dramatically different in performing the procedure or theresults compared to traditional laparoscopic surgery. However, armed withhope for improved results, the urology community has increased the rate ofthese surgeries, and their search for cancer at alarming rates. In 2000,there were 1500 robotic prostatectomies performed. Last year, 2007, it isestimated that 50,000 robotic prostatectomies were performed.(1) The rate ofprocedures is still climbing, with projected 80,000 or more roboticprostatectomy procedures in 2008. The number is staggering when you addrobotic surgeries to all other curative procedures performed which includeopen prostatectomy, conventional laparoscopic prostatectomy, radiation in allforms, radiation seed implantation, cryosurgery, thermometry, focusedultrasound ablation, etc. The significant cost of the robotic system may bedriving the search for new cancers in addition to an increase in the number ofsurgeries. A typical robotic surgery device costs $1.2M with annualmaintenance of approximately $120,000.00 per year.(2) In spite of thepopularity of this procedure, robotic prostatectomy has yet to deliver anyresults or evidence that it will provide any improvement over other treatmentsto cure prostate cancer.
A great number of urologists and academic centers promote early detectionand early curative treatment, citing a better cure rate.
Concurrently, the leadership in Urology and academic institutions have forseveral years expressed concern regarding "over treatment" of prostate cancer.Retrospective studies have revealed that a very high percentage, exceeding30%, of surgeries were performed for "insignificant" cancers.(3) In addition,physicians promote cure rates for robotic prostatectomy using statistics withonly five years of data. The failure rates for treatments of all prostatecancers become quite significant by 7 to 10 years. Without any evidence forimprovement in the rate of cure, surgeons are wagering on the hope that thisnew approach will deliver better results. As the numbers of treatmentsescalates, so will increased numbers of treatment failures and the devastatingside effects that accompany them. A seemingly incongruous announcement in apolicy statement released by the American College of Preventive M
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