Tuesday, October 13, 2009

More confusion about prostate cancer treatments

A new study raises more questions than it answers about the serious, long-term after-effects of surgery for prostate cancer.

The study finds that men who undergo the less invasive, laparoscopic surgery tend to have a greater chance of impotence and incontinence than those who have surgery by traditional methods.

Published this week in the Journal of the American Medical Association, the prostate surgery report finds that men who choose minimally invasive surgery had a lower rate of blood transfusions and internal scarring, as well as shorter hospital stays.

After 18 months, however, the men who had minimally invasive surgeries reported a high incidence of incontinence and erectile dysfunction.

The minimally invasive surgery includes, but is not limited to, the da Vinci robotic system that is gaining widespread support. Other types of laparoscopic surgery is performed by hand.

It's unfortunate that the researchers lumped all types of minimally invasive surgery together in the report, rendering it totally useless for anyone trying to make an informed decision about what route to take for cancer treatment.

Many doctors tout the da Vinci system as superior to other forms of hands-on laprascopic surgery; this study does nothing to prove or disprove that.

The study by Dr. Jim Hu of Brigham and Women's Hospital in Boston also did not take into account the several forms of radiation or hormone therapies that are used in cancer treatments.

According to the AP, Hu analyzed the Medicare data for nearly 9,000 prostate cancer patients who had surgical treatment from 2003-07. Of those, 1,938 patients had minimally invasive surgery and 6,899 patients had standard surgery. Note that since these were Medicare cases, the age of the men involved was probably older than the average age of men who undergo prostatectomies.

Among the results, diagnoses of incontinence was 15.9 (minimally invasive) vs. 12.2 (standard) per 100 person years and erectile dysfunction was 26.8 (minimally invasive) vs. 19.2 (standard) per 100 person years. (The rate of "100 person years" is primarily for comparison. It's the rate for 100 people for 1 year, or 1 person for 100 years, or however else you want to divide it.)

Said Hu:

"The take-home message for men is they need to dig deeper than simply the message they might be getting from planted stories from device manufacturers or radio ads or billboards."

Unfortunately, this study itself doesn't dig deep enough.

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