LEADING urologists have rejected claims that commercial interests are influencing the management of prostate cancer and say that over-treatment causing impotence and incontinence is being minimised.
On Tuesday, Melbourne cancer specialist Ian Haines said prostate cancer treatment had been hijacked by commercial interests, causing many men to be ”over-diagnosed” with low-risk disease that led them to have damaging surgery unnecessarily.
An Associate Professor of Medicine from Monash University, he said PSA (prostate specific antigen) tests and Gleason scores to diagnose and score prostate cancers were unreliable and he criticised the marketing of expensive robotic surgery, saying it was only marginally better than standard prostatectomy procedures.
Professor Tony Costello – the Melbourne urologist who pioneered robotic surgery for prostate cancer – yesterday described his comments as ”provocative” and stood by prostate cancer tests for many men and robotic surgery for prostate removal.
He said while hospitals had to ”claw back” the millions of dollars invested in robotic surgical equipment, in his experience, it did not influence surgeons’ advice to patients.
Furthermore, he said while no data had been published yet, he had found robotic surgery to be better for his patients, reducing rates of impotence and incontinence two years after surgery.
Professor Costello said growing evidence of over-treatment had caused a shift to more surveillance and less treatment for men with low-risk cancers. He said a registry set up to track cancers in Victoria showed about half of the 5500 men diagnosed in Victoria last year were being monitored to see if the cancer got worse. This showed urologists were acting in their patients’ best interests, he said. ”If you get a positive biopsy for prostate cancer in Victoria, 46 per cent are getting surveillance … and you’re more likely to be put on surveillance in private practice than you are in the public system, so there’s no commercial advantage,” he said.
Monash Medical Centre urologist and a spokesman for the Urological Society of Australia and New Zealand, Associate Professor Mark Frydenberg, said Gleason scoring was a reliable way to differentiate low, intermediate and high-risk cancers, allowing some men to have life-saving treatment. However, he said men deciding on treatment should seek various opinions because robotic surgery only offered marginal benefits. ”The differences to date are not huge. The complication rates for continence and potency appear similar,” he said.
Several men contacted The Age yesterday with stories about prostate testing and treatment, including one man who was told he did not have cancer after having his prostate removed.
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