Marketing surgery during Prostate Cancer Awareness Month

If I was the VP of marketing for Intuitive Surgical — the makers of the da Vinci surgical “robot” — I would probably have done what the company has just done, which is to partner with a national cancer organization to promote prostate cancer awareness while linking such awareness closely to awareness about robot-assisted laparoscopic prostatectomy (RALP). It’s a “no-brainer.”

I would “look good” by supporting and encouraging donations to a high profile cancer organization. I would expect to look good to the prostate cancer advocacy community by supporting Prostate Cancer Awareness Month. And I would look good to many urologists and to my bosses because I would have found a relatively low cost mechanism to promote awareness of RALP.

Of course, it is also open to question whether this really leads to “good medicine.” If much of the most recent data is correct, it is likely to be the case that significantly fewer than half of the men currently diagnosed with prostate cancer each year in the USA need treatment at all, because they can be managed in a conservative manner using some form of expectant management. A small percentage of men are always going to be diagnosed with advanced disease — and for the majority of these men, surgery of any type may be questionable. So this means that something of the order of 75,000 newly diagnosed men may actually need interventional treatment each year, and we have multiple forms of treatment which will be suitable for most of these men — of which RALP is only one.

The increasing evidence that early stage, low risk prostate cancer is being “over-treated” — most particularly in men with a life expectancy of less than 15 years — is a real problem for the manufacturers of a variety of high technology equipment, including the da Vinci robot, the CyberKnife system, proton beam radiation systems, and high-intensity focused ultrasound equipment. How does one justify the costs associated with such technology (in a hospital or in a self-standing radiotherapy unit) in a declining market? Will insurers and other payers be willing to go on “footing the bills” when there is increasing evidence that application of such technology may not be producing the outcomes that are really needed? What will happen if the “Baby Boomer” generation decides that expectant management is the “way to go” for the management of more than half the cases of prostate cancer that get diagnosed each year?

The other question that may start to arise is whether some of the major advocacy groups — focused as they certainly are and should be on the importance of new diagnostic and prognostic tests that can help to distinguish between aggressive and indolent disease early in the diagnostic process — “get religion” and decide that they can no longer partner with organizations that have a very specific commercial interest in maximizing early interventional treatment for prostate cancer? There is a strong argument to be made that accepting commercial money to support educational initiatives that do not clearly spell out the fact that early treatment may be highly inappropriate is hypocritical at best and unethical at worst.

Prostate Cancer Awareness Month, given the information available today, should be about real awareness of the risks for prostate cancer and the risks associated with potentially unnecessary treatment. We are all too well aware, now (even if we weren’t before), that the downsides of treatment for the individual patient may be more significant than the upsides. If this isn’t made clear to potential prostate cancer patients, we do them no favors by bringing a specific form of treatment to their notice. According to the Intuitive Surgical media release, “Hundreds of hospitals nationwide are participating in the [da Vinci Surgery] Awareness Initiative through various locally sponsored events designed to increase awareness and featuring varied activities including cancer screening, guest speakers, health fairs, family and sports events.” But the only form of treatment for prostate cancer referred to on the Awareness Initiative web site is da Vinci surgery. That does not seem to be right or proper, and nor does the fact that there is no evidence of a link from the daVinci site to any prostate cancer-specific advocacy or patient education web site — but then we have no one to blame for that but ourselves!

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