Data-less opinion gets too much space in Forbes this week


A misleadingly titled op-ed in Forbes magazine this week by two very committed prostate cancer surgeons reflects the sad lack of reality exhibited by some representatives of the clinical treatment community.

No one is arguing today whether surgical “Removal of a cancerous prostate is now possible with a rapid return of both continence and sexual function.” We all know that it is, with or without a daVinci robot. Indeed, if you select the right patients, this has been possible since Pat Walsh carried out the very first nerve-sparing radical prostatectomy in 1982. But the fact that it is possible does not mean that it is done effectively, safely, and in the most appropriate patients all the time (even by the two authors of the Forbes article). It means that it can be done in some patients, who still lose normal orgasmic function and may suffer other side effects of treatment that the authors fail to mention at all. And if it is being regularly attempted by surgeons who are less than completely expert, this risk for complications and side effects is far from negligible.

Forbes should know better than to give space to such a sales pitch.

The two surgeons in question are entirely entitled to their opinions, but if they really believe what they write in the first part of their article, why on Earth do they include the piece at the end that states, “It still makes sense to carefully consider all options before proceeding.”

The only reason to do that is because they are in fact wrong when they state, earlier in their article, that robotic prostatectomy is “the definitive treatment and best chance at a cure in the right hands” and that CyberKnife radiation therapy “is an unproven flashy treatment that is at best a salvage approach when surgery is unsuccessful.” If surgery is as good as they are suggesting, how can it possibly be “unsuccessful”? And, interestingly, the idea that CyberKnife radiation would be an appropriate form of salvage radiation therapy for a man who had failed surgery appears to demonstrate a sad lack of understanding of the appropriate use of stereotactic body radiation therapy, which would only be appropriate for salvage radiation therapy if one knew with absolute certainty that recurrence had been caused by a singular focus of unexcised cancer cells within the prostate bed — a clear implication of surgical failure!

Alas, the authors offer not a single piece of data to substantiate what is little more than a poor and biased advertorial for what they do for a living … and an advertorial that completely ignores the sensibilities of patients who may (and commonly should) value the quality of their lives at least as highly as the fact that someone can remove their prostate efficiently using a robot.

We get the impression that CyberKnife radiation therapy may be starting to do to daVinci surgeons what daVinci surgeons had previously done to practitioners of open surgery. And we would point out that in neither case is there any specific evidence to suggest that any one technique is “better” than the other for the treatment of localized prostate cancer. There are no comparative data … nor does anyone with the power to do anything about it seem to feel that the development of such data would actually be of value. Alas!

7 Responses

  1. This dangerously simplistic and misleading article reminds me of a typical reaction I got from several friends when I told them I had prostate cancer. It was, “Don’t worry, prostate cancer is one of the most easily cured cancers, 50% of the patients don’t die.”

    When I told them that I would prefer to see results subdivided according to the standard parameters and risk categories, they were stymied. They are not stupid, just ignorant of the complexity of analysis. This article can only fuel a similar lack of knowledge, which can be a partial cause of death.

  2. Yes, and your friends were actually wrong. Far, far, far fewer of men diagnosed with prostate cancer will die from prostate cancer. The most recent American Cancer Society data use the statistics that while 1 in 6 men will be diagnosed with prostate cancer, 1 in 36 men will succumb to the disease.

    Your friends must have been confusing the relatively low level risk for mortality with the extraordinarily high level risk for morbidity of sexual function, which is a flip of a coin at best — and mostly a burden placed upon those who didn’t need to bear it in the first place.

    This is an incredibly irresponsible spew of self-promotion (and yet I immediately began researching the SMART method — pathetic the sway these gods hold over us mere mortals). And is the frequent commenter on the Forbes site “THE Pat Walsh”? If so, boy howdy, the pro-surgery community really gave the old, rich white guys community the ol’ one, two punch with that advertorial. There will be no love for the ladies on the Upper West tonight (or any night)!

    Seriously, if these physicians want to take out full page ads in high end demographic magazines to promote their techniques and outcomes, good on ’em, it’s their ca’ching.

    However, most men in this country can get to some surgeon with access to a da Vinci. And most of those surgeons won’t know diddley-squat about the SMART technique or even how to competently run the machine. And most men who are subjected to the technology without the skill will be SOL (“so outta luck”)when it comes to recovering their capacity for life’s most basic functions — and may or may not have their prostate cancer under control.

    And I do feel some compassion for the thousands of readers of Forbes who will file the unsubstantiated, unscientific “gold standard” claim away in their brain cache and use it as a needling question whenever they may be faced with reality of the research on prostate cancer over-diagnosis and over-treatment. These doctors will in all likelihood realize paying patients that did not require treatment out of this advertorial. How can that be right?

  3. Thanks Tracy, your spirited yet properly derisive approach to such articles is, in my opinion, exactly what is needed. Although the subject is serious, I’m laughing. Well, I have no idea where my friends got the claim from. Certainly not from considerations of anyone’s sexual function. For all I know that 50% might have been approximately correct, since all of us lived in the Netherlands then, not in America. I don’t know what the Dutch statistics were, and I don’t care; I live elsewhere now. But seriously, I was then fully aware of the parameters by which prostate cancers are assessed. So even if that statistic is correct, it is misleading. It would be more helpful to give a man some information based on that man’s specific parameters; the division into risk classes is not that difficult. Indeed, not to do so can cause false hope of survival and block a rational choice for treatment. Perhaps that was the writers’ intention: to attract customers. If so, it’s a health hazard.

  4. I’d like to point out that the prostate cancer patient and advocacy world is similarly guilty of this type of “advertising.” There are many that feel that there is “the one” doctor or only a select few that can truly be great at treating prostate cancer. I have found this to also be on the same level when it gets as over-emphasized as I have witnessed.

    It’s is true that 50% of doctors are below median average. It’s also true that doctors who work outside the medical institution, demanding cash payment because they charge more than the carriers will pay, have never been proven to be any better than those at great centers of excellence in prostate cancer therapy. In fact, seldom if ever do these doctors publish research papers that can be found on PubMed or in the well-known and respected medical journals. And just say the word “Medicare” and your call will end soon.

    I’m sure to get push back on this. …

  5. Tony:

    I would concur that some members of the patient community become passionately focused on the supposed benefits of a particular type of treatment (sometimes to the exclusion of rational thought and data-based evidence to the contrary). It is less common, however, to come across patients today who argue that “only” Dr. X or Dr. Y knows what he (or she) is doing when it comes to prostate cancer (although I have certainly come across these advocates too).

    The latter is more likely when only a very small number of physicians is offering a specific type of treatment. Thus, in the early days of things like cryotherapy and nerve-sparing radical prostatectomy, it was certainly true that patients would tell others that “only” Dr. X or Dr. Y was capable of practicing those forms of treatment with the requisite level of skill — and there was probably some truth to that. The speed of dissemination of new technology today has tended to eliminate that type of historic exclusivity.

  6. What a bunch of crap!!!!!!!!!!!!!

  7. Dear Dr. Chodak:

    Are we to assume that this is an expert medical opinion on the ruminations of the physicians writing in Forbes?

    :O)

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