Urologist speaks out


In an era when the number of prostatectomies is on the rise, one urologist is declaring it’s time to hold the knife.

Dr. Bert Vorstman, a Florida urologist with nearly 30 years experience, has made reducing the number of men who go under the knife for prostate cancer a personal cause.

In a release titled, “Prostate cancer surgery myths and … lies, lies and more damned lies,” Vorstman outlines his reasons men should wait before readily agreeing to surgery when they receive a positive diagnosis for prostate cancer.

The number of prostatectomies done between 2005 and 2008 increased by nearly 50 percent after actually beginning to decline in number between 1997 and 2004, according to the American Urological Association. Between 1997 and 2008, the incidence of prostate cancer actually dropped by 2.2 cases per 100,000 men. The increase was blamed on the adoption of robotic-assisted laparoscopic procedures and driven by concentration of the technology at medical centers that proceeded to  do cases in high volumes, according to a 2012 report in the medical journal Cancer.

“Although offered with curative intent, it is known that there is NO scientific validation for significant curative life extension after radical surgery/robotics for prostate cancer,” says Vorstman. “In fact, this one surgery is associated more with permanent complications (especially incontinence and impotence) than probably any other operation ever performed on humans.”

Vorstman says men who’ve been told they have prostate cancer are often urged to make a treatment decision quickly, with surgery presented as the optimal treatment option. It’s important, he says, for patients to understand that prostate cancer grows slowly and to take time considering and researching their options.

“Though the second leading cause of cancer related deaths for men, only some 7 percent of men treated will actually die from prostate cancer,” he says. “Clearly, prostate cancer is not going to ‘spread’ while a man enters a period of active surveillance seeking out second opinions and empowering and educating himself on treatment options.”

For those who do jump quickly into surgery, the results aren’t pretty.

“I’m sure that there are some men who claim no complications following radical surgery/robotics for their prostate cancer. However, in addition to shortening of the penis and a high rate of residual cancer in men after radical surgery/robotics, many men are often too embarrassed to admit to post operative urinary leakage and issues of a sexual nature,” Vorstman says. “These quality of life issues clearly underscore the fact that surgery/robotics is no panacea for prostate cancer treatment.”

The only reason surgery is considered the “gold standard” for prostate cancer treatment is that it is the old standard, he says. And that, Vorstman concludes, is not a good reason to hop on the bandwagon.

“Surgeons as well as marketers continue to promote robotic technology for radical prostatectomy by a creative spin, using such terms as ‘advanced,’  ‘minimally invasive,’ and ‘superior outcomes,’” he says. “The sad truth is that prostate cancer surgery is solely responsible for the worldwide increase in urinary incontinence and impotence but without the benefit of curative life extension.”

In contrast to the issues with surgery, patients who have been treated with proton therapy rather than surgery have seen increased longterm cure rates as well as a drastic reduction in side effects from treatment.

In a study of more than 200 prostate cancer patients treated with proton therapy, the University of Florida Proton Therapy Institute showed 99 percent cancer-free survival rates five years following treatment for low- and intermediate- and 76 percent survival rates for high-risk patients. Additionally, just 1.4 percent of patients experience serious gastrointestinal complications and 5.3 percent had urologic problems. Patients also reported good outcomes for both urologic and bowel function.

There ARE better alternatives to surgery for prostate cancer, and we believe proton therapy is at the top of the list.