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Sit back & watch urologists go at it over robotic surgery claims

I’m on vacation this week but I enjoyed sitting back and watching a urology kerfuffle over claims about a robotic surgery study and associated news release.

Here’s what the American Urological Association (AUA) tweeted earlier today.

 The Twitter responses are from a Pittsburgh urologist whose Twitter handle is @daviesbj.

There’s a lot going on here, so let me break it down.

The AUA’s link – in its Tweet – goes to a news release from David B. Samadi, M.D, Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital.  He cites a study published online in the July issue of European Journal, “Oncologic Outcomes at 10 Years Following Robotic Radical Prostatectomy.”  Samadi wasn’t involved in that study.  But he has a sterling track record of self-promotion, as we’ve written in the past.  The Samadi news release states:

According to a new study from Detroit, Michigan, robotic prostatectomy yields highly successful long-term prostate cancer results. In fact, nearly all — 98.8% — of the patients remained prostate cancer survivors at ten years post-surgery; results comparable to the more invasive surgical method used in the past.

That’s what even urologist Davies reacted to.

Richard Hoffman, MD, MPH, FACP

My gut reacted immediately.  But I’m not supposed to be working – and besides, I have no funding now anyway – so I leaned on one of our past content experts, Dr. Richard Hoffman, to comment on the study. Hoffman isn’t a urologist.  He has been Interim Director for Cancer Prevention at the University of New Mexico Cancer Center. And his areas of research interest are prostate and colorectal cancer screening and prostate cancer treatment outcomes, with expertise in clinical epidemiology, health services research, and meta-analysis. He has helped develop shared decision making tools for prostate cancer screening and treatment of localized prostate cancer.

He wrote me:

“The AUA does misrepresent the data.  The 98.8% refers to the proportion of subjects who had not died from prostate cancer.  Only 73.1% were biochemically free of cancer, meaning that the rest had a rising PSA suggesting cancer progression/recurrence.  

The observational design means that investigators cannot make any meaningful comparisons of robotic surgery results with those obtained by open prostatectomy,  Thus, Samadi’s comment that robotic prostatectomy is “a preferred treatment” is not based on convincing evidence, just on the “preferences” of surgeons and patients who see the surgeons’ ads.  

The investigators did not address treatment complications, which occur frequently (particularly erectile dysfunction, urinary incontinence) and adversely affect quality of life.  The issue of treatment harm is particularly important for this study because–based on Gleason score, PSA levels, and clinical stage–a substantial proportion of these men had low-risk prostate cancers.  The optimal treatment for such men is actually active surveillance, meaning that they would be monitored closely and offered active treatment only if there was evidence of disease progression.  While the study shows good surgical outcomes, many of the men likely would have done well without any treatment.”

Gee, that’s quite a different story than what the AUA tweeted, and what Dr. Samadi’s news release stated.

Let’s see how the urologists duke it out.

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