In the UK, more men die of prostate than women die of breast cancer. There is no national screening programme for the former, while there is one for the latter (and one for cervical cancer, too, a much rarer cancer). The lack of a national screening programme for prostate cancer is sometimes explained as being the result of higher screening costs for prostate cancer, false positives and negatives, and the fact that prostate cancer usually strikes at a later age than breast cancer. To reveal the truth, we only need do a gender switch. Does anyone really believe that if testing for breast cancer was more expensive than testing for prostate cancer, and suffered the same rates of false positives and negatives, and mainly affected older women while prostate cancer affected younger men, there would be a national screening programme for prostate cancer, but not breast cancer? Of course not.
Investment in prostate cancer and treatment are scandalously low, as we’d expect for a male-specific disease. So it’s good to get some good news from time to time. A piece in The Times today by Tom Whipple, Science Editor:
Men, the robots are coming for your prostate. And that’s probably a good thing.
A British surgeon is offering a form of prostate surgery that, for the first time, virtually guarantees that men will stay continent. This is thanks to a robot in what, despite their increasing presence in hospitals, is believed to be the first operation that is impossible to perform without such assistance.
One of the biggest barriers to men agreeing to have their potentially cancerous prostate surgically removed is concern about side-effects. “For most men continence is No 1 after cancer control on their list of concerns,” Christopher Eden, right, said. “Potency follows pretty soon after.”
Both erectile dysfunction and incontinence are often an unavoidable consequence of prostate surgery, which involves cutting nerves and tissue around the bladder. However, if you can approach the prostate from below rather than above, most of that can be avoided. For a human surgeon, such a technique is impossible.
“You would need to have your head inside the patient’s pelvis; it’s a really small workspace,” said Professor Eden, a urology surgeon who practises privately at the Princess Grace Hospital in Marylebone, London, and on the NHS at Royal Surrey County Hospital. He has joined two other surgeons, in Italy and South Korea, in pioneering a new approach using surgical robots.
In the past ten years, robots have found their way into operating rooms around the world. They work by translating the actions of a surgeon at a console into the motion of tools inside the patient. With software to cancel out tremors their goal is to allow surgeons to work more precisely and safely. There is little proof so far, however, that they actually lead to better patient outcomes.
“What the companies say is, ‘If you really want an operation done well, it needs to be done robotically’. The evidence for that is pretty flimsy,” said Professor Eden, who thinks that much of the robots’ success has been due to patient demand. “If you put the word ‘laser’ or ‘robot’ into a sentence most men’s eyes light up.”
The new technique, called retzius-sparing prostatectomy, is different though, in that it would be impossible without robotic assistance. “The robot holds the camera steady, and gives you an unnatural view you cannot get with open surgery. It leaves completely intact all the anchor points of the continence mechanism, that historically we had to take apart.”
Research on 200 patients, all from the Italian surgeon, found that 90 per cent were continent, but Tim Windle, policy manager at Prostate Cancer UK, said that it was early days for the procedure, which Professor Eden has been carrying out for a little over a year.
“This technique sounds promising. However, published research has only looked at a small number of men,” Mr Windle said. “It will also be important to understand what type of training for surgeons will be required.”
For Nigel Ashdown, it was enough that one surgeon had the skills. He had sought out Professor Eden specifically, and was treated at the Princess Grace Hospital, which is part of HCA Healthcare UK. Speaking a day after the operation Mr Ashdown, 63, said that having an option to have surgery without the normal side-effects could save lives.
“There are men who would rather ignore prostate cancer, who don’t want to pursue it in case they get incontinent,” he said. “If they know it is possible to have an operation where the chances are that that won’t happen, I think men would be far more likely to pursue the surgery.”
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