Has surgery changed for PCa in the past decade?

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Dick Smith - 10 Aug 2005 03:27 GMT

I read messages about how in five years, things will be much better in
terms of PCa surgery. But looking back 10 years, has surgery really
changed for PCa? Assuming everything else from diagnostic technology to
post surgery follow up, stayed the same. What has really changed?
Robotic and LRP are fairly new, but does it really result in better
outcomes?

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ron - 10 Aug 2005 03:48 GMT

> I read messages about how in five years, things will be much better in
> terms of PCa surgery. But looking back 10 years, has surgery really
> changed for PCa? Assuming everything else from diagnostic technology to
> post surgery follow up, stayed the same. What has really changed?
> Robotic and LRP are fairly new, but does it really result in better
> outcomes?

Dick...Walsh and his team were the first to note what has become known
as the "year of RP factor". When the outcomes of men with a certain
GS, PSA and TNM stage treated by RP are compared over time, Walsh found
that the outcome improved as we move closer to the present time
(Walsh's data covered 1982-1998). Walsh offered no explanantion in
terms of surgical changes, or any other variable for that matter, it
was just something teased out of the data. Scardino and Kattin have
corroborated Walsh's findings.

Even 5-year biochemical recurrence data for LRP and Robotic RP has not
yet been published, so one cannot say that they are better or worse
than standard RRP. They are not the explanation behind the observed
improvement in RP outcomes over the last 20-25 years...Best wishes and
good health, Ron

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Dick Smith - 10 Aug 2005 05:45 GMT

Ron, my understanding is that Walsh was referring to the benefits of
earlier detection via PSA. Once the PSA era was included in the PCa
surgical statistics, the outcomes improved...Or am I missing something
here...

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ron - 10 Aug 2005 15:00 GMT

Dick...Walsh says, "We have previously demonstrated the decreasing
relative risk of
biochemical recurrence following surgery in the modern era.9 That
change may reflect the benefits of early detection, better preoperative
selection of patients for surgery as well as lead time bias.9 In the
current study we attempted to delineate whether downward stage
migration alone could account for the improved therapeutic outcome over
time. When the relative risk of biochemical recurrence was adjusted for
clinical
TNM stage, preoperative PSA and Gleason score, there was still a
significant decrease in relative risk of biochemical recurrence over
time (see figure)." To me, this means that earlier detetction due to
PSA screening, etc., which has led to downward stage migration and
improved surgical outcomes, cannot alone explain the entire improvement
in outcomes over time. There must be an additional factor; this factor
has been termed "year of RP" factor...Best wishes and good health, Ron

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Leonard Evens - 10 Aug 2005 15:27 GMT

I think Walsh mentions some new insights about how to do surgery in his
book, but there didn't really seem to be anything earthshaking.
Nothing, for example, like the improvement in radiation results achieved
by increasing radiation dosage to the prostate while avoiding
surrounding tissue by new techniques. The study Ron mentioned
suggested there may be some not very well understood improvement. But
it seems to me it is still basically the same procedure it was ten years
ago, but that more practioners are doing it at the top level.

I don't see any reason to believe that five years from now surgery will
be substantially more effective at curing prostate cancer. But what may
happen is that physicians may be better able to distinguish those cases
for which surgery is likely to be helpful from those needing no
treatment at all.

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