Dear All,This article is written by Dr Mani Menon,who is few of the specialist in this field.You can visit his website www.drmanimennon.com for more details.
"In 2006, we published our technique of robotic radical
prostatectomy, the Vattikuti Institute Prostatectomy (VIP)
[1]. Since then, three new steps were sequentially incorporated
into the operation: enhanced nerve sparing (superveil)
inpatientswithfocal Gleason6cancer, bladderdrainagewith
a percutaneous suprapubic tube (PST) rather than a Foley
catheter, and preferential dissection of the internal iliac and
obturator nodes rather that the external iliac nodes in
patients with disease of lowormoderate aggressiveness. This
article focuses on the technical description of these refinements
and provides early outcomes."
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Prostate cancer deaths have gradually declined for the past 10 years - starting 10 years after the introduction of widespread PSA testing. The death rate is now lower than it was in the early 1970's and the decline is the reverse of the trend from the 1970's to 1990. To claim there hasn't been a significant decline in death from prostate cancer is patently false.
The studies themselves had a 9 year duration, and have numerous flaws including the use of PSA testing in both the "screened" and "unscreened" populations. And, in the European study, there is a 41% increase in the discovery of late stage (metastatic) prostate cancer. These men will likely die of prostate cancer in the next 5-10 years.
At the current rate of decline in the deaths of prostate cancer, there may come a time when there are no deaths. Will that be enough of a change in the mortality for news organizations to acknowledge that there has been a significant decline in mortality? Or will the dead have to start coming back to life?
Prostate cancer remains the second most common cause of cancer death in men - more than colon, leukemia, stomach, kidney, or liver. But not for long. As the mortality decreases, other cancers will take the place of prostate cancer. What will you say then? "Prostate cancer deaths are so low that PSA testing is counterproductive." That's like saying "Deaths from automobile crashes are so low that we don't need to wear seatbelts anymore."
Also, focusing ONLY on mortality ignores the morbidity of the disease - urinary retention, bleeding, infections, kidney failure, bone pain AND the morbidity of treatments for advanced prostate cancer.
When do we get to see the headline, "PSA testing has resulted in a dramatic decline in prostate cancer deaths"?