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Claus Roehrborn, M.D. Answers Questions On Prostate Cancer

Claus Roehrborn, M.D. Answers Questions On: Prostate Cancer

What are the next big breakthroughs in the treatment of prostate cancer?

In prostate cancer, the one thing that seems to be getting everyone’s attention is the idea of not removing the whole prostate, but treating half the prostate or a portion of the prostate, namely the portion with cancer. One of the absolute prerequisites for doing that is having a way to image the cancer so that you can tell precisely where it is. That’s one of those elusive goals that everyone is trying to find. Once we do that, then we can treat the cancer with some type of ablation — either freezing it, using high-intensity focus ultrasound, or some such manner.

Do robotic prostatectomies carry more risk than traditional open surgical procedures?

ln my experience, no. In one study of a large sample of Medicare patients, it was found that those who had robotic surgery had a higher rate of incontinence and impotence than those who had the standard open procedure. But the problem with the study was that during the time the observations were made, there were many doctors in their initial learning phase regarding robotic surgery. So they weren’t yet experts in it, but they were compared with expert open surgeons. Like anything else, you have to have a certain degree of experience to get good at one thing or another. I estimate 95 percent of my patients undergoing robotic prostatectomies end up with urinary control the same as before the surgery, and up to 75 percent have potency restored to the point of being able to have intercourse.

Do you agree with the U.S. Preventive Task Force recommendation against PSA screening for prostate cancer?

The Task Force consists of 16 physicians, pediatricians, family physicians, geriatricians, epidemiologists, and statisticians, public health officials, obstetricians, nursing personnel, and others — but no medical or radiation oncologists and no urologists. In my opinion, PSA testing does have value. Is it the key that unlocks the secret to your health? No. It’s just one of many tests that your health care provider may decide to order in a shared decision-making process, to help with the management of your prostate health or prostate diseases. Let’s not throw out the baby with the bathwater by saying PSA mass screening of the population is not useful, and therefore, PSA testing is altogether bad. PSA testing can serve a very meaningful and useful role in many situations.