Drs. Shteynshlyuger and Kibel cover several valid points regarding cancer control
rates, morbidities, and adjuvant radiation for prostatectomy. I agree that in good
hands, both prostatectomy and brachytherapy afford very high, durable cancer control
rates (
1
,
2
). I have little argument with most of their statements. However, their points in no
way diminish my concerns over the wildly variable results reported for prostatectomy,
even from big-name institutions. Highly variable surgical quality includes perioperative
complications, cure rates, and long-term incontinence (
3
,
4
,
5
). Inconsistent quality appears to be far less with brachytherapy and can be minimized
with attention to postimplant dose analysis (with touch up of inadequate implants).
In contrast, the path to minimization of surgical quality variance is hazy, other
than the volume of cases accrued by each surgeon (
[5]
). I would not want to be the 28th patient of a recently minted robotic laparoscopic
surgeon.To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to BrachytherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Natural history of clinically staged low- and intermediate-risk prostate cancer treated with monotherapeutic permanent interstitial brachytherapy.Int J Rad Oncol Biol Phys. 2010; 76: 349-354
- Oncologic outcome after extraperioneal laparoscopic radical prostatectomy: Midterm follow-up of 1115 procedures.Eur Urol. 2010; 57: 267-273
- Utilization and outcomes of minimally invasive radical prostatectomy.J Clin Oncol. 2008; 26: 2278-2284
- Analysis of continence rates following robot-assisted radical prostatectomy: Strict leak-free and pad-free incontinence.Urology. 2010; 75: 431-438
- Impact of hospital and surgeon volume on mortality and complications after prostatectomy.J Urol. 2008; 180: 155-163
Article Info
Publication History
Published online: July 01, 2010
Identification
Copyright
© 2010 Published by Elsevier Inc.
