Beware of Wise Men Bearing Gifts

I’m sitting writing this the day after Twelfth Night, which in the Christian world is called Epiphany, when the three wise men arrived bearing gifts for the young Christ. The expression “Beware of wise men bearing gifts” comes about as the wise men supposedly told Herod of the location of Christ and Herod then set out to kill him.

Developments in prostate cancer treatment

Prostate cancer treatments have quite rightly moved on a long way in the past twenty-five years with the advent of much less invasive surgical techniques, new drugs and improvements in ways of delivering radiotherapy to the prostate which lies deep in the pelvis. In the last category comes the arrival of proton beam therapy (PBT) which competes with external beam radiation therapy (EBRT).

The cost of PBT is typically twice that of EBRT and amongst its claims are that the lower overall dose causes less damage to the other organs and tissue of the pelvis. Although relatively accessible in the US it’s still only available outside the UK’s National Health Service and therefore at significant cost to the patient. Just today in the UK’s Daily Mail is an article about PBT for prostate cancer claiming that PBT does not cause erectile dysfunction (ED), unlike EBRT¹.

Comparing PBT and EBRT

If you know anything about the three main treatments for localized prostate cancer you will have come across ED. It’s common following surgery, EBRT and in those having hormone treatment, also known as Androgen Deprivation Therapy. As awareness of prostate cancer grows we will see more young men being diagnosed who are more likely to wish to minimize their chances of ED and therefore take the claims of PBT more seriously.

So here’s the real crux of my concern with PBT. Before a new drug is launched it undergoes rigorous checks both for efficacy and safety, quite understandably. The trials are called random controlled trials in which patients do not know whether they are taking the new drug, the established older drug or in some cases no drug at all. The data gathered proves the value of the new drug.

You would, therefore, expect that before PBT was launched to treat prostate cancer it would have been trialed extensively to compare it with EBRT. It wasn’t. Not a single random controlled trial has been completed. Trials are underway, but right now there is no hard data that can point a patient firmly towards a choice of PBT over EBRT, as a study from UC Berkeley confirms².

Be an informed patient

“OK”, I hear you say, “I’ll drop the idea of radiotherapy altogether and go with surgery because that’s really common. Robotic surgery is the most modern technique, so that’s going to be best for me.”

Guess what? I’ve another surprise for you. There’s never been a random controlled trial to prove the benefits of robotic surgery over laparoscopic surgery either. While there’s plenty of data showing some short-term benefits such as shorter hospital stays, little blood loss, and fewer immediate complications there’s no really reliable long-term data that compares the two types of procedure.

The only trial is the Brisbane trial which only looked at two year results and couldn’t show that robotic surgery had any real advantages³. “The results were equal at 12 weeks and remained so at six, 12 and 24 months” it reported.

Talk to your doctor

So next time you are sat in front of a highly-educated medical professional, ask yourself this — what’s inside that gift he’s offering me? It might not be gold, incense or myrrh, just plain fresh air.