Marketing therapies for prostate cancer – what is fair comment?

There is a page on the Dattoli Center website which lists and compares virtually all available therapies for prostate cancer at TREATMENT REFERENCE CHART

The relevant entries about surgery clearly make the point that surgery was at one time regarded – erroneously - as the best method of dealing with prostate cancer, but with failure rates up to 80% and surgery commonly leaving cells behind causing spread to the bloodstream it seems to be pretty poor choice. Here are the extracts from the page for ease of reference.

Surgery: The old “Gold Standard." Previously perceived as best method to eradicate any cancer. Misconception of guarantee that all cancer is gone. Many, however 40 – 80% of cases found to have more cancer after surgery is completed, requiring additional treatment. Pierorazio PM, et al, "Long-term Survival After [RP]...", Urology 2010 Mar 27, shows an 80% failure rate with high risk patients

Radical Prostatectomy: Surgical removal of bulk of the gland by incisions either retropubic or perineal. Physically removes the tumor from the body. (A psychological benefit.) Most aggressive surgery to be performed on the patient’s body but least aggressive treatment to the cancer. Commonly leaves microscopic tumor cells behind, may spread cancer cells to blood stream. Results have been reported for many years, as this was the only treatment for decades. Moul, J Urol,Vol 163, 2000 “30,000 men per year will develop recurrence after radical prostatectomy.”

Robotic “da Vinci” Laparoscopic: Uses “sophisticated” robotic equipment to remove gland tissue through small openings in the abdomen. Possibly easier to tolerate than major open surgery. Still surgery with similar outcome and side effects of open surgical procedure. Success very dependent on operator’s level of experience. Recent studies report a 3-fold failure rate at only 6 months, with increased complications compared with standard prostatectomy. Blute, J Clin Onc, (Mayo Clinic, Rochester MN) Vol 28, No 14, 2008 “patients have been led to believe ..outcomes are better, but is not the case.” Just another way to extract the prostate.

What about radiation therapies then, or the newer ones like Cryotherapy or HIFU (High Intensity Focused Ultrasound). Not so good – here are some extracts:

Cryotherapy: Cryosurgery: Cryoablation: As primary treatment, uses the process of freezing and thawing to destroy cancer cells. No cutting; performed on outpatient basis. Recent methods reduce risk of rectal injury. Can be repeated. Highest risk of permanent erectile dysfunction; some risk of incontinence, rectal fistula, and urethral sloughing. Cancers return and are frequently more aggressive after recurrence. Not recommended for cases where cancer is known or suspected to have spread beyond the prostate. Very few studies. Despite dating back to the 80s, there is still a lack of long-term data on cryosurgery. Long JP, Bahn D, Lee F "Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cyrosurgical ablation of the prostate." Urol 57:518-523, 2001

Proton Therapy: Uses Proton beams to kill cancer cells. Non-invasive, excellent treatment for tiny tumors of the eyes/brain. However advantages become disadvantages when treating large areas, i.e. prostate plus margins and lymph nodes. Risks of radiation “scatter,” not effective for targeting large areas (such as the prostate), a likely risk of secondary tumors from proton by-product – neutrons. Unable to adjust targeting to account for organ motion; unproven, expensive, limited availability No studies longer than 10 years and most are devoted to protons combined with photons. Hall, IJ, et al "Intensity modulated radiation therapy, protons, and the risk of second cancers," IJ Rad Onc Biol Physics, Vol 65 No 1, 2006 "When compared to photons, a 10-fold increased total body dose is delivered to the patients by neutrons."

Cyberknife® : Fancy name, actually a method of external radiation therapy. This involves what is known as “hypo-fractionated” dose delivery (fewer sessions but higher doses of radiation). Treatment usually delivered in only 5 fractions (treatment sessions). All extreme radiation hypofractionated studies to date reveal a high risk of significant complications including high incidence of urethral/rectal fistula, bladder damage, ulcerations, bone necrosis. No long-term results published (should be reserved for non-curative cases; patients who will not live long enough to suffer harsh complications). King CR, et al Stanford Univ.Sch of Med, "Stereotactic body radiotherapy for localized prostate cancer: interim results of a prospective phase II clinical trial," Int J Rad Onc Biol & Physics, 2009 Mar 15; 73(4): 1043-1048.

And on the page goes dismissing therapy after therapy, so what’s a man do do?

Why! Buy New Improved DART!! DART now with 4D IG-IMRT. True Dynamic Adaptive Radiation Therapy made possible only by numerous components of 4D image-guided intensity modulated radiotherapy (4D IG-IMRT)

New improved DART provides the most exquisite control of photon beams through SonArray, respiratory gating, cone beam helical tomography, on-board imaging and the "exact couch" functions.

Where can I get New Improved DART? This new level of technology in its most advanced "true" state is currently available at only one center - Dattoli Cancer Center.

Where can I see the long term results of New Improved DART? Evolutionary – in process, since 2008 (yet already “time-tested” since this is a dramatic improvement upon previous successful technology). There is a study, authored by our very own Dr Dattoli and Nurse Practitioner Cash, published in the prestigious Journal of Radiology Nursing – see Cash, J; Dattoli, M et al Radiology Nursing, vol 28, # 3; 87-95; Combined Modality Treatment for Prostate Cancer with Dynamic Adaptive Radiation Therapy. 2009

Is this good marketing? Are the options fairly presented to help a newly diagnosed man to decide what his best option might be? Or is this a marketing ploy focussing on the negatives for all but one therapy, a therapy that apparently does not have a long history or any independently published studies in peer reviewed journals?

They sure twisted the numbers.
I like this one: Many, however 40 – 80% of cases found to have more cancer after surgery is completed, requiring additional treatment. Pierorazio PM, et al, "Long-term Survival After [RP]...", Urology 2010 Mar 27, shows an 80% failure rate with high risk patients.
What a ridiculous comment. What's the "failure rate" for other treatments of high risk patients? Define failure. Define high risk.

Every statement they made is carefully worded to hide the good side of that particular treatment.
Here's some balance for you. A recent study by Jeff, et all, indicates the application of the Improved DART 4D shows a 100% failure in the treatment of broken arms and legs, and has no any effect in shortening the duration of flu symptoms.

The brief sounds like it was written by a lawyer and his marketing manager wife. Watch out.
Jeff

Interesting post and comments. There is always a certain amount of "puffery" in marketing materials. One would hope that it was limited in such a situation as medical treatment for a potentially deadly disease. However, that is not always the case. In the medical practice in question are any of the statements patently false? Or just stated in a way that bolster their particular point of view? There is so much conflicting information and contradiction in studies in the medical field that a patient is at a disadvantage without honest evaluation and discourse with the professionals. One must keep in mind that medicine is, afterall, a busness and not a charitable endeavor. Hopefully we find a physician who puts the patient's best interest above those of the business interest.

Don

 

Sonny, like they say: if it looks like a duck, walks like a duck, and quacks like a duck, its probably a duck. I am real big in trusting those inner gut feelings for the most part.

The fact that Dattoli uses these tactics to promote his business, using carefully selected dubious studies to support as negative a picture as possible of competing treatments while selecting equally dubious studies, many written by his own staff, supporting his "DART" linac, which, surprise surprise, is ONLY available at HIS treatment center.....

If he uses these tactics to denigrate his competition then you can be sure he is using equally twisted information to support his treatment outcomes..

By refusing to treat the difficult cases that are likely to have negative outcomes, a treatment center can make itself look very good indeed..His sales pitch comes right out of the playbook of any good carnival barker..

The problem with health care in the US is that the economic incentives pervert medical practice. If MDs make money by doing procedures, regardless of the outcome, well, unscrupulous doctors will advertise so that they can do more procedures. People often don't like University Hospitals, because the staff doesn't always seem eager to please. I bet at the Dattoli Center, they bend over backwards to please you, because they want your business. Maybe it's better to go to an MD that isn't quite so eager for your business.

Somehow, there has to be a change in how doctors get paid. Oh wait, that's "health care rationing", "socialized medicine", "death panels"--maybe we can't have a better health care system in the US because we can't have a practical discussion about fixing it, only a political, ideology driven one.

tud, i fully agree with your post

Great post Piano. Right on the mark. However, as with anything that we buy. We need to kick the tires, check the reputation and track record of the business. If there are compliants about their product, reputation or service, if they have deceptive sales practices or are dishonest, we shop elsewhere. Aggressive marketing is not, in and of itself, a concern (for me anyway) as long as the product or service is as advertised. If the sales pratcies are agressive, but customers are satisfied with the service, what's the problem. The question is the service. If it is so good, why is there a need for the agressive sales tactics? I think that you need to be more careful in checking out the quality of the product your getting. I know I will be if I am ever in the need of radiation treatment again.

I've never chosen a physician based on marketing strategy or sales pitch.  In fact, no doctor I've ever utilized has even remotely  had a marketing strategy or sales pitch.  They're just good doctors going about the business of helping people (and, yes, earning a pretty good living doing so, but given the nature of their work, I think that' fair).

I agree that the Dattoli propaganda is highly misleading and skewed in their favor, but the doctors I've known are not salesmen and have no reason to be.  To make a blanket statement such as "doctors are salesmen," seems completely foreign and inaccurate to me.  Maybe it would be better to say "some doctors" or "a few doctors," or even "many doctors," but not ALL doctors.  Good doctors in our communities don't need to advertise.  Patients flock to them because of word of mouth recommendations based on their madical proficiency and bedside manner.  Patients shun them if they're not good at what they do. 

I would certainly never have made a decision regarding treatment of my prostate cancer based on something I read on the internet or a piece of written advertisiing, anymore than I would buy a car based on a glossy brochure or a TV ad showing the car doing 360's and racing through city streets.

All of the procedures listed in this thread obviously have their merits and their disadvantages.  Anyone who thinks that any one of them provides a sure-fire guarantee against recurrence or SE's is surely not doing any critical thinking.  Caveat emptor is an old Latin saying that still applies in 2011.