Prostate Cancer Canada calls for caution
Don’t close door on robotic prostate surgery
A decision of this magnitude, we feel, requires more information than is currently available ROCCO ROSSI
Understandably, men with prostate cancer in Ontario are expressing concern over the fact that their voices went unheard when a recommendation against public funding for robot-assisted prostatectomies was made in July of 2017 by the Ontario Health Technology Advisory Committee (OHTAC). Men who have undergone prostatectomies of all forms should undoubtedly be included in such important policy-shaping discussions.
At Prostate Cancer Canada, we firmly believe in the importance of actively including individuals with direct experience in decision-making processes that will have an influence on the future of prostate cancer care. As we’ve learned from the inclusion of individuals with lived experience (survivors, caregivers, etc.) into the decision-making bodies we employ when deciding how to allocate generous donor dollars, their perspectives provide invaluable insights that might not have otherwise been considered.
The rationale put forth to support OHTAC’s recommendation is, however, quite measured and in keeping with the available evidence. To date, there is very little evidence from the few completed studies that have compared robot-assisted and open prostatectomies to suggest that robot-assisted prostatectomies improve survival, reduce side-effects and complications, or justify the additional cost to the health-care system.
A Cochrane systematic review that compiled the results of the only two major studies covering this very topic was published earlier this month and arrived at the same conclusion as the OHTAC. Internationally recognized as the highest standard in evidence-based systematic reviews of primary research in human health care and health policy, the following were its key results:
“We found no evidence as to how (robot-assisted surgery) compared (open surgery) in terms of reducing the risk of dying from prostate cancer, preventing the cancer from coming back or dying of any cause. Mens’ quality of life was likely similar related to their urinary and sexual function. There appears to be no differences in postoperative surgical complications. (Robot-assisted surgery) may have a small possibly unimportant effect on postoperative pain at one day and up to one week. However, no difference between (the two) was found at 12 weeks post-operatively. Men having (robot-assisted surgery) likely have a shorter hospital stay and may need fewer blood transfusions.”
The full Cochrane review can be found at www.cochrane.org.
While the current evidence makes a compelling case against public funding for robot-assisted prostatectomies, we urge caution against closing the door just yet. A decision of this magnitude, we feel, requires more information than is currently available. Prior to adopting the OHTAC’s recommendation as public policy, Prostate Cancer Canada looks forward to the results of further research conducted in the form of controlled clinical trials with the express purpose of comparing the different types of prostatectomies and their respective outcomes. We also recommend reconsidering the decision to exclude direct prostate cancer patient engagement from the equation. As both taxpayers and the ones who have been in the trenches, these men and their families deserve to have their voices heard. When weighing decisions that will have a direct impact on the provision of publicly funded health care, we should first, as a rule of thumb, err on the side of gathering as much information as we possibly can.
Rocco Rossi is President & CEO, Prostate Cancer Canada