RO­BOT REDUX

Popular Mechanics (South Africa) - - Letters - DR F DU P BOEZAART UROL­O­GIST THE UROL­OGY HOS­PI­TAL, PRE­TO­RIA

Al­though Pop­u­lar Me­chan­ics is hardly the proper fo­rum to en­ter into to and fro aca­demic dis­cus­sions re­gard­ing med­i­cal con­di­tions such as the ap­pro­pri­ate treat­ment of prostate can­cer, the re­sponse of a Dur­ban-based urol­o­gist in your March is­sue to an ar­ti­cle con­cern­ing ro­botic surgery in your Jan­uary is­sue can­not be left unan­swered. Cer­tain state­ments can lead to mis­in­ter­pre­ta­tions by the lay pub­lic such as the ma­jor­ity of your read­ers.

Re­gard­ing screen­ing for prostate can­cer (which wasn’t even men­tioned in the orig­i­nal ar­ti­cle), it is true that there has been a lot of con­tro­versy in re­cent years on this sub­ject, but the orig­i­nal outright con­dem­na­tion of it as stated in the re­sponse has been tem­pered by the Euro­pean and Amer­i­can uro­log­i­cal as­so­ci­a­tions in their most re­cent guide­lines.

Re­gard­ing brachyther­apy for the treat­ment of lo­calised prostate can­cer, it is true that it is an ac­cept­able treat­ment op­tion that should be dis­cussed be­tween doc­tor and pa­tient. The orig­i­nal ar­ti­cle may have cre­ated the false im­pres­sion that its use is strictly lim­ited to poor sur­gi­cal risk pa­tients (al­though brachyther­apy in it­self wasn’t men­tioned, but ra­dio­ther­apy in gen­eral). Bear in mind that the in­tent of the ar­ti­cle was merely to in­tro­duce ro­botic tech­nol­ogy in medicine to your gen­er­ally me­chan­i­cally minded read­er­ship and not to dis­cuss the spec­trum of treat­ment op­tions. EUA guide­lines state brachyther­apy clearly as a treat­ment op­tion for low-risk prostate can­cer. To state that (it) has bet­ter out­comes for “all stages and grades” of prostate can­cer than surgery is a gross ex­ag­ger­a­tion and sim­ply not true.

The state­ment that “so-called ex­perts in their field do not of­fer brachyther­apy as an al­ter­na­tive” is also com­pletely un­true if he refers to the urol­o­gists at The Urol­ogy Hos­pi­tal in Pre­to­ria, where we do in­deed of­fer (it) at our hos­pi­tal.

Re­gard­ing the rather slan­der­ous ac­cu­sa­tion that the ro­bot is used for fi­nan­cial rea­sons, I can safely state that I am not aware of any hos­pi­tal in our coun­try that makes money out of the de­vice. It is a costly treat­ment op­tion (as is brachyther­apy) but we be­lieve that the ad­van­tages to our se­lected pa­tients of this min­i­mally in­va­sive sur­gi­cal pro­ce­dure far out­weigh the fi­nan­cial dis­ad­van­tages. Fur­ther­more the urol­o­gists’ re­mu­ner­a­tion for brachyther­apy and surgery (open, la­paro­scopic and ro­botic) in South Africa is equiv­a­lent de­spite the fact that there is a huge dis­crep­ancy in skill lev­els and time that it takes to per­form the pro­ce­dure.

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