SETTING THE RECORD STRAIGHT

Although Popular Mechanics is hardly the proper forum to enter into 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 misinterpretation 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. However, 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.