I have never met Dr. Bert Vorstman, a urologist in Coral Springs, FL, but he sounds like a doctor who is not afraid to speak his mind. In fact, he calls robotic prostate cancer surgery “a public health nightmare” and a “boondoggle for public health.”[i] These are strong words, especially coming from a surgically-trained urologist!
Dr. Vorstman is objecting to the mass marketing of a device before there has been any scientific data to support claims of its benefits. In fact, he sees the heavy promotion of the robot as part of the tremendously misguided overdiagnosis and overtreatment of prostate cancer in men who might otherwise do just fine to delay treatment, undergo a targeted treatment, or avoid treatment altogether. Dr. Vorstman cites new thinking about Gleason 3+3 prostate cancer, which often does not behave like cancer at all in the sense that it may never become aggressive. He implies that rushing such patients to an invasive whole-gland treatment is like going after a mouse with a nuclear weapon (my words, not his).
As I perceive what Dr. Vorstman is saying, I believe his bottom line is that many physicians still approach prostate cancer with a one-size-fits-all mentality. They treat every case of prostate cancer, no matter how low grade or early stage it is, as if it must come out of the body—the sooner, the better—and they have the device to do just that! I understand Dr. Vorstman’s concern. I consider the work that I do with multiparametric MRI-guided focal laser ablation to be a valuable alternative to the kneejerk cookie-cutter approach. I can’t count the number of men over the years who have come to me for an mpMRI consultation, saying, “After my biopsy, my doctor said he could take it out and be done with it.” They are amazed when I show them the location and size of their disease, discuss whether or not it’s significant (needs treatment), and what their treatment options are—including active surveillance.
Although my style is perhaps not as forceful and public as Dr. Vorstman’s, I applaud his courage in calling out the “many unscrupulous physicians misleading men about their cancer and the debilitating robotic treatment purposefully for self-gain.” Our efforts at the Sperling Prostate Center are based in our mission to offer men options for detection, diagnosis and treatment they would not otherwise know about. I would like to think that Dr. Vorstman and I would be pleased to make each other’s acquaintance.