Dr. Dan Sperling Speaks Out About Robotic Surgery, Proton Beam

What makes an expensive prostate cancer treatment worth its cost? Dr. Dan Sperling, an authority on minimally invasive, MRI-guided biopsy and treatment for prostate tumors, challenges the high cost of two newer treatments that don’t have a clinical edge over less costly therapies. In an editorial he reviews two articles exploring high dollar outlay vs. benefits for proton beam radiation and robotic surgery.

Dr. Sperling questions the use of very expensive treatment for prostate cancer when the U.S. healthcare system is already overburdened. Currently, Medicare pays about twice as much for proton beam radiation (,000) as for other types of radiation. He acknowledges that proton beam is excellent for some rare cancers, but for prostate cancer it lacks long term data on success and side effects. He says, “Further research is needed to justify the cost of proton beam for prostate cancer, study that should be covered by industry and grants, not Medicare payments.”

Dr. Sperling also points out that the so-called advantages of robot-assisted prostatectomy (surgical prostate removal) may be “overhyped.” He writes, “…the issue is whether robotic prostatectomy offers clear benefits over other techniques,” pointing to a recently published study showing that open surgery vs. robotic surgery had the same rates of incontinence and impotence. As for the healthcare system, a single robotic device adds over a million dollars to the costs.

The crux of the matter, then, is the lack of economic justification for treatments that are either not yet clinically proven over the long term, or that may not offer significant reduction in side effects. He suggests that for select patients whose prostate tumors are detected early when they are still contained and small, there are less expensive, minimally invasive therapies that offer comparable success with conventional treatments, yet have very rapid recovery and low-to-no risk of urinary and sexual side effects.

As Dr. Sperling writes, “I am convinced [we] are on the right track in two crucial areas: combating disease, and combating the wasteful spending for costly treatment options that may come with a higher risk of hidden, lifestyle costs.”