EDITOR -- As a prostate cancer patient successfully treated by
radical prostatectomy, I was appalled by Peter Gotzshe's (1) dismissive
attitude to the condition and to surgical treatment. True, the total loss
of erection and some urinary incontinence are unwelcome, as are the side
effects -- gynaecomastia and perhaps a general loss of 'masculinity' -- of
subsequent treatment with a testosterone receptor blocker. But life is
still very worthwhile! And, as I know from my father's death from
prostate cancer in 1967, dying with paraplegia from spinal bone
secondaries is not a pleasant way to go. As I understand it radical
prostatectomy is most appropriate when actively malignant cells are
present but have not spread beyond the prostate capsule; this can be
reliably diagnosed by biopsy guided by ultrasound scanning. I hope no-one
will ever set up a randomized trial of radical prostatectomy in this
situation against no treatment or 'watchful waiting'. In my younger days
I believe I was one of the first to use matched double-blind trials (of
motion sickness remedies, for the Navy in the early 1950s): but I am
thankful that my treatment four years ago was guided by the judgement of a
good clinician.
Romaine Hervey Emeritus Professor of Physiology, University of
Leeds
Garth House, Beryl Lane, Wells, Somerset BA5 2XQ
(1) Gotzsche P C Commentary: Medicalisation of risk factors. BMJ
2002; 324: 890-1. (13 April)
[N.b. Modified 'o' in Gotzsche]
[Professor G. R. Hervey, Garth House, Beryl Lane, Wells, Somerset
BA5 2XQ
phone 01-749-670161, fax 01-749-678020, email g.r.hervey@btinternet.com
No competing interest.]
Rapid Response:
Prostate cancer: medicalization?
EDITOR -- As a prostate cancer patient successfully treated by
radical prostatectomy, I was appalled by Peter Gotzshe's (1) dismissive
attitude to the condition and to surgical treatment. True, the total loss
of erection and some urinary incontinence are unwelcome, as are the side
effects -- gynaecomastia and perhaps a general loss of 'masculinity' -- of
subsequent treatment with a testosterone receptor blocker. But life is
still very worthwhile! And, as I know from my father's death from
prostate cancer in 1967, dying with paraplegia from spinal bone
secondaries is not a pleasant way to go. As I understand it radical
prostatectomy is most appropriate when actively malignant cells are
present but have not spread beyond the prostate capsule; this can be
reliably diagnosed by biopsy guided by ultrasound scanning. I hope no-one
will ever set up a randomized trial of radical prostatectomy in this
situation against no treatment or 'watchful waiting'. In my younger days
I believe I was one of the first to use matched double-blind trials (of
motion sickness remedies, for the Navy in the early 1950s): but I am
thankful that my treatment four years ago was guided by the judgement of a
good clinician.
Romaine Hervey Emeritus Professor of Physiology, University of
Leeds
Garth House, Beryl Lane, Wells, Somerset BA5 2XQ
(1) Gotzsche P C Commentary: Medicalisation of risk factors. BMJ
2002; 324: 890-1. (13 April)
[N.b. Modified 'o' in Gotzsche]
[Professor G. R. Hervey, Garth House, Beryl Lane, Wells, Somerset
BA5 2XQ
phone 01-749-670161, fax 01-749-678020, email g.r.hervey@btinternet.com
No competing interest.]
Competing interests: No competing interests