Intended for healthcare professionals

Clinical Review

Clinically localised prostate cancer

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39022.423588.DE (Published 23 November 2006) Cite this as: BMJ 2006;333:1102

Organ removal is not necessary for cure of Cancer

In an otherwise excellent article summarising the treatment options
for prostate cancer, Wilt and Thompson, inadvertently promote an outmoded
surgical concept i.e. removal of an organ is essential for cure of cancer.
(1).

In discussing the disadvantages of external beam radiotherapy and
Brachytherapy, they imply that failure to cure with radiation is related
to not removing the prostate. There is no evidence to support this and
indeed cancer control rates with radiotherapy are equivalent to radical
surgery (2).

In many other cancers, radical mutilating surgery has not been shown
to improve cure rates. For example, in breast cancer, organ preserving
surgery and post operative breast radiotherapy is as good as radical
disfiguring mastectomy (3). Management of all cancer patients involves
consideration of quality of life and organ preservation can improve
quality of life.

Removal of an organ and its resultant commodity is unnecessary in
treatment of many cancers and indeed could be ethically indefensible in
some patients with cancers of larynx, anus and cervix. (4) (5).

References

1. Wilt JW , Thompson IM. Clinically localised prostate cancer. BMJ.
2006; 333: 1102-1106

2. Kupelian PA, Potters L, Khuntia D, et al. Radical prostatectomy,
external beam radiotherapy <72 Gy, external beam radiotherapy > or
=72 Gy, permanent seed implantation, or combined seeds/external beam
radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol
Phys. 2004; 58(1):25-33.

3. Fisher B, Anderson S, Bryant J, et al.: Twenty-year follow-up of a
randomized trial comparing total mastectomy, lumpectomy, and lumpectomy
plus irradiation for the treatment of invasive breast cancer. N Engl J Med
2002. 347(16): 1233-41.

4. Landoni F, Maneo A, Colombo A, et al.: Randomised study of radical
surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet 1997.
350: 535-40.

5. Forastiere AA, Goepfert H, Maor M, et al.: Concurrent chemotherapy
and radiotherapy for organ preservation in advanced laryngeal cancer. N
Engl J Med 349 (22): 2091-8, 2003.

Competing interests:
None declared

Competing interests: No competing interests

26 November 2006
Santhanam Sundar
Consultant Oncologist
Nottingham University Hospital. City Campus. Nottingham. NG5 1PB