Provenge Later vs. Robotic Prostatectomy Now

13 July 2011

This week Medicare announced that it will continue to pay in full for the use of Provenge in treating prostate cancer when used in accordance with label indications. Provenge is a relatively new, FDA-approved drug used for patients with advanced prostate cancer. Unlike immunotherapy or chemotherapy, it uses a patient’s own cells to fight the cancer. Over a series of three procedures, cells are removed from the prostate cancer patient, “trained” in a lab, and then reintroduced in the patient in hopes that the body will attack the cancer like an infection. Provenge is reporting success in patients who are able to extend their lives with minimal side effects.

There are two main concerns I have with the use of drugs such as Provenge. First and foremost, this is a late game effort. Most prostate cancer patients using Provenge are doing so because earlier treatments failed or because their “watchful waiting” led them too far in their cancer’s progression. I don’t want my patients to reach this stage in prostate cancer treatment. From the moment men are diagnosed with prostate cancer, I want to help them make decisions that will remove prostate cancer from their lives for good. I believe that my experience in robotic prostatectomy procedures and my SMART (Samadi Modified Advanced Robotic Technology) surgery can help do this.

Prostate cancer is often referred to as the silent killer. Nearly symptomless, prostate cancer can develop, and progress significantly, in patients without their knowledge. For that reason, the key to eradicating prostate cancer is to start early – test early, treat early. Early detection of prostate cancer buys valuable time. Watchful waiting may waste that time, especially since studies indicate that in post-surgery biopsies many patients’ prostate cancer was actually far more advanced than initial staging tests indicated. And patients who do decide to treat their prostate cancer, but with less-aggressive options, may face a lifetime of worry and additional treatments. Robotic surgery removes the prostate and all surrounding cancer. Other treatments may not provide such concrete results.

Second, as the United States is on the brink of healthcare reform, I worry that focusing on high-priced drugs like Provenge (estimated to cost $93,000 per patient) distracts from healthcare efficiencies. The most efficient way to manage cancer patients of all types is to provide the method of treatment that leads them most directly to the best possible cure rate. Naturally, this varies by patient and by type of cancer. In my opinion, robotic prostate surgery is an early, aggressive way to remove cancer from the body and eliminate the need for a lifetime of costly treatments, drugs and care.

So, while Provenge may be doing very good things for certain patients, patients should never be faced with taking a drug that will buy them a year or two; not when they can act early to remove prostate cancer from their lives.

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