On November 25, 2004, I reported the radical prostatectomy being misleadingly advertised on a web site called Andrology Australia to the Australian Competition and Consumer Commission. My report was limited to 1,500 characters so I will expand upon it here.

The misstatement about the radical prostatectomy on the web site was that:

"Approximately 90% of men with localized cancer live for at least ten years after treatment and for 75% of men, the cancer does not return during this time. Based on these results, this surgery is recognised as being able to cure prostate cancer." (From: http://www.andrologyaustralia.org/prostate/treatment/localised.htm, accessed 11/25/2004)

The above statement implies that radical prostate surgery cures 75 percent of men with prostate cancer and that is clearly false.

The full statement about prostate cancer on the web site was:

"Surgery for prostate cancer involves the removal of the whole of the prostate gland through a cut in the abdomen, called radical or open prostatectomy. The prostate and the prostatic urethra (the part of the urethra within the prostate gland) are removed, and the remaining parts of the bladder and urethra are re-joined.

"A hospital stay of between 3-7 days and a recovery period of up to 6 weeks is usually needed after a radical prostatectomy procedure. Immediately after the surgery, a thin tube or catheter will be present in the urethra running from the bladder through the tip of the penis to help empty the bladder during recovery. At what stage this catheter is removed will depend upon the advice from the doctor. Some degree of incontinence occurs in many men when the catheter is removed because the mechanisms concerned with continence will have been disturbed during surgery.

"Approximately 90% of men with localized cancer live for at least ten years after treatment and for 75% of men, the cancer does not return during this time [4]. Based on these results, this surgery is recognised as being able to cure prostate cancer."

It's reprehensible that this last statement implies the radical prostatectomy cures prostate cancer 75 percent of the time, which is absolutely false. If nothing was done for this same group of men, it's just as likely that 75 percent of them would live with their prostate cancer for over 10 years, because prostate cancer is a remarkably slow-growing cancer in the majority of men, and because many men die of some other disease before prostate cancer becomes large enough to affect them.

In fact, in a 15-year-long watchful waiting study by Johansson et al., only 11 percent of the men died from prostate cancer.

(Jan-Erik Johansson, Lars Holmberg, Sara Johannson, Reinhold Bergström, and Hans-Olov Adami: Fifteen Year Survival in Prostate Cancer: A Prospective, Population-Based Study in Sweden. JAMA. 1997;277(6):467-471.)

Studies show that with watchful waiting, or other less invasive treatments than surgery, there is a very high prostate cancer-specific survival rate, often 80 percent or better. If only 20 percent of men need to be cured of their prostate cancer in the first place, how can the web site above suggest that surgery cures 75 percent of men with prostate cancer? It doesn't add up.

I wrote the following to the Australian Competition and Consumer Division:

Dear Sir/Madam, I am disturbed about the increasing number of false reports being made from Australian sources that the radical prostatectomy cures prostate cancer.
(Example: http://www.andrologyaustralia.org/content/aboutus.html.)

The radical prostatectomy has failed to increase overall survival in two randomized controlled studies. The two randomized controlled studies, which show that the radical prostatectomy does not increase survival in men, are:

1. Iversen P, Madsen PO, and Corle DK: Radical prostatectomy versus expectant treatment for early carcinoma of the prostate. Twenty-three year follow-up of a prospective randomized trial. Scandinavian Journal of Urology and Nephrology, supplement 1995, Jan 1;172:65-72.

2. Holmberg L, Bill-Axelson A, Helgesen F, Salo JO, Folmerz P, Haggman M, Andersson SO, Spangberg A, Busch C, Nordling S, Palmgren J, Adami HO, Johansson JE, Norlen BJ; Scandinavian Prostatic Cancer Group Study Number 4. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. New England Journal of Medicine. 2002:Sep 12;347(11):781-789.

Please consult with the many excellent epidemiologists and statisticians in Australia. This surgery should not be promoted until proof that it actually helps anyone can be shown. We clearly know that it harms every man who undergoes it.
My best,
Bradley Hennenfent, MD
Author of: Surviving Prostate Cancer Without Surgery

My prostate cancer post received a confirmation

Confirmation
Thank you for contacting the ACCC.

Where possible the staff of the ACCC Infocentre will phone and discuss your inquiry/complaint. This provides an opportunity to better understand your questions and provide a more useful response. In normal circumstances you can expect a telephone call from the ACCC within seven working days of the reciept of your inquiry/complaint.

ACC Responds

Dear Dr Hennenfent

Thank you for your e-mail to the Australian Competition and Consumer Commission (the ACCC). As you will be aware, the ACCC is the statutory authority responsible for ensuring compliance with the Trade Practices Act 1974 (the TPA). The TPA prohibits a range of anti-competitive conduct and provides for the protection of consumers, including through the prohibition of misleading, deceptive or otherwise false trading practices.

I have examined the information contained at www.andrologyaustralia.org in light of the relevant provisions of the TPA. I note that this website discusses surgery as one of several treatment options, depending on the circumstances, and specifically mentions numerous risks. As a result, I am not satisfied that the content of the website is misleading in this respect.

In light of the above, the ACCC will not take further action in relation to your complaint at this stage. If you have any questions, please contact me on +61 2 6243 1050.

Yours sincerely

_________________________________________

Kathryn Kerr
Senior Investigator
Australian Competition and Consumer Commission
Ph: 02 6243 1050
Fax: 02 6243 1047
Find out more at www.accc.gov.au

My Second Letter to ACC

Dear Kathryn,

Thank you for your reply. I would like to pursue the issue further as the following statement on the web site is false:

(http://www.andrologyaustralia.org/prostate/treatment/localised.htm)

The randomized controlled studies, done to date, show that the radical prostatectomy has not cured anyone. Essentially, the 25 percent of men who need to be cured are not being cured. Surgery has not been show to extend life in any controlled study done to date.

Please consult with Professor Alan Coates of the Cancer Council of Australia before allowing such false advertising to stand.

My best regards,

Bradley Hennenfent, MD

More about Andrology Australia

The funding of the Andrology Australia web site is interesting. The web site says:

"Andrology Australia (The Australian Centre of Excellence in Male Reproductive Health) was recently established with funding from the Commonwealth Government and officially launched in 1999 by the Federal Minister of Health and Aged Care, Dr. Michael Wooldridge. The aim of the Centre of Excellence is to assist Australian men with a range of reproductive health problems by undertaking programs to improve knowledge and provide much needed education in specific areas of male reproductive health."

Andrology Australia is doing a disservice to men, by assuming that the radical prostatectomy cures 75 percent of men with prostate cancer, when we know for a fact that it does not.

In the meantime, a third randomized controlled study has come out.

Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med. 2005 May 12;352(19):1977-84.Bill-Axelson A, Holmberg L, Ruutu M, Häggman M, Andersson SO, Bratell S, Spångberg A, Busch C, Nordling S, Garmo H, Palmgren J, Adami HO, Norlén BJ, Johansson JE; Scandinavian Prostate Cancer Group Study No. 4.

This study says that the radical prostatectomy works 5% of the time if you wait 10 years for results. This is a far cry from working 75% of the time.

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