UPDATE - Issue 04 - November 1999
Would you let your treatment be decided at random by a computer?
In February 1997 the NHS Centre for Reviews and Dissemination in York published a report on prostate cancer, which came down against the introduction of a screening programme. In it they pointed out that there is uncertainty about the effects of the three treatment options (Watchful Waiting, Radiotherapy and Radical Prostatectomy) because no randomised clinical trials have reliably evaluated them. Three years on there is still no current UK data available from a controlled randomised trial.
Some professionals would argue that patients should only have access to treatment by agreeing to abide by the protocol of a trial which would include randomisation. At Stepping Hill Urology Department in Cheshire this was put to the test recently. 20 patients fulfilling the entry criteria of the prospective controlled randomised trial were identified. Each was counselled by a urologist, a radiation oncologist and a urological specialist nurse. They were then invited to be randomised to the two treatment groups. Only one patient agreed to have his treatment determined by the computer. Of the others, 13 chose surgery, 5 chose radiotherapy and one watchful waiting.
So what was learnt? Simply that men with a life expectancy of 10 to 25 years who develop prostate cancer will not allow their treatment to be decided by computer. They wish to make their own fully informed decisions. The patient must be enabled to determine his own destiny. A study comparing surgery with radiotherapy is still possible but it is unlikely ever to be a randomised one.