doi:10.1111/j.1744-1633.2006.00298.x Theme symposium

Surgical Practice (2006) 10, 62 © 2006 The AuthorJournal compilation © 2006 College of Surgeons of Hong Kong

Blackwell Publishing AsiaMelbourne, AustraliaASHSurgical Practice1744-16252006 Blackwell Publishing Asia Pty LtdMay 200610262••EditorialEditorial noteC-W Man

Theme symposium

Editorial note

Don’t procrastinate.The adage that ‘treatment is possible when it is not

necessary and necessary when it is not possible’underpinned the nihilistic view our profession used tohave on the intriguing disease of prostate cancer.Prostate cancer does grow slower than other cancers.Even without treatment early cases can live for quitea long time. Prostate is difficult to resect, and theoperation had been associated with severe bleeding,incontinence and impotence. So, it was just natural forthe surgeon to keep his fingers crossed and hope thathis patient would die of something else before theprostate cancer took its toll. This murky state of affairscan no longer remain as such. First, prostate canceris increasing in incidence to become an importanthealth issue. The increase is especially marked inoriental populations adopting a Western way of lifeand, in Hong Kong, prostate cancer rises to becomethe commonest urological cancer in males against abackground of general decline in the incidence ofother cancers. Second, people are living longer. HongKong men are among the longest living in the worldand a wait and see policy simply pays off no longer.Third, through the hard work of generations of sur-geons, radical prostatectomy is now associated withmuch higher safety and much lower morbidities thanever before.

The final blow is dealt by the recent long-term out-comes on early prostate cancer from a Scandinaviangroup.1 It was demonstrated for the first time througha randomized controlled trial that increased overallsurvival and cancer-specific survival, and decreasedmetastatic disease can be achieved by radical cura-tive treatment of early prostate cancer. The question

now is not whether we should treat, but how. It is onsuch a vibrant note that a group of urologists, underthe auspices of the College of Surgeons of HongKong, created a workshop on the treatment of earlyprostate cancer. Various approaches were presented.The advantages and difficulties were discussed. Theoverall trend was to strive for minimal invasion whilemaintaining good cancer control. Surgical access isreduced by laparoscopic and perineal approaches.Cryoablation could be an option for the poor surgicalcandidate. Obviously, each technique would be bestsuited to a particular group of patients and it is there-fore important to keep the options open rather than toinsist on one single solution. I am particularly gratefulto some of the presenters who have burnt the midnightoil to write up their techniques. In the article publishedin this issue of the Journal entitled Cryosurgery forprostate cancer: How I do it, I hope the reader will beguided by the practical and factual narration toglimpse their ongoing struggle with prostate cancer.The message they spell out is loud and clear: Don’tprocrastinate!

Reference

1. Bill-Axelson A, Holmberg L, Ruutu M et al. Scandinavian Pros-tate Cancer Group Study No. 4. Radical prostatectomy versuswatchful waiting in early prostate cancer. N. Engl. J. Med.2005; 352: 1977–84.

Chi-Wai ManSection Editor, Consultant Urologist, Division of Urology,

Department of Surgery, Tuen Mun Hospital,Hong Kong SAR.