Doctors unsure why Olmert would seek prostate cancer treatment abroad

Available procedures are the same here as in the US, say Israeli experts.

By JUDY SIEGEL-ITZKOVICH
Olmert worried 224.88 (photo credit: Ariel Jerozolimski [file])
Olmert worried 224.88
(photo credit: Ariel Jerozolimski [file])
Former prime minister Ehud Olmert, who was diagnosed with what his doctors called a "microscopic, small early-stage, malignant prostate gland tumor" 18 months ago, is entitled to go abroad for treatment or surgery, as he may be doing now that he has left office, say leading Israeli oncologists and urologists. However, they add, any treatments available in the best American medical centers are "no different" from what he could undergo here. Prostate cancer is diagnosed annually in some 2,250 other Israeli men and kills 380. Olmert was supposed to have had surgery at Sheba Medical Center at Tel Hashomer in the fall of 2007, after the Annapolis peace summit. But the procedure was postponed for unexplained reasons. It is not known whether the tumor would be treated by radical prostatectomy (complete removal of the gland) or radiation. Although those close to him did not say where he was going, he was examined during a visit in New York while in office at Memorial Sloane-Kettering Cancer Center there. The delicate surgery, which lasts about two hours, can be carried out under local or full anesthesia and requires about two or three days of hospitalization, followed by a few weeks of recovery. Dr. Ofer Shenfeld, chief of urology at Jerusalem's Shaare Zedek Medical Center, told The Jerusalem Post on Sunday that he obviously could not comment on Olmert's case. However, he stressed that "all existing treatments for prostate cancer - including radical open surgery and laparoscopic surgery, cryosurgery, radiation from outside the body and brachytherapy [radioactive seed treatment inside] are routinely used in Israel." Prostate cancer affects one in six Israeli men, and only a very small number go abroad for treatment, as the necessary procedures, which are available at most Israeli hospitals, are fully covered by the health funds, Shenfeld said. The only thing that is "tenuous in Israel is robot-assisted surgery," continued Shenfeld. "It is offered at Hadassah-University Medical Center in Jerusalem's Ein Kerem and been performed on a small minority of patients, but it has not yet proved to be more effective than conventional surgery. "In the US, it is very expensive and costs a lot for upkeep, but widely used. While it has been shown to speed recovery after surgery, this technique has not yet demonstrated better results than surgery without robots," he said. Shenfeld said that according to what has been published in the media and to statistics, Olmert has a very good chance of recovery, because he has not needed treatment until now and the tumor has probably grown very slowly. In approximately one-quarter of prostate cancer patients, the cancer returns after treatment. Prof. Haim Matzkin, chief of urology at Tel Aviv's Sourasky Medical Center, noted that Israeli urological surgeons have a great deal of experience in performing radical prostatectomy. "The US is a much larger country, but the learning curve for the surgery is only several dozen rather than hundreds of thousands, and most Israeli urological surgeons have much more experience than the minimum necessary," Matzkin said. Brachytherapy and conventional radiation have also been available here for a long time, as well as cryotherapy. What worries most men, besides ridding themselves of the tumor, is avoiding urinary incontinence and sexual impotency, which can occur. "In the US as well as here, surgeons cannot promise 100% success in preventing urinary incontinence and impotency," Matzkin said. Matzkin said he did not regard Olmert's going abroad for treatment as a "slap in the face" for Israeli urologists. "He has the right, and he is not the first Israeli to do it. But there is the distance from home; if there is a complication, it's harder to deal with it in another country. In any case, from what has been publicized - even though I am not his doctor - I think he would be an excellent candidate for brachytherapy." Shaare Zedek's Prof. Alberto Gabizon, one of the country's leading oncologists, commented that nerve sparing to prevent harm to those nerves involved in potency and urination, is "a very delicate procedure, as the neurovascular bundle is very close to and even envelops the prostate gland. "But the surgery is done many times a day here. I myself see patients with very advanced disease, not those whose tumor is microscopic," Gabizon said, adding, "Olmert has the full right to go abroad if he wants to preserve his privacy in a country where there will be less talk about him. I wish him good health."