The increasingly heated conversation around the proper role of prostate cancer testing has played a big part in dragging down the market, which in turn has taken a toll on Intuitive’s numbers. But the debate can be framed rather simply from a patient perspective.
"I would rather know than not know," Guthart told MassDevice.com during an exclusive meeting at the medical device company’s Sunnyvale, Calif., headquarters yesterday. "The hear no evil, see no evil, speak no evil strategy doesn’t seem like a healthcare strategy to me."
The potential downsides of routine prostate cancer testing have gotten extra attention lately in light of the recent publication of a landmark study and a highly contested recommendation from a U.S. Preventative Services Task Force.
In May the USPSTF panel advised physicians against using a common prostate cancer screening tool, the PSA or prostate-specific antigen test, in monitoring men’s health over concerns about the dangers of aggressive treatment in patients who are asymptomatic and whose cancer may have remained neutral without intervention.
"Many people have a blind faith in early detection of cancer and subsequent aggressive medical intervention whenever cancer is found," American Cancer Society chief medical officer Dr. Otis Brawley wrote in an accompanying commentary on the panel’s decision. "There is little appreciation of the harms that screening and medical interventions can cause."
The guidance created outrage among several groups, including the Large Urology Group Practice Assn., which warned that "failing to detect cancer early will create a public health catastrophe in 5-10 years."
Although Intuitive Surgical doesn’t plan to play a big role in the public debate, the company’s stance is that testing is an important part of saving men’s lives.
"Closing your eyes and hoping there’s not a problem is probably not a good strategy," Guthart told MassDevice.com yesterday. "Having an informed conversation with a caregiver … and a long conversation about what the possibilities are for you as a person – in terms of the aggressiveness of your disease and what your comfort level is with living with something versus not – I think that is the right approach. I think that’s true of my personal opinion and I think it’s true of Intuitive’s stance."
Earlier this month the the New England Journal of Medicine published a highly anticipated decade-long study comparing surgical prostate cancer treatment to "watchful waiting," the authors of which concluded that the surgical approach “may be neither necessary nor effective” for men diagnosed with early stages of prostate cancer.
Researchers followed more than 730 men for an average of 10 years, concluding that low-risk patients who underwent radical prostatectomy were about 3% more likely to survive than men under the "wait and see" arm of the trial, regardless of age, race, comorbidity, health status or histology.
The timing of the trial and the release of the USPSTF recommendation combined may have taken an extra toll on the prostatectomy market, in which Intuitive Surgical has become the preferred option.
ISRG shares have taken a beating since the company reported softness in its da Vinci robot-assisted prostatectomy procedures during the 2nd quarter. Shares, which opened at $553.58 the morning prior to the earnings release, have since lost 14.7%, trading around $472.17 as of about 1:45 p.m. today.
"When there’s a big push like this, in the past we’ve seen people move toward active surveillance," Guthart told us. "It comes back over time."
Roughly speaking, about a third of patients who opt for "watchful waiting" stay with it, he added. Another third see their disease progress to the point of requiring intervention and the remaining third get tired of waiting and decide on more aggressive treatment.