Hi, I'm not a doctor, but I've been lurking and wanted to reply to a
post, but I can't figure out how to do it. Google doesn't seem to have
the reply to group button working. Anyway, I am replying to this:

Hi Dr. Hennenfent...In the study I am aware of ("A
randomized trial comparing radical prostatectomy with
watchful waiting in early prostate cancer"; N Engl J
Med. 2002 Sep 12;347(11):781-9; 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), 17%
more men died in the WW arm as compared to the RP
arm.  At about 6 years of follow-up this difference
did not yet test statistically significant, but it
was an observed difference favoring the RP arm of the
study.

Given the known natural history of PCa progression
(increasing PSA to mets to death; see, for example,
Pound, et.al., JAMA, May 5, 1999, Vol 281, No. 17,
1591-1597), how do you see the 270% greater rate of
local disease progression, the 54% greater rate of
distant met formation and the a 93% higher rate of
PCa-specific deaths in the WW arm vs. the RP arm of
Holmberg's study, ultimately affecting overall
mortality in these two study arms? PCa often
progresses slowly, so it may take many years for
a study to see statistically significant impacts on
survival, but given the striking differences already
observed in local disease progression, progression to
mets, and PCa-specific death between the two study
arms, can there really be any doubt about how
survival will ultimately be impacted?

Further, it has been noted by biostatisticians that
as study times increase, overall mortality becomes a
less-valid indicator of treatment success than
disease-specific mortality.  This is because
unanticipated factors are more likely to "seep" into
long-term experiments and confound such general
measures of success like overall mortality as opposed
to disease-specific mortality.
/end

-- Reader to complete...
-- Please reply to this ng as my email adress is fake:

-- Regards

-- CC

The poster takes the study, and is trying to say that surgery works.
Clearly, the conclusion of the study is that the radical prostectomy
does not work. I think you Americans call what this poster did, spin.
Here is the abstract:
-
A randomized trial comparing radical prostatectomy with watchful
waiting in early prostate cancer.

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.

Regional Oncologic Center, University Hospital, Uppsala, Sweden.

BACKGROUND: Radical prostatectomy is widely used in the treatment of
early prostate cancer. The possible survival benefit of this treatment,
however, is unclear. We conducted a randomized trial to address this
question. METHODS: From October 1989 through February 1999, 695 men
with newly diagnosed prostate cancer in International Union against
Cancer clinical stage T1b, T1c, or T2 were randomly assigned to
watchful waiting or radical prostatectomy. We achieved complete
follow-up through the year 2000 with blinded evaluation of causes of
death. The primary end point was death due to prostate cancer, and the
secondary end points were overall mortality, metastasis-free survival,
and local progression. RESULTS: During a median of 6.2 years of
follow-up, 62 men in the watchful-waiting group and 53 in the
radical-prostatectomy group died (P=0.31). Death due to prostate cancer
occurred in 31 of 348 of those assigned to watchful waiting (8.9
percent) and in 16 of 347 of those assigned to radical prostatectomy
(4.6 percent) (relative hazard, 0.50; 95 percent confidence interval,
0.27 to 0.91; P=0.02). Death due to other causes occurred in 31 of 348
men in the watchful-waiting group (8.9 percent) and in 37 of 347 men in
the radical-prostatectomy group (10.6 percent). The men assigned to
surgery had a lower relative risk of distant metastases than the men
assigned to watchful waiting (relative hazard, 0.63; 95 percent
confidence interval, 0.41 to 0.96). CONCLUSIONS: In this randomized
trial, radical prostatectomy significantly reduced disease-specific
mortality, but there was no significant difference between surgery and
watchful waiting in terms of overall survival.
-
The poster listed all the positive aspects of the study for surgery.
That's his glass half full view of surgery. The glass half empty view
is that surgery kills men and that's why the positive effects were
counterbalanced and why surgery did not achieve significance. The
bottom line, overall survival did not increase, surgery was a bust.