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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2008No PCa treatment is found to be superior
Available data insufficiently characterize the relative benefits of various treatments for clinically localized prostate cancer, and all therapies cause some harms. http://www.annals.org/cgi/content/full/0000605-200803180-00209v1#R5-2321 Last year, 218,000 men were diagnosed with prostate cancer, but nobody can tell them what type of treatment is most likely to save their life. Those are the findings of a troubling new report from the Agency for Healthcare Research and Quality, which analyzed hundreds of studies in an effort to advise men about the best treatments for prostate cancer. The report compared the effectiveness and risks of eight prostate cancer treatments, ranging from prostate removal to radioactive implants to no treatment at all. None of the studies provided definitive answers. Surprisingly, no treatment emerged as superior to doing nothing at all. ... Prostate cancer is typically a slow-growing cancer, and many men can live with it for years, often dying of another cause. But some men have aggressive prostate cancers, and last year 27,050 men died from the disease. The lifetime risk of being diagnosed with prostate cancer has nearly doubled to 20 percent since the late 1980s, due mostly to expanded use of the prostate-specific antigen, or P.S.A., blood test. But the risk of dying of prostate cancer remains about 3 percent. “Considerable overdetection and overtreatment may exist,'’ an agency press release stated. ... The study also evaluated research on “watchful waiting,'’ which means monitoring the cancer and initiating treatment only if it appears the disease is progressing. http://well.blogs.nytimes.com/2008/02/05/no-answers-for-men-with-prostate-cancer/ On Feb 6, 12:55 am, safire <saf...@tele-net.com> wrote...snip... > Available data insufficiently characterize the relative benefits of > various treatments for clinically localized prostate cancer, and all > therapies cause some harms. > > http://www.annals.org/cgi/content/full/0000605-200803180-00209v1#R5-2321 This meta-analysis only considered randomized trials. It seems quite unlikely that a study where men with varying degrees of PCa would be randomly assigned to surgery, radiation, AS, cryo, etc. will ever occur. Such a study would knowingly impact the health of these men in an adverse manner (e.g. randomly assigning a man with high-risk, organ- confined disease to the AS arm). However, if one looks at non- randomized studies which have compared PCa treatment efficacies, one will see that conclusions have been drawn which do characterize the relative benefits of the various treatments considered. It is also reassuring to find that most of these studies reach similar conclusions...ron On Feb 6, 12:55 am, safire <saf...@tele-net.com> wrote...snip... This meta-analysis only considered randomized trials. It seems quite unlikely that a study where men with varying degrees of PCa would be randomly assigned to surgery, radiation, AS, cryo, etc. will ever occur. ==> Actually, that sounds a lot like England's NHS. After my RP, the surgeon said the cancer had spread all the way around the prostate and that if I did not do anything, in 3-4 months I wouldn't be able to urinate. How does that fit in those studies, re: not doing anything? > After my RP, the surgeon said the cancer had spread all the way around > the prostate and that if I did not do anything, in 3-4 months I > wouldn't be able to urinate. How does that fit in those studies, re: > not doing anything? That's a very good question! And one I had not considered. >> After my RP, the surgeon said the cancer had spread all the way around >> the prostate and that if I did not do anything, in 3-4 months I >> wouldn't be able to urinate. How does that fit in those studies, re: >> not doing anything? > > That's a very good question! And one I had not considered. OMG, Steve thinks it is a very good question! Is it? If you're playing black on 38 double zero wheel roulette rounds, wagering $5 each time, you should expect to lose $10. Something with probability theory. Yet, in 1938, Frank Sinatra told me his girlfriend's aunt's second husband had won $20 doing exactly the same thing. How does that fit in probability theory??? The article deals with the risk of dying after having been diagnosed with prostate cancer. BTW: the pain in your shoulder is not at all related to gas as Steve suggested. The gas doesn't get to your shoulders. When you were operated on your entire body weight was on your shoulders. That's why you felt pain after recovery. If you do a google search on "shoulder pain gas laproscopy" you will get numerous references to gas causing shoulder pain after a laproscopy. >>> After my RP, the surgeon said the cancer had spread all the way around >>> the prostate and that if I did not do anything, in 3-4 months I [quoted text clipped - 18 lines] > on your entire body weight was on your shoulders. That's why you felt pain > after recovery. The NYT article completely miss-characterizes the results of the study. The only context in which the study makes the conclusion that "no treatment emerged as superior to doing nothing at all." is in regard to occurrence of side effects. Well, duh, if you don't have treatment you don't get side effects from the treatment. All the study is pointing out for that issue is that treatment WILL have side effects. Also, much of the data in the study seems to come from Scandinavia, which my recollection tells me is a country that has been very reluctant to treat PCa until its pretty far advanced. So by the time they treat it there is no nearly as much likely hood of benefit compared to not treating it. This is indicated by a statement in the study that most of the DX were NOT from PSA results... in other words, the cancer was sufficiently advanced that it was discovered from a DRE plus, and this is just my supposition, I suspect most of the cohort were fairly old men compared to what we see with PSA screening. So that makes it much more difficult to see a strong benefit in terms of life extension, they were only seeing a few years benefit. In short, the study really doesn't tell us anything, it just confirms what most people who have been following this stuff have known for a long time but mainly in terms of 20 year old data before PSA screening and early intervention started improving the survival rates. The NYT really botched the reporting. >Available data insufficiently characterize the relative benefits of >various treatments for clinically localized prostate cancer, and all [quoted text clipped - 28 lines] > >http://well.blogs.nytimes.com/2008/02/05/no-answers-for-men-with-prostate-cancer/ On February 6, 007 wrote: (snip) > The NYT really botched the reporting. Nothing unusual. Illustrates once more why I do not trust some ignoramus reporter on medical or any other technical subject, but prefer to see the primary source. I posted a link to the original article on the fifth. Regards, Steve J Who has been on-scene many times and could see little resemblance between what I saw and what the media reported. |
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