Re: U.K. Prostate Cancer Study Questions Benefits.....

George Conklin wrote:
<ralphv_in_az@xxxxxxxxx> wrote in message
news:1148919373.112822.80640@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
The problem I see with studies such as the BJC one is the fact that in
press releases, the true nature of the study is misinterpreted and what
comes to light is that treatments for early disease (as discovered by
screening with PSA) do not provide a survival benefit (and invariably
affect the QOL of the patient). The model does not directly account for
age and Gleason score, which are important covariates in modelling
survival from prostate cancer.


Actually what you do below is change the subject.... I suggest you deal
with the article posted.
RV>+++++++++>
As usual, YOU are the one not addressing the issue and running with the
ball with results that are calculated and not REAL. Garbage in, garbage
out...

To resolve this the authors went to the med lit to obtain some survival
data in men treated conservatively. They used the Albertsen P et al
study which monitored the survival of 767 men from the Connecticut

Again, you have changed the subject. They claim 1% progression......
RV>++++++++>
They claim 1% progression in their calculation which is an obvious
contradiction of what happened when untreated PCa follows a natural
course even for early disease. Why did they ignore THAT data in
constructing their model?


Tumor Registry with localized prostate cancer diagnosed between 1971
and 1984, treated conservatively and followed up for a median of 24
years. (note that this data is pre-PSA data). Based on this and other
mathematical manipulations (involving lead-time and overdetection) they
did their calculations and came out with the study results.

Reading the conclusions of the study by Parker C et al does clarify the
issue. This is a modeling exercise. In other words, it is a
mathematical calculation that depending on the data input predicts
results. The authors, rightfully so, caution on interpreting results
and yet what is published in the press is that treatment is
ineffective. This is nothing new in the confused world of PCa. Just one
more step to make the issue more confusing.

Why then the authors ignored the history of the natural course of
untreated prostate cancer? It has been almost ten years since
significant data was published in Sweden. Age and tumor grade
(differentiation) had a significant impact in prostate cancer
mortality. Why is the reality of actual data not considered when
developing a mathematical model? Read on:

In a retrospective study 6890 patients with prostate cancer from
theNorth Swedish Cancer Register were analyzed according to cancer
specific survival. Prostate cancer mortality was 40% in patients with
well-differentiated cancers, 54% in patients with
moderate-differentiated prostate cancer and 72% in men with
low-differentiated prostate cancer. Prostate cancer mortality was 80%
in men younger than 60 years, 63% in men 60-69 years old, 53% in men
70-79 years old and 49% in men older than 80 years.

Source:
Damber JE, Gronberg H.[Mortality due to prostatic carcinoma in northern
Sweden]
Urologe A. 1996 Nov;35(6):443-5
PMID: 9064879 [PubMed - indexed for MEDLINE]

The reality is that at this point the decision to treat or not should
belong to the patient. Data such as reported by the Swedish study above
should enter in the decision making process of current patients.

Experts that tell us that there is overtreatment cannot distinguish (at
this point in time) who benefits and who doesn't with any degree of
significant clarity or even with how much overtreatment exists. Figures
are bounced off the wall from 80% down to low teens. There is a
recognized and significant amount of understaging in the interpretation
of biopsy results. Based on this and on the fact that since the
inception of PCa screening, disease-specific mortality is being
reduced, until further clarified, screening should be encouraged rather
than discouraged and educated patients should decide what to do for
their own benefit. Patient education to the risk of prostate cancer is
the only avenue presently available.

UK does not screen asymptomatic patients. They also have the same
trends we do, and are supposed to be healthier overall than we are.
RV>+++++++++++++>
The first part of the statement is not true. The PCa mortality trend
there is not the same as ours. The fact that they are healthier than us
has nothing to do with this study. You are changing the topic.

.

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