Re: Delayed Interventions

George Conklin wrote:
With news reports out that the Journal of the National Cancer Institute has
found that delayed intervention for prostate cancer is better than
overtreatment, links to the August 16 journal site require you to PAY for
the article. Has anyone posting here paid or has a university subscription
to the journal? What about some details? News reports are pretty bad on
the details.



I tried accessing it through Northwestern, but they don't have anything from that Journal newer than February.

I found the abstract using Medline/Pubmed and it says the following

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BACKGROUND: The frequently indolent nature of early-stage prostate cancer in older men and in men with low- or moderate-grade tumors and the demonstration that the survival benefits of radical prostatectomy are primarily among men younger than 65 years have led to concerns about prostate cancer overtreatment. METHODS: Using data from 13 Surveillance, Epidemiology, and End Results registries, we performed a retrospective cohort study of 71,602 men who were diagnosed with localized or regional prostate cancer between 2000 and 2002. We quantified the incidence of initial curative therapy (i.e., surgery or radiation therapy) among men with lower-risk cancers as defined by their limited likelihood of either dying from expectantly managed prostate cancer or achieving a survival benefit from local therapy. Stratified analyses and multinomial logistic regression models were used to quantify the absolute and relative rates of curative therapy among men in various age-grade strata. All statistical tests were two-sided. RESULTS: We identified 24,405 men with lower-risk prostate cancers and complete data for the first course of treatment. Initial curative therapy was undertaken in 13,537 of these men (55%); 81% of treated men received radiation therapy. The likelihood of curative therapy, relative to expectant management, varied statistically significantly among lower-risk age-grade strata (all P<.05). Assuming that initial expectant management is appropriate for all lower-risk cancers, 2564 men (10%) in this population-based sample were overtreated with radical prostatectomy and 10,973 (45%) with radiation therapy. CONCLUSIONS: These data quantify a target population for whom greater use of expectant approaches may reduce overtreatment and improve the quality of localized prostate cancer care.

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As you can see, they identified a large number of 'low risk' cases diagnosed between 2002 and 2006. They don't give a definition in the abstract of 'low risk'. Also, since it is much to soon to know what actually will happen to these men, they did not report observed data on results. (Keep in mind that for truly low risk prostate cancer patients, the likelihood of dying of the disease within 5 years is essentially zero.) So they relied on some models of what might be expected in such cases, and assuming also that expectant management was an appropriate choice for all of them, tried to estimate the degree of overtreatment.

As best I can see, this is all highly conjectural. For older men today, competent urologists don't by and large overtreat low risk cancers. We also know that some low risk younger men will never be troubled by their cancers during their lifetimes, so there is definitely some degree of overtreatment. But the actual real data about this is murky. It seems to me that this study is trying to quantify that by analyzing existing data, but without any new data, the results are bound to be open to question. But I would really like to look at the article to see just what they say.
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Relevant Pages

  • Re: Delayed Interventions
    ... overtreatment, links to the August 16 journal site require you to PAY ... prostate cancer between 2000 and 2002. ... of curative therapy among men in various age-grade strata. ... of curative therapy, relative to expectant management, varied ...
    (sci.med.prostate.cancer)
  • Re: Delayed Interventions
    ... overtreatment, links to the August 16 journal site require you to PAY ... prostate cancer between 2000 and 2002. ... of curative therapy among men in various age-grade strata. ... of curative therapy, relative to expectant management, varied ...
    (sci.med.prostate.cancer)
  • Re: Delayed Interventions
    ... overtreatment, links to the August 16 journal site require you to PAY ... prostate cancer between 2000 and 2002. ... of curative therapy among men in various age-grade strata. ... of curative therapy, relative to expectant management, varied ...
    (sci.med.prostate.cancer)