Re: Medical Research-Evidence


"George Conklin" <georgeconklin1@xxxxxxxxxxxxx> wrote in message
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"Skeptic" <bcs002b@xxxxxxxxx> wrote in message
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"George Conklin" <georgeconklin1@xxxxxxxxxxxxx> wrote in message
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"George Conklin" <georgeconklin1@xxxxxxxxxxxxx> wrote in message
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Prostate cancer treatments are being evaluated, such as the
PIVOT
study. But some going on for 10 years have yielded no results yet,
strongly
suggesting that all current modes of treatment cure those who would
not
die
of the disease anyway. Those who advocate PSA tests and aggressive
treatments now claim that the best results will show up AFTER 15
years!!!
But that is another 5 years out, and then it will be raised to 20.

There is recent 10 year data showing a survival benefit of surgery vs.
watchful waiting. It's long been known that survival benefit studies
would
need to go out at least that far except in metastatic cases.



Here is a comment from another newsgroup:

Both Dale and George are correct.

Dale is correct in that radical prostectomy has been shown to lower the
death rate due to prostate cancer (see the New England Journal of
Medicine article at:
http://content.nejm.org/cgi/content/abstract/347/11/781).

George is correct in that radical prostectomy has been shown to have no
significant difference over watchful waiting in overall survival (see
the New England Journal of Medicine article at:
http://content.nejm.org/cgi/content/abstract/347/11/781).

Now, what do you have to add with a link?

You're using outdated information. That study had a mean followup of
only
6.2 years, which was too short for a survival study with prostate cancer.
Allow me to refer to a followup the same study you posted above, done
with
the same patient population and the same authors, just longer timepoints
for
data:

3 years later, a newer/better study was published in the same Journal:

"Radical Prostatectomy versus Watchful Waiting in Early Prostate Cancer",
May 12, 2005 by Bill-Axelson and Holmberg et al. (same authors, longer
followup)
This paper is *the* landmark paper for this topic in the field.

The study showed that "radical prostatectomy reduces disease-specific
mortality, overall mortality, and the risks of metastasis and local
progression".


and then the following, which is what Herman talks about allowing the
patient to make decisions:

You're welcome for the reference.

"THE ABSOLUTE REDUCTION IN THE RISK OF DEATH AFTER 10 YEARS IS SMALL...."

The risk of death was not seen at 6 years, which was to be expected. 3
years later it was noticed - before it should have been expected to be
seen - and was both clinically and statistically significant. The more time
that elapses, the more signficant the differences will become.

I'm not one of those guys who advocates prostatectomy for every patient with
prostate cancer. I think there are a large number of patients for whom
watchful waiting is appropriate. However, we can now say, conclusively,
that in the face of diagnosed prostate cancer, surgery will save lives.

The study showed 30 men dying of prostate cancer in the surgical arm with
50
men dying of prostate cancer in the watchful waiting arm. The total
number
of deaths from other causes were 53 and 56, resepectively - so
equivalent.

For Herman - that is both statistically and clinically significant :)

These numbers will likely to become even more disparate between the two
groups as time goes on, since that is the nature and natural history of
prostate cancer. In truth, this study found a signficant survival
advantage
a few years earlier than most had predicted.

So you can tell your poster in the other newsgroup his data is outdated
and
now you, George, have been given evidence that early intervention
prostate
cancer saves lives.

Good day.

And let me remind you a point I made earlier: the progress against adult
cancers is SMALL.

That's an opinion, one that I don't share.

Methods such as surgery are crude

Another opinion and again, one that I don't agree with. Many surgical
techniques are quite elogant.

and apparently only
remove tumor load.

And if the entire tumor load is removed, the patient is cured of his cancer.

Now, as for the flame wars over surgery vs. brachytherapy, what is your
comment on that one?

Flame wars? Where I practice, the same people who do brachy also do
prostatectomies. Besides, I'd hardly call an intellectual debate a flame
war. Brachytherapy has been established as a good treatment alternative for
low grade prostate cancer - defined as gleason 6 or less (out of 10, based
on biopsies). For higher grade cancers, brachytherapy has been conclusively
shown to be inferior and it's not recommended. The imaging modalities and
radiation placement for brachytherapy have improved - but the benefit of
this will likely be most pronounced with fewer side effects.


.

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