Re: Delayed Treatments for Prostate Cancer


"Skeptic" <bcs002b@xxxxxxxxx> wrote in message
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"George Conklin" <georgeconklin1@xxxxxxxxxxxxx> wrote in message
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"Skeptic" <bcs002b@xxxxxxxxx> wrote in message
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Are you talking about,
"Incidence of Initial Local Therapy Among Men With Lower-Risk Prostate
Cancer in the United States " ?

All that that article finds is that we are overtreating some men with
low
grade prostate cancer - something which we all know already.

A major journal does not publish articles about what is already known.

LOL... yes they do - all the time. Confirmational studies. They're
actually much easier to get published than are novel ideas. But hey,
thanks
for expressing your ignorance.

The study cited is based on real-world experience rather than from a
self-selected group of volunteers. That is always a difference.



These are real-world outcomes, not those projected from a few hundred
self-selected men in a so-called 'clinical' study.

It was actually nothing more than a retrospective review, which is much
weaker than a randomized control trial would be.

Incorrect. It is everyone they could get ahold of, not a self-selected
group of volunteers, which gives unreliable results when applied to general
populations.



But until we
have a way to find out which men will die of prostate cancer and which
ones
will die of something else, overtreating is far better than not
treating.

This specific point is contradicted in the article itself. It
states,
"In particular, for some men with localized prostate cancer, the use of
'curative' therapy (.e., surgery or radiation therapy) may result in
substantial morbidity without a consequent survival benefits." (page
1134).
The 'quotes' around curative are in the original.

Indeed. Treatment may result in morbidity. Treatment may also result in
a
cure. We don't don't which patients get cured which is why we tend to
treat
rather than ignore prostate cancer. Why is that concept so difficult for
you? Is not treating an alternative? Sure. Each patient can decide that
for himself. Most young patients with prostate once fully informed that
we
don't know if prostate cancer will kill them or not strongly - very
strongly - desire some form of treatment.

You sure hate research. Fully informed? Not by you. You push your
services hard, very hard. In the end, patients are hardly left much choice
unless they go out and read the literature. It is a cultural bias too to
push doing something, even if it provides many with only harm.


Also, "Given the cumulative health burden which is attriutable to
prostate
cancer and its associated therapies and the recognition that unnecsssary
care is POOR-QUALITY CARE (emphasis added), efforts to better define
these
'upstream' determinants of initial expectant management are an important
clinical and public health endavor." (p. 1138).

Which is what I've been saying - we don't know which patients will benefit
most from treatment and this paper does NOTHING to help resolve that
problem.


Which is a total misreading of the paper. Did you actually read it or
are you just giving us your personal opinions which are not important at
this point?


Further and this applies to YOU:

It is also likely that some clinicians will disagree with our
classification
of lower-risk cancers with the general notion some prostate cancers
require
no initital intervention. For example, two studies (39,40) have used
similation techniques to demonstate that curative therapy benefits
healthy
men over 70 years. However, the survival gains projected by; these data
were concentrated among patients with high-grade tumors who would not be
classified as lower-risk in the current analysis." (p. 1138).

So, YES, the study did provide a control for who would benefit and you
know
it did since you read the study, right? Or did you? Tell us.

Of course, and I previously summarized in a post for you to understand.
Clearly I failed.


All you showed was your bias. The paper speaks for itself. I am sorry
you are so overwhelmed by your personal opinions. Why don't you give me a
cite of YOUR refereed work to see whether your personal feelings are
accepted by the field in general? What about a real cite, authored by
someone named Skeptic.


That must be the article you're talking about, since it's the only one
from
August that discusses this issue. That study is just another (of many
many
many) that is data mining from the SEER database. Their paper has
surprisingly little data in it.

Nonsense. It has all the data it needs, since it uses multivariate
analysis. You must be used to high-school data presentations.

Read the article again. They don't talk about overall survival, disease
specific mortality, PSA values/doubling time/velocity/etc., need for
additional treatment, morbidity from delayed treatment, etc etc etc etc
etc
etc etc. They present on table of results. That's it. In a relative
sense, that's VERY little data. If you ever read medical journals I
wouldn't have had to explain that to you.

I think it is obvious I read statistics quite well, and have read
numerous medical journals any time I feel like it. You seems to prefer
ignoring outcomes in the real world. Remember that the field has ignored
overall survival for the past 100 years and concentrated on things like PSA
or tumor size, ignoring survival. Only now will studies such as the PIVOT
study look at mortality. And the Swedish study? 3% differences after 10
years? Only a few hundred people? This study looks at real world out comes
on 72,000+. That is what it takes. Real world.



At least they looked at a data file with 73,566 men, and not a few
hundred
self-selected men in a so-called clinical study. These were real-world
decisions.

Yep, a retrospective review of a well known database. And their
conclusion?
That some men are being overtreated but we don't know who and have no way
as
of now to determine that - information is well known already.

They provide a discussion of the criteria used. Why do you want to
ignore it?


Of course, younger guys are also the perfect age group to treat
surgically since a 55 year old man has almost 30 years left of life
expenctancy - and if the prostate is left to grow, it may well end up
killing him.

The authors even admit they have, essentially, nothing of substance.
They
state, "Given the substantial body of evidence supporting expectant
management as an evidence based option for the initial treatment of men
with
lower risk prostate cancers, our data highlight the need to better
define
potential catalysts and barriers to the use of initial expectant
management
among CAREFULLY SELECTED PATIENTS [emphasis added] with new diagnosed
prostate cancer"

Uh huh... riiiight. There should have been an editorial reply of "no
***
Sherlock". And just how does one "carefully select" these patients?

The criteria were specified.

No - they do NOT come and say men with Gleason X and a PSA of Y with a
doubling time of Z and are DD years old should get treatment vs watchful
waiting.

They provide guidelines for age and tumor grade and SES as well. Are
you blind or something?


Ah,
why with a crystal ball of course. "You, Mr. S, will die of a heart
attack
in 9 years so no need to deal with your low risk prostate cancer right
now.
But you, Mr. L, will live a long and healthy life if we operate on your
prostate before it goes metastatic".

Sigh. There's nothing new in this article. Nothing.

You only wish.

George, the stats and information around prostate cancer are well known.
The SEER database has generated dozens of other articles on prostate
cancer
(meaning the same patients have already been looked and reported on).
It's
common knowledge that treating every patient with prostate cancer results
in
over treatment of some patients. Common knowledge. This article provides
no new information



Then write the journal and tell them that. I am looking forward to
reading your refereed response.


.

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