Re: Delayed Treatments for Prostate Cancer


"george conklin" <george@xxxxxxx> wrote in message
news:7mqGg.11538$0e5.5494@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

"Skeptic" <bcs002b@xxxxxxxxx> wrote in message
I want to operate only on those people who I think I will be doing a
service for by either improving the quality of their lives or increasing
the length of their lives.


And that is the problem: personal opinion in place of science.



With prostate cancer, some cases are pretty obvious - such as a high
grade cancer with no evidence of spread in an otherwise healthy man with
a life expectancy well in excess of a decade - you treat him.

Still with only self-selection to show what benefit the treatment is.
That is the whole problem: 100 years of surgery with only the idea that
cutting into something helps a person.


Whether it be with
surgery or XRT, he would be best served with treatment. An older or
sicker man with no evidence of metastasis, you probably use XRT. Cancer
that has spread to distant sites, you go with hormone treatment.

You are just telling me what current practices are. High-dose
chemotherapy for breast cancer was no more effective than regular
treatments, which surprised everyone once the real science was done. Men
have not insisted on such studies for prostate cancer. Sad. But they are
underway now. After 100 years. Sad.

A few points:

1. Breast cancer? I don't treat that nor have I mentioned in any context
in this discussion.

2. Prostate cancer surgery has changed dramatically in recent decades and
is actually undergoing another period of change. I don't know what your 100
years is in reference to.

3. Patients come to us not only for our expertise and objective knowledge,
but also - at least in the vast majority of cases - for our opinions about
how to proceed. Opinions of the treating physician are valuable to
patients.

4. Allow me to post a link to web site that explains "level of evidence".
http://www.eboncall.org/content/levels.html
This will be a good start for you. You seem to think a retrospective review
is good quality evidence, but in *fact* it is not. It is considered Level 4
evidence (of 5 with 1 being best). A prospective randomized controlled
trial is Level 1B with the only better level of evidence being a systematic
review of Level 1B prospective randomized controlled trials.


.

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