Re: Delayed Treatments for Prostate Cancer


"Skeptic" <bcs002b@xxxxxxxxx> wrote in message
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"george conklin" <george@xxxxxxx> wrote in message
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"george conklin" <george@xxxxxxx> wrote in message
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"george conklin" <george@xxxxxxx> wrote in message
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The issue is to what degree surgery, by any technique, is going to
do much for a patient. You point to a 3% difference over 10 years as
a major victory, even while the big studies, much delayed, are just
getting started. One has been going 10 years with no results
announced yet.

NEJM V347(11) from Sept 2002:
studied 700 men with prostate cancer. Median f/u of 6 years (not
adequate for prostate cancer studies) showed an improved disease
specific survival - a decrease from 8.9% to 4.6% which is a 48%
reduction.


So, go tell government to get rid of the PIVOT studies since
everything has been decided. 700 men? And from that pitifully small
number you are going to treat millions? Horrid.

We have the studies that we have. It's not easy to RANDOMIZE men to
treatment vs. no treatment. Only time will tell what PIVOT shows.

NEJM V352(19) from May 2005
Same group with longer followup, now out to 8 years (still not
adequate). Showed that "radical prostatectomy reduces disease specific
mortality, overall mortality, and the risks of metastasis and local
progresssion". Overall survival was improved by 22%. Not 3%...... but
22%. That was statistically and is clinically significant.


3% of a sample turns into 22% 'reduction.' A committee had to
decide what the men really died of, since there were multiple causes.
Just a few differences in committee opinion would have changed the
result since you are dealing with a small sample. You know that too,
but you cannot fool the whole world with nasty posts. I still view you
as once reason why research into female cancers is so advanced compared
to men. Neither is all that good, but women have been politically
active against attitudes like yours.

22% improvement in survival. Bitch all you want - that's what the data
shows - a 22% improvement in survival after just 8 years of followup.


Look you continually fail to realize you cannot construct life tables
with disease-specific mortality with a sample of 700 and expect stable
results. 22% is based on only 3% of the sample, with a committee having
to decide who died of what, since it was often unclear. Politics is
obviously involved too. It is pitiful that treatment procedures for
millions are based on as few as 20-25 possible deaths in a sample of 700.
You may like the results, but it is a scandal that never ceases to amaze
me. At the individual level, would you tell a patient that he had a 3%
chance in 10 years of having a better outcome of doing nothing? I doubt
it. You want the income first, the faith second, and your belief system
is in always doing something. Others might not make that choice, but as
the article on overtreatment showed, the cultural norms are always to do
something, even if it won't help. The system is set up for that, and it
is reinforced by the culture. You are a good example of faith-based
outcomes.

You're off your rocker again. You think organizing a randomized
controlled trial of 700 patients to surgery vs. no surgery is a simple
thing?

Only in the medical business are millions treated on the basis of a tiny
sample. You say, "It is too much bother to keep track of all outcomes."
Yet billions of $$$ are spent on treatments; virtually nothing on outcomes.
You really do NOT want to know, do you?


That's a
huge number for that kind of study, which is the best study that can be
done. We have the data that we have. We'd all like to have more more
more data on lots of things, but we don't.

Billions for treatments; nothing for results. Sad, scandal and horrible,
but you say that is the deck? YOU make the deck up. You can change it.
But the
AMA is a bill collecting organization. Science? Maybe now and then, but
not often.

So we play the cards we're dealt. In
the case of prostate cancer, we have the best studies done in the world
showing a 22% improvement in overall survival with surgery vs. no surgery
after 8 years.

I have no confidence in a life table constructed on 3% of the initial
sample with a total N of 700.


That number will almost suredly increase with time due to
the nature of prostate cancer. That's not "faith based" that's EVIDENCE
based. Period.

Evidence? Your evidence is so limited it is simply unreliable. You HOPE
it is correct because you believe it ought to be, but when committees have
to decide who died of what, and you are dealing with a few dozen cases to
prove your point, I am left wondering where the billion of dollars for
treatment went with so little evaluation. Life is not a deck of cards. The
deck is created for research by politics, and the deck is anything you want
to make it. Right now the money is not in even attempting evaluations which
include large-scale evaluation. We have know for years that surgery is three
or four times more common in some parts of the country than in others, but
the death rates from prostate cancer are about the same in all regions.
This would be based on large populations, not a pitiful few.


.

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