Logoslidat, thx for a fantastic thread and study!
Logo:"Oh feel free to poke holes in it, including My own "all studies are inherently wrong""
OK, I will do some of that as devil's advocate(DA) even though I sure love the study and find it very encouraging. And it fits well with a previous study not discussed here in a while of the mortality(PC or overall) of
high risk men following RP. Only 13% had any form of salvage, and the % were all very good. It went out 20 or 25 years from a mean age of 60+.
Still, like you say about
all studies, it's just another study, right? You know there has got to be another one somewhere showing less encouraging results. Kind of like me showing lot's of studies about
Vitamin D where the results seem to me at least sometimes unimpeachable, some even seem to be the rare RCT or very close to it, and from a source that should be reliable and unbiased. After all, why would medical centers, universities and MDs even be biased
in favor of any vitamin? It's not like they hold stock in cheap as dirt Vitamin X. Although it might be possible they are paid off by vitamin manufacturers, though they declare no conflict of interest. Still, there are quite a few of these researchers from many different places. Plus, seems to me if there is a potential bias it would be from the other direction. After all, if vitamins or herbs or minerals actually did a lot of good, it would hurt that billion $ business.
But even though I can see no reason for these researchers to be biased to give good reports for Vitamin X, the other studies always show up showing either no help or rarely even some possible harm, don't they? So, who you gonna believe? I don't see how it can be this way, but it does seem to be.
Now the first thing that occurred to me(the DA in me) about
this study was it was
all risk factor groups who had surgery from 1990-2006. So most likely the majority of those patients were G6, and a lot possibly even low volume G6 and the majority contained. So right off the bat, by what we think we know in 2015, the majority or a lot of those guys were going to be OK for a long time, maybe 20+ years, even if they did nothing, right? Most would die of something else even if they did nothing. At least those who were
truly G6 or less, those whose Bx did not miss a G8-10 or something. And that lucky group was probably a good hunk of the study.
But still, we are only looking at the BCR group, and >/= 0.4 at that! So I suppose this is most likely only the guys who were actually >G6 in their post op path. So maybe that kind of rules out my 1st concern. I think so. So, back to being excited until the new study trashing all of this shows up!
But does this: "Prostate cancer-specific mortality at 10 years after BCR occurred in 9.9 percent for Group A, 9.3 percent for Group B, 7.8 percent for Group C, and 4.7 percent for Group D." conflict with the next line: "On multivariate analysis, time from RRP to BCR was not significantly associated with either the risk of systemic progression (p = 0.50) or the risk of prostate cancer-specific mortality (p =0.81)."? Perhaps 9.9% for group A and 4.7% for Gr D is not significant? Could be.
Then there was this, which mostly confirms what we already think we know: "Older patient age, increased pathologic Gleason score, advanced tumor stage, and rapid PSA doubling time predicted systemic progression and death from prostate cancer." OK, nothing new there except: older age? I would have thought it just the opposite. Older age= less years to live anyway thus fewer years for a PC to met and kill you. But maybe not?
"This study has a number of limitations above and beyond the fact that it is a retrospective analysis. These limitations include the use of differing forms of salvage therapy and the inclusion in this database of relatively few patients with positive lymph nodes at the time of surgery." Of course, as with most or all studies it would seem.
"What is clear from this study, however, is that less than 10 percent of the men who had a BCR went on to experience systemic progression and death from prostate cancer."
Yes, that seems to be the worse case scenario, doesn't it? Although I am actually surprised that any in group D, who did not BCR until >5.9 years after surgery, were dead from PC at 10 years (or less?) after BCR. Admittedly, 4.7% is very small unless you are in that group. But even group A(BCR<1.2 years) only had a 9.9% PC mortality rate at 10 years post BCR. Oh well.
study said...
Boorjian and his colleagues conclude their study by noting that, “The decision to institute secondary therapies must balance the risk of disease progression with the cost and morbidity of treatment, independent of time from RRP to BCR.” In other word, the tendency to rush into second-line therapy the second that any patient’s PSA exceeds 0.2 or 0.4 ng/ml needs to be tempered by a careful assessment of that patient’s real risk for progressive, systemic disease over the next 15 years.
But there is the fly in the ointment. I suppose that most of these guys had salvage at whatever time they had BCR of .4. Did any of D have salvage before .4? Say at 2 years when they reached .2? It says "who received no form of neoadjuvant or adjuvant therapy before or immediately after their initial surgery". But that does not mean someone who was in D did not receive salvage before he got to .4 does it? Or does it?
Well, either way, < 10% of the worse case scenario succumbed to PC at 10 years(or less?) after being > .4, so it really does seem to be encouraging. Thx again, Logo!
Bill in MS