15 year survivial rate for men under 50

Right. That's one of the frustrating things about learning about a study from a press release, which is often SIGNIFICANTLY distorted.

Forgiven that, note that this was a retrospective study. So guys weren't thrown with careful randomness into the different treatments. It may be as simple as that the guys in the radiation group had poorer prognosis than the watchful-waiting guys. Which maybe makes sense--would you do WW if you had serious, aggressive cancer? It may just show that radiation wasn't able to bring the guys with aggressive cancer up to the survival of guys with mostly indolent cancer.

Without reading the study--and maybe not even then--we'll never know.

Thanks, Squirm.

I like those odds!

All the best,

Barry

Hi Guys and Gals:

This will probably label me as a bit of a skeptic but I guess I was not surprised that a study by two uro-surgeons would come out with surgery as a recommendation!  And, oh by the way, the robotic surgery center at Henry Ford Hospital is one of their big profit centers. 

I tried to find the actual study so I could understand why radiation patients did not survive as well as those who did nothing as that obviously does not make sense.  I couldn't find it so I'm buying into CapnLarry's guess that the study was not randomized... and/or the study was selective for initial diagnosis so that surgery won the contest.

By the way, while I was looking for the study in Science Daily, I ran across another study that was referenced on the same page.  That study was titled, "Radiation Seeds Effectively Cure Prostate Cancer in Young Men".  That study noted  "...studies have shown brachytherapy to be just as effective as surgery" and "Radiation seed implants (brachytherapy) are just as effective at curing prostate cancer in younger men (aged 60 and younger) as they are in older men, according to a new study".  This study was conducted by a radiation oncologist at MSK.  So, I guess I was not surprised at this conclusion either!

I guess the bottom line for me is:

1.  I can probably find a study that will prove almost any thesis...especially when economic motives are in play.

2.  While each man's cancer is different, most men with PCa can be equally cured by surgery or radiation.  This is especially true for early stage cancers. 

3.  It then becomes a trade off between side effects, pathology knowledge and the psychological makeup of the patient.

That is my two cents worth for a Friday!

Tudpock

 

If we ignore radiation, (I think we can assume the radiation cases were more advanced) there is still a big difference between Surgery and doing nothing, 6 out of 100 vs 22 out of 100 is a 350% improvement the way I look at it. But there is still a large group of experts saying we should do nothing.

Engineer.
Doing nothing is appropriate is certain situations. A summary of all the Active Survelience studies showed that men meeting the AS Criteria over 75% had no progression in 7 years and only 1% died. In these deaths the PC progressed within 6 months and was probably already matastized when diagonosed.
The remaining 25% had a local treatment as soon as any progression was noted. There was no more progression in the treated group. 12% of the group decided on local treatment even though there was no sign of progression. This is a 99% success rate.
Again, it is selection criteria. If you are a good candidate for AS your chances of a cure is extremely high even if your PC progresses and your chances of non progression is 75%. The worst case senerio is that you have delayed treatment for several years. If you meet the AS criteria and choose to have immediate treatment your cure rate will still be 99%. Basically there is agressive PC and non agressive PC. Any cure, including doing nothing, works on the non agressive, and is included in all the stats for cure rates for all the various options. The real question is not what the cure rate is for low grade PC, but what are the cure rates for intermediate and high grade PC.
Tud,
Excellent post and reasoning.
Jt

Squirm,
I saw this report before. The discussion adbout WW versus radiation within the advocacy groups is that the radiation arm consisted of those who could qualify for watchful waiting, but also those who had higher Gleasons, or more extensive invasions, that made watchful waiting less attractive. There is no distortion just a miss in the study to evaluation criteria. Most peopel with watchful waiting are G6 and low PSA's. The radiation arm could have Gleasons as high as G10 and T3 clinical evaluations.  But RP clearly won this race and I believe that a guy under 50 will benefir from this option better.

Tony

TC
I'm not sure that WW has remained the same since 1989. We have better PSA tests, safer biopsies and better ones (think color dopler.) and better information for the supervising doctors about when to "pull the trigger." I'm not sure about reading the pathology of biopsies, but I would bet that has improved too.

Probably the least improvement is in what WW does to the psychological state of the waiter.