Thanks for the link!
I'll have to reread the study, but it appears to support what others have said and is in the NCCN guidelines. It only supports AS for patients older men, since it says...
"Active surveillance for favorable-risk prostate cancer for men of all ages, and intermediate-risk disease in men of age more than 70, is feasible and appears safe in the 10–15-year timeframe."
and
"Uncertainty remains regarding the long-term impact of delayed treatment in men reclassified as higher risk after a period of observation and repeat biopsy."
This is really no different that what is in the current NCCN guidelines.
He also states that
"MRI has recently emerged as an accurate diagnostic tool for the identification of larger-volume cancer."
I have to read it again, but I am not sure he cites data that supports this claim.
Also, It is not clear how to define PSADT, for instance, do I fail the test? Some would argue I do not, since my latest PSA could be due to benign reasons. Also, if I got for another biopsy and the finding is still G6, do I continue AS?
Finally, I still cannot see where you come up with:
"and many of the remaining third did so before there was a medical necessity"
since there is not enough time frame in the study to determine this and it is not stratified by age.
So, IMHO, this does not help the group of younger (<60) men that fall in the G6, low volume category. Which I think have the biggest struggle in determining what to do. But I could be wrong.
I'll read it again after some turkey and see if I misinterpreted or see something else.
Post Edited (Mikla) : 11/28/2013 7:58:09 AM (GMT-7)