No PCa treatment is found to be superior

Available data insufficiently characterize the relative benefits of
various treatments for clinically localized prostate cancer, and all
therapies cause some harms.



http://www.annals.org/cgi/content/fu...0209v1#R5-2321

Last year, 218,000 men were diagnosed with prostate cancer, but nobody
can tell them what type of treatment is most likely to save their life.

Those are the findings of a troubling new report from the Agency for
Healthcare Research and Quality, which analyzed hundreds of studies in
an effort to advise men about the best treatments for prostate cancer.
The report compared the effectiveness and risks of eight prostate cancer
treatments, ranging from prostate removal to radioactive implants to no
treatment at all. None of the studies provided definitive answers.
Surprisingly, no treatment emerged as superior to doing nothing at all.

.... Prostate cancer is typically a slow-growing cancer, and many men can
live with it for years, often dying of another cause. But some men have
aggressive prostate cancers, and last year 27,050 men died from the
disease. The lifetime risk of being diagnosed with prostate cancer has
nearly doubled to 20 percent since the late 1980s, due mostly to
expanded use of the prostate-specific antigen, or P.S.A., blood test.
But the risk of dying of prostate cancer remains about 3 percent.
“Considerable overdetection and overtreatment may exist,'’ an agency
press release stated.

.... The study also evaluated research on “watchful waiting,'’ which
means monitoring the cancer and initiating treatment only if it appears
the disease is progressing.

http://well.blogs.nytimes.com/2008/0...ostate-cancer/

On Feb 6, 12:55*am, safire <saf...@tele-net.com> wrote...snip...

> Available data insufficiently characterize the relative benefits of
> various treatments for clinically localized prostate cancer, and all
> therapies cause some harms.
>
> http://www.annals.org/cgi/content/fu...0209v1#R5-2321

This meta-analysis only considered randomized trials. It seems quite
unlikely that a study where men with varying degrees of PCa would be
randomly assigned to surgery, radiation, AS, cryo, etc. will ever
occur. Such a study would knowingly impact the health of these men in
an adverse manner (e.g. randomly assigning a man with high-risk, organ-
confined disease to the AS arm). However, if one looks at non-
randomized studies which have compared PCa treatment efficacies, one
will see that conclusions have been drawn which do characterize the
relative benefits of the various treatments considered. It is also
reassuring to find that most of these studies reach similar
conclusions...ron

"ron" <oitbso@yahoo.com> wrote in message
news:d21c31f7-4d5f-45eb-a7ce-4b481476f6ad@k39g2000hsf.googlegroups.com...
On Feb 6, 12:55 am, safire <saf...@tele-net.com> wrote...snip...


This meta-analysis only considered randomized trials. It seems quite
unlikely that a study where men with varying degrees of PCa would be
randomly assigned to surgery, radiation, AS, cryo, etc. will ever
occur.

==> Actually, that sounds a lot like England's NHS.

After my RP, the surgeon said the cancer had spread all the way around
the prostate and that if I did not do anything, in 3-4 months I
wouldn't be able to urinate. How does that fit in those studies, re:
not doing anything?

"skeptic" <ribrass@aol.com> wrote in message
news:6238bb57-b938-4e94-a3cd-dafd226e6633@i72g2000hsd.googlegroups.com...
> After my RP, the surgeon said the cancer had spread all the way around
> the prostate and that if I did not do anything, in 3-4 months I
> wouldn't be able to urinate. How does that fit in those studies, re:
> not doing anything?

That's a very good question! And one I had not considered.

Steve Kramer wrote:
> "skeptic" <ribrass@aol.com> wrote in message
> news:6238bb57-b938-4e94-a3cd-dafd226e6633@i72g2000hsd.googlegroups.com...
>> After my RP, the surgeon said the cancer had spread all the way around
>> the prostate and that if I did not do anything, in 3-4 months I
>> wouldn't be able to urinate. How does that fit in those studies, re:
>> not doing anything?
>
> That's a very good question! And one I had not considered.
>
>

OMG, Steve thinks it is a very good question! Is it?

If you're playing black on 38 double zero wheel roulette rounds,
wagering $5 each time, you should expect to lose $10. Something with
probability theory. Yet, in 1938, Frank Sinatra told me his girlfriend's
aunt's second husband had won $20 doing exactly the same thing. How does
that fit in probability theory???

The article deals with the risk of dying after having been diagnosed
with prostate cancer.

BTW: the pain in your shoulder is not at all related to gas as Steve
suggested. The gas doesn't get to your shoulders. When you were operated
on your entire body weight was on your shoulders. That's why you felt
pain after recovery.

If you do a google search on "shoulder pain gas laproscopy" you will get
numerous references to gas causing shoulder pain after a laproscopy.


"safire" <safire@tele-net.com> wrote in message
news:foda2u$qvb$1@aioe.org...
> Steve Kramer wrote:
>> "skeptic" <ribrass@aol.com> wrote in message
>> news:6238bb57-b938-4e94-a3cd-dafd226e6633@i72g2000hsd.googlegroups.com...
>>> After my RP, the surgeon said the cancer had spread all the way around
>>> the prostate and that if I did not do anything, in 3-4 months I
>>> wouldn't be able to urinate. How does that fit in those studies, re:
>>> not doing anything?
>>
>> That's a very good question! And one I had not considered.
>
> OMG, Steve thinks it is a very good question! Is it?
>
> If you're playing black on 38 double zero wheel roulette rounds, wagering
> $5 each time, you should expect to lose $10. Something with probability
> theory. Yet, in 1938, Frank Sinatra told me his girlfriend's aunt's second
> husband had won $20 doing exactly the same thing. How does that fit in
> probability theory???
>
> The article deals with the risk of dying after having been diagnosed with
> prostate cancer.
>
> BTW: the pain in your shoulder is not at all related to gas as Steve
> suggested. The gas doesn't get to your shoulders. When you were operated
> on your entire body weight was on your shoulders. That's why you felt pain
> after recovery.

The NYT article completely miss-characterizes the results of the
study. The only context in which the study makes the conclusion that
"no treatment emerged as superior to doing nothing at all." is in
regard to occurrence of side effects. Well, duh, if you don't have
treatment you don't get side effects from the treatment. All the
study is pointing out for that issue is that treatment WILL have side
effects. Also, much of the data in the study seems to come from
Scandinavia, which my recollection tells me is a country that has been
very reluctant to treat PCa until its pretty far advanced. So by the
time they treat it there is no nearly as much likely hood of benefit
compared to not treating it. This is indicated by a statement in the
study that most of the DX were NOT from PSA results... in other words,
the cancer was sufficiently advanced that it was discovered from a DRE
plus, and this is just my supposition, I suspect most of the cohort
were fairly old men compared to what we see with PSA screening. So
that makes it much more difficult to see a strong benefit in terms of
life extension, they were only seeing a few years benefit.

In short, the study really doesn't tell us anything, it just confirms
what most people who have been following this stuff have known for a
long time but mainly in terms of 20 year old data before PSA screening
and early intervention started improving the survival rates.

The NYT really botched the reporting.


On Wed, 06 Feb 2008 08:55:25 +0100, safire <safire@tele-net.com>
wrote:

>Available data insufficiently characterize the relative benefits of
>various treatments for clinically localized prostate cancer, and all
>therapies cause some harms.
>
>
>
>http://www.annals.org/cgi/content/fu...0209v1#R5-2321
>
>Last year, 218,000 men were diagnosed with prostate cancer, but nobody
>can tell them what type of treatment is most likely to save their life.
>
>Those are the findings of a troubling new report from the Agency for
>Healthcare Research and Quality, which analyzed hundreds of studies in
>an effort to advise men about the best treatments for prostate cancer.
>The report compared the effectiveness and risks of eight prostate cancer
>treatments, ranging from prostate removal to radioactive implants to no
>treatment at all. None of the studies provided definitive answers.
>Surprisingly, no treatment emerged as superior to doing nothing at all.
>
>... Prostate cancer is typically a slow-growing cancer, and many men can
>live with it for years, often dying of another cause. But some men have
>aggressive prostate cancers, and last year 27,050 men died from the
>disease. The lifetime risk of being diagnosed with prostate cancer has
>nearly doubled to 20 percent since the late 1980s, due mostly to
>expanded use of the prostate-specific antigen, or P.S.A., blood test.
>But the risk of dying of prostate cancer remains about 3 percent.
>“Considerable overdetection and overtreatment may exist,'’ an agency
>press release stated.
>
>... The study also evaluated research on “watchful waiting,'’ which
>means monitoring the cancer and initiating treatment only if it appears
>the disease is progressing.
>
>http://well.blogs.nytimes.com/2008/0...ostate-cancer/

On February 6, 007 wrote:

(snip)

> The NYT really botched the reporting.

Nothing unusual. Illustrates once more why I do not trust some ignoramus
reporter on medical or any other technical subject, but prefer to see
the primary source.

I posted a link to the original article on the fifth.

Regards,

Steve J
Who has been on-scene many times and could see little resemblance
between what I saw and what the media reported.