New Study Results Dangerously Oversimplified By The Media
Was watching the National News on ABC a day or two ago. One of the major stories was a "breakthrough study" regarding Prostate Cancer. They refer to a recently released New England Journal of Medicine article citing a study done between 1999 and 2009 in the United Kingdom, 82,429 men between 50 and 69 years of age. The way the study was summarized by the news anchor was that it was a major breakthrough study indicating you don't have a higher chance of dying from Prostate Cancer if you did no surgery or radiation than if you did.
WOW
I haven't dove deep into the study but only one third was medium to high risk. Also as we all know typically prostate cancer is diagnosed at an older age 60's and 70's. So a 15-year study like that, a significant portion of the cohort will die of other causes but do you want to be on ADT at the end of your life despite your cause of death? Do a study of patients diagnosed via biopsy with Prostate Cancer in their 50's with even Gleason 6 and follow them for 25 years instead of 15, or limit the study to Stage 2 but Gleason 8 and up and follow them for 15 years, and let me know how that turns out. (rolleyes)
I totally agree with you. I have just posted the study in a new thread, unaware that you had already mentioned it. 
I recall the US Preventative Services Task Force a few years back saying men did not need to be concerned with PSA testing - and VA hospitals across the US jumped on it - along with a many GP's
And sure enough fewer and fewer men were being diagnosed with treatable early stage prostate cancer. Amazing how fast the disease was "cured" Then ....a few years later VA hospitals suddenly began to see a dramatic increased in advanced late stage prostate cancer and more men are dying - USPSTF suddenly decides to modify their recommendations.
Some how declaring treatment for PCa is not effective sort of reminded me of that history and the accuracy of media reporting. Draw your own conclusions as always I have mine ..... Dennis (ProstateCancer.net TEAM)If you recall why the USPSTF made that recommendation in 2012, it was not an arbitrary decision. In the early 2000s, after having only a slightly elevated PSA, so many men were opting for radical treatment (usually surgery) when it wasn’t medically necessary - having surgery only because they couldn’t “bear the thought of a cancer in their bodies” - that the USPSTF recommended against routine prostate cancer screening (assigning the screening a “D” recommendation): https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening-2012
(Despite that “D” recommendation, I still requested - and my doctor ordered and my insurance company paid for - a PSA test every year as part of my health checkup. That’s what all men should have done - kept getting PSA tests anyway.)
Of course, there was much pushback to that “D” recommendation, so in 2018 the USPSTF backed down and increased the recommendation to a “C,” with recommendation for PSA screening not until age 55y because (in their words), “Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men.”: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screeningBut, there was also more of a push for active surveillance (which is what we see happening these days) when that’s what is called for. (Which % we’ve seen more than double over the last decade - up to almost 60% of G6 cases in the U.S.)
What I took away from that study and from the news report, is that more men with localized prostate cancer - especially G6 prostate cancers - should consider active surveillance over surgery or radiation (if the other diagnostic numbers support it).Certainly agree it was not an arbitrary suggestion even though the voluntary members of USPSTF offered their collective point of view. YUP as patients it is always best to ask lots of questions and do your research vs jumping into the frying pan when told you have a series diagnosis.
I suspect and research appears to support the national trend that most men do not pay much attention to their PSA scores or the need for regular physicals until they receive that unexpected diagnosis.
I do get the sense that urologists and oncologists today are getting a bit better at not over reacting or jumping into aggressive and unneeded treatment protocols . It is nice to see some calm emerging on the horizon when it comes to diagnosing and making decisions on next steps when facing PCa ... Dennis(ProstateCancer.net TEAM)
I will concede that any patient and their doctor that are on the fence with whether to go with Active Surveilance or not can feel more comfortable choosing AS. But the patients where AS is even an option is just one subset of PCa patients.
All true, But there is an emotional factor along with a data driven approach. I could have chosen to go with AS and the doctors would be OK with it. I did NOT want to have multiple biopsies only to probably need either surgery/ radiation in the future. I was 64 when I was treated. Having surgery or radiation as a 70 or 75 year old was unappealing. Those factors are not data, but emotional.
Honest question. If you know what you know now, would you do it the same way? If you did radiation 9 years ago with not having ADT treatment, would you do it?What I’ve found is that active surveillance has morphed since I was diagnosed in 2012. No longer are there periodic biopsies every few years; today there are periodic MRIs, but only biopsies if there are changed or new lesions. So, at some age - 75y perhaps - the decision would be made to minimize invasive treatments given the shortened time horizon, other comorbidities, and all the other causes of death that might occur. (Yes, even age is a numerical datapoint that plays a role in the decision.)
If I were making the decision today, knowing what I know now, the only change I would make would be to add an additional datapoint — a PET CT or a PSMA PET scan — to provide confirmation beyond what a bone scan and CT scan can provide. When I made the active surveillance decision in early 2012 and the proton radiation decision in early 2021, Pylarify had not been FDA-approved yet, Illuccix was only available at UCLA/UCSF, Axumin was not approved for initial diagnosis, and Choline C11 was only used at Mayo.
I used the data that I had available at the time to make each decision. And I’m confident that each was the correct decision based on that information (including the use of ADT, the side-effects of which were greatly minimized with strength-training). Whether additional data would have resulted in a different decision, we’ll never know……
I saw the same news report. It started a good conversation between my wife and I, both of us understanding where the study, the report, as well as the gentleman being interviewed fell short. But, all things considered, it was not expected to be a tutorial on prostate cancer; it was a satisfactory report for the 2 minutes most news stories are given.
(I was diagnosed with low-grade, localized prostate cancer in 2012, was on active surveillance for 9 years, had 28 sessions of Proton radiation treatments during April-May 2021 (+6 months of ADT +SpaceOAR Vue injected). Treatments were uneventful, and I have had no lingering after-effects from either the Proton radiation or the ADT. PSA is averaging around 0.400 ng/mL; so far, so good.)
As studies continue, and more funding is allocated to prostate cancer research, more and more data will be collected for longer periods of time. But, if 15 years is the longest study they have so far, that’s great. I’ll take that and integrate it into my analysis for future treatment.
Would this study have changed your decision in 2021 to precede with treatment instead of remaining on AS longer? Your data must not have been that concerning to proceed with Active Surveillance in the first place and you chose treatment 9 years later where this study followed people that chose AS just as you did but stayed on AS 6 years longer (and possibly beyond.) If this study had it come out in 2020 would have not changed your mind to proceed with treatment, then that's my case in point. Because if you let the study help guide your decision, then it's saying your chance you're going to die of Prostate Cancer is no less if you proceed with treatment because after 6 more years than you there was still no difference.
