Dr. Weeks’ Comment: In medicine (as in all human endeavors), let us appreciate that there is always a “money trail” and that it always merits “following” in order to attain an orientation as to why providers might recommend one treatment as opposed to another. Here following is a report in The Lancet written by doctors who do NOT offer prostatectomy. It concludes that the benefits of radical prostatectomy are “generally overestimated”.
The tale of the lady who travelled the world in order to find the right doctor is instructive. “Oh Dr. Schnicklefritz, I am so glad I finally found you and I trust you can treat what I have!” to which the doc replied: “Lady, I hope you have what I treat!” (Many thanks to Dr. Larry L Weed for that lesson 25 years ago!)
“…Previous studies that used a treatment-received approach have generally overestimated the benefits of radical prostatectomy…”
Population-based study of long-term survival in patients with clinically localised prostate cancer
Grace L Lu-Yao, PhDa, Dr Siu-Long Yao, MDb,
a Health Care Financing Administration, Office of Research and Demonstrations, Division of Health Information and Outcomes, 7500 Security Boulevard, Mail Stop C3-24-07, Baltimore, MD 21244-1850
b Johns Hopkins Oncology Center, Baltimore (S-L Yao MD), USA
Choice of treatment in localized prostate cancer has been hampered by a lack of unbiased, representative data on outcome. Most existing data have come from small cohorts at specialized academic centres; precise overall and cancer-grade-specific data are not available, and the data are subject to differential staging bias. Randomized clinical trials have been undertaken, but the results will not be available for another decade. We have carried out a large population-based study to ascertain overall and prostate-cancer-specific survival in men treated by prostatectomy, radiotherapy, or conservative management.
Data for 59 876 cancer-registry patients aged 50-79 were analyzed. We examined the effect of differential staging of prostate cancer by analyzing the data both by intention to treat and by treatment received. Estimated survival was calculated by the Kaplan-Meier method.
By the intention-to-treat approach, 10-year prostate-cancer-specific survival for grade 1 cancer was 94% (95% CI 91-95) after prostatectomy, 90% (87-92) after radiotherapy, and 93% (91-94) after conservative management. The corresponding survival figures in grade 2 cancers were 87% (85-89), 76% (72-79), and 77% (74-80); those in grade 3 cancer were 67% (62-71), 53% (47-58), and 45% (40-51). Although the intention-to-treat and treatment-received analyses yielded similar results for radiotherapy and conservative management, the 10-year disease-specific survival after prostatectomy differed substantially (83% [81-84] by intention to treat vs 89% [87-91] by treatment received).
The overall and cancer-grade-specific survival found in this study differ substantially from those in previous studies. Previous studies that used a treatment-received approach have generally overestimated the benefits of radical prostatectomy. We found that grade 3 tumours are highly aggressive irrespective of stage.