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I feel everyone must watch Dr Myers' video summarizing the NIH conference on Active Surveillance.
"After this conference the treatment for prostate cancer can never be what it has been."
He focuses on the "true" Gleason 6 patient, and reports that "one of the results of the recent PIVOT trial was that for men with Gleason 3+3 biopsies, the death rate from prostate surgery was higher than for those on Active Surveillance."
So not only do you not save lives, you harm the patient by causing impotence and incontinence. "This is the death knell for surgery as a treatment for true Gleason 6 disease."
Please watch the video:
http://askdrmyers.wordpress.com/
Whilst the recently concluded conference on Active Surveillance is a very important one I believe that Dr Myers may have jumped the gun somewhat and focussed on an issue that may be somewhat misleading if he has based his remarks on the draft report.
You can read the DRAFT REPORT for yourselves and see if you come to a different conclusion to that presented by Dr Myers. It seems that the relevant section of the report upon which Dr Myers' statement is based is on page 14, line 7 The 30-day mortality of radical prostatectomy is one-half percent. This presumably refers to the risks associated with any major surgery.
On the other hand in lin 4 on the same page the statment is made
There is weak evidence from cohort studies that observational strategies [ie Active Surveillance or Watchful Waiting] result in an increase in death rates relative to both radiation therapy and radical prostatectomy.
What is undoubtedly likey to be an unintended consequence of this meetings is that the number of men diagnosed with Gleason Scores of 3+3=6 will decline and the number diagnosed with GS 7a (3+4) and 7b (4+3) will increase. We have already seen this, dubbed the Gleason Migration, after the decision was made to no longer define Gleason Grade 2 material as 'cancer'. This meant that GS 5 diagnoses disappeared, but GS 6 diagnoses increased.
It seems likely now that pathologists may proceed with the proposal to use a third focus. This will mean that if there is any material graded as 5 in a sample, this will lead to a Gleason Score of 8 or 9. A scary prposition.
