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The PIVOTAL 10 year, 9018 man study data behind my AS decision
I thought I would share this study summary data with the readers (taken from an article dated 2/14/2008, which stated that this was the largest study to look at this issue since PSA tests became popular). I gathered a lot of research information following my diagnosis, but it was this data that was my main reason for choosing AS over surgery. Even today, four years later, I remind myself of these results when I come across disturbing news that shakes my confidence in my decision. So, hear it is:
Dr. Grace Lu-Yao headed a study of 9018 men (half over the age of 75) that were diagnosed from 1992-2002 with EARLY-STAGE prostate cancer. While MOST OF THESE MEN NEVER GOT ANY TREATMENT AT ALL, those who were treated did not undergo any surgery, radiation or hormone therapy for at least 6 months. (That 6 month time frame is deceiving though because, while 30% of these men eventually sought treatment, as a whole, THEY WERE ABLE TO DELAY IT FOR AN AVERAGE OF 11 YEARS). Furthermore, ten years later, THE VAST MAJORITY WERE ALIVE WITHOUT SIGNIFICANTLY WORSENING SYMPTOMS or had died of other causes. (In fact, only 10% had died from the disease over the decade).**
**NOTE: The 10% is an overall figure. The following quote from the article explains it: “A decade later, 3% to 7% of those with low or moderate grade tumors (rated by how aggressive the cells appear) had died of prostate cancer, vs. 23% of those with high grade tumors. Overall, prostate cancer killed 10% of them”.
I should note that despite all this, when I e-mailed Dr Lu-Yao this past year regarding my circumstances, she told me that, because of my age, I should be seeking treatment. (For those readers who aren’t familiar with my case, I am 55 and was diagnosed a Gleason 6 at age 51. My last TRUS biopsy results were 4 out of 12 cores that were all 45% cancerous).
I hope you have found this informative and enlightening, but please do not consider this a recommendation that you practice AS over seeking treatment. In my mind, that is a deeply personal decision that should only come after a lot of individual research and soul searching. (Personally, while this study was my main reason for choosing AS, it certainly wasn’t my only one). My only intention in writing this post is to help both those on AS and those who are contemplating it by providing the information, nothing more.
Anyone interested in this critical study might like to read Mike Scott's comments in a presentation on the otucome of the study at The New Prostate Cancer Infolink
Like virtually every other issue on prostate cancer, this study is not without controversary.
One of the points that I always look for in this kind of study is the relationship between total deaths and prostate cancer specific deaths. In Mike's summary he says that almost half the men in the study died during the time of the study, but only 7% of the deaths were due to prostate cancer.
This is not unexpected because prostate cancer accounts for about 3% of all male deaths, a figure that has not changed signifcantly since 1976 in the USA.
As Dr Willet Whitmore said many years ago
Growing old is invariably fatal while prostate cancer is only sometimes so.
