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Re: OMG - more confusion in data and how!!

Call me a nitpicker if you will but how does your study fact 2 add up?

David in England

Re: OMG - more confusion in data and how!!

Good question David. The fact is that it adds up to 110%; so there is obviously a mistake. It wasn't mine though because I just re-checked my source & the mistake is there in print. Therefore, I cannnot supply the correct figures, but I don't see it changing the essence of the study results anyway.

Good eye though. You have one-upped this OCD guy. Thanks for the reply.

Best Wishes,
Alan in the USA

Re: The Problem with PCa Mortality Statistics (My Own Personal Perspective)

Albertsen PC, Hanley JA, Gleason DF, Barry MJ.
Competing risk analysis of men aged 55 to 74 years at diagnosis managed CONSERVATIVELY for clinically localized prostate cancer.
JAMA 1998 Sep 16;280(11):975-80

I wonder if knowing what is meant by CONSERVATIVELY would help further understanding of this study.

Jack
USA

Re: The Problem with PCa Mortality Statistics (My Own Personal Perspective)

"Conservative Managment" meant that there was no immediate aggressive therapy.

The term was probably synonymous with Watchful Waiting at the time and would have evntailed men being treated for symptoms rather than making an attempt at "cure".

It was the path folowed in most countries outside of the USA where the surgeons particularly have always been very aggressive in their treatments. As Dr Christopher Logothetis said in a talk to an US-Too group back in December 1993.

One of the problems with prostate cancer is definition. They label it as a cancer, and they force us all to behave in a way that introduces us to a cascade of events that sends us to very morbid therapy. It's sort of like once that cancer label is put on there we are obligated to behave in a certain way, and its driven by physician beliefs and patient beliefs and frequently they don't have anything to do with reality.

People who come from a totally different social background like the Swedes are very frustrated with us for the frequency with which we do prostatectomies. In fact, they are very angry. And urologists are probably the most embattled surgeons across the country in the United States. If you go overseas, and you are a urology surgeon in the U.S., there is a reputation that you carry with you that you are willing to operate on anybody the minute they sneeze.

Now that's not necessarily true. Actually, the U.S. surgeons are driven by attempts to cure more people. So I think the motives are very correct in the overwhelming majority of them. But one can't ignore the paradox that the earlier you treat, the larger number of patients you do operations on who would do well despite you. So proportionately the patients who benefit, that is those patients who are cured by your operation, start becoming a smaller and smaller fraction of the total. So there's the paradox with prostate cancer.


Nothing much changed from 1993 until fairly recently when there was finally a recognition that Dr Thmoas Stamey was correct when he said in 2001

I believe that when the final chapter of this disease is written, which is unlikely to be in my lifetime, never in the history of oncology will so many men have been so overtreated for one disease.

All the best
Terry in Australia

Re: The Problem with PCa Mortality Statistics (My Own Personal Perspective)

Hello Terry,

It does get more confusing when one reads, as I did, the abstract in JAMA which says the study included men who had no treatment or were treated with immediate or delayed hormonal therapy.

Jack
New Jersey

Re: The Problem with PCa Mortality Statistics (My Own Personal Perspective)

Yes, Jack, that is what I said:

"Conservative Managment" meant that there was no immediate aggressive therapy.

The term was probably synonymous with Watchful Waiting at the time and would have evntailed men being treated for symptoms rather than making an attempt at "cure".


Hormonal therapy is a management tool.

Re: The Problem with PCa Mortality Statistics (My Own Personal Perspective)

Terry,

I see where I made a wrong assumption of when this conservative management took place. It would have been clearer if they had said the study included men who HAD HAD either no treatment or immediate or delayed hormonal therapy PRIOR to their being included in the study. One of the limitations of the study mentioned is that some of these patients received aggressive management at a later date. I assume if they had been doing ADT during the period of observation that would not have been considered a limitation of the study. Still, it looks like the findings are valid. So you're saying in 1988 Watchful Waiting included hormonal therapy. Is that still the case? I note that one study showed the outlook for an older man (like me) diagnosed with Gleason 9 was pretty good, but that was later refuted. Darn!

Jack
USA

Re: The Problem with PCa Mortality Statistics (My Own Personal Perspective)

Jack,

There is what has always seemed to me to be an artifically created 'divide' between Watchful Waiting WW and Active Surveillance AS.

WW is said, in this type of fine division, to be a choice that mainly treats symptoms and makes no attempt at cure, the aim being to manage the disease with a minimum of loss of quality of life until the man dies - whether of PCa or some other cause

AS on the other hand is said to be a choice that monitors the man as closely as possible to ensure that aggressive action, aimed at curing the man but with the inevitable loss of some quality of life, is taken as soon as there is evidence that this would be in his best interests.

Now those are very broad statemetnts and there are many overlaps and lack of clarity.

So WW would almost inevitably include ADT if the circumstances warranted it and the man lived long enough (me for example!!) as would any conventional treatment that failed to 'cure' the man as a large percentage does at present. Well, if you defined bio-chemical failure as 'failure.'

The reason that older men often show a better disease specific survival rate compared to younger men is that they are more suscetible to death from other causes. You can't die twice.

Re: The Problem with PCa Mortality Statistics (My Own Personal Perspective)

the advantage of being a pca surviour is we may or may not now from what we will die from. If we wake up in the morning we are alive, then get on with the day and enjoy it. Age is unimportant. bob

Re: The Problem with PCa Mortality Statistics (My Own Personal Perspective)

I want to say thank you to David, Terry & Frank for replying to my post.

I appreciate the statistical insight, but I may have given the wrong impression. I do understand statistics in the sense of knowing how to interpret ratios & percentages. An example of what I meant when I said that I found statistics hard to grasp is when I said this in my last post: “When you compare these two statistics, the 3% figure appears to be reassuringly low, while the ACS figure seems rather high, but in reality 3% & 1 in 36 are basically the same”. Similarly, when you look at the ratio supplied by Frank, 1 in 6 seems like bad odds, but when you convert the ratio into a percentage, it is 17% and that seems like a rather small figure (especially when you factor in what Terry said about half of those men being over 80 years old).

That being said, I don’t want my main reason for writing that post to be sidetracked by the responses that, while helpful & appreciated, focus on the perception that I need help understanding statistics. What I really wanted readers to get out of that post is best summed up in the long second to last paragraph. Here is another example of the point I am trying to make: In Terry’s initial response, he said that only half of the estimated 34,000 PCa deaths in the U.S. in 2011 would involve men under 80 years of age. That seems like a very low figure indeed, but I think that it is important that an individual not put too much stock in it. I say this because his individual circumstances MAY result in him being one of the 17,000 fatalities. So, IMO, his focus should be on his, & ONLY HIS, individual statistics & not the national ones.

This is not to say that I think that Terry disagrees with my assessment. I believe that the following statement from his second to last post shows that, basically, we are on the same page: “Statistically men diagnosed with prostate cancer are as likely to die from the causes of death that the non-diagnosed men will die of. Of course this doesn't apply to all individual cases and it is not possible to predict with accuracy which of the PCa men will die from the disease over the next 30 years.”

Lastly, IMO, if somebody was going to give any weight to national PCa mortality statistics, it should be the ratio of 1 death for every 6 PCa patients quoted by Frank. I believe that it is a much more relevant statistic than the often cited < 3% mortality figure that is based on the population as a whole.

Alan in the USA

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