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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.
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".
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!
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.
