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Johns Hopkins Article Supporting RP over AS GUILTY of its own Flaws (Omissions)
The Johns Hopkins article that appears in the post from Bobby Mac entitled “Re: Good News for Radical Prostatectomy Patients - Johns Hopkins Article” criticizes the Pivot Study for being “severely flawed” (and I’m not sayng that it isn’t true), but the rebuttal from Johns Hopkins is also flawed in that it conveniently omits certain data from the Swedish study that, if revealed, would hurt their position that the findings support RP over AS.
To highlight the omissions that Johns Hopkins is guilty of, I have included below an excerpt from an article entitled “Swedish Study Finds Surgery For Prostate Cancer Better Than Waiting”. Note: the whole article can be obtained by cutting & pasting the following URL into your browser:
http://www.npr.org/sections/healthshots/2011/05/04/135995705/swedish-study-finds-surgery-for-prostate-cancer-better-than-waiting
'So is this a slam-dunk for radical prostatectomy? Game over?
Far from it. In an editorial accompanying the study, Dr. Dr. Matthew Smith of Massachusetts General Hospital makes some important points.
First, only about 1 in 20 men in the Swedish study had a prostate cancer diagnosis based on a high PSA level. Almost 90 percent had tumors their doctors could feel on digital rectal exams. But in the U.S., most prostate cancers are identified by PSA screening, and less than half have palpable tumors.
This is important, because experts believe many prostate tumors found by PSA are likely to be slow-growing — perhaps so slow they will never cause a problem before the man dies of something else.
So "low risk" in the Swedish study means higher-risk than the current "low risk" men diagnosed in the United States. By the way, 9 out of 10 prostate cancers in the U.S. these days is considered low risk.
Second, the Swedish study compared radical prostatectomy to watchful waiting. And Smith points out that "watchful waiting" does not mean the same thing as "active surveillance."
"Watchful waiting means we're not going to treat you now and if you progress clinically, we'll treat you with hormone therapy – not with curative intent," Smith tells Shots.
"Active surveillance means observing the patient in a proactive way, with regularly scheduled biopsies," he adds. If there's a sign the cancer is progressing, doctors currently would treat with intent to cure, using surgery, radiation or both.
Smith makes another point: Both surgical techniques and radiation therapy technology have improved since the Swedish study was done. So there's reason to think men followed with active surveillance and treated when necessary would fare better than the "watchful waiting" group in the newly published study'.
In closing, it is clear that, in the Swedish study, the great majority of the patients (almost 90%) were not low-risk at all (since feeling the tumor during a DRE would mean that you are not a low-risk). Also, if you make a comparison between immediate RP treatment and AS for “true” low-risk patients, without the understanding that AS is all about “curative intent”, then your analysis has no merit.
Re: Johns Hopkins Article Supporting RP over AS GUILTY of its own Flaws (Omissions)
Hi Alan -
Yes, there are certainly opposing views on study results and treatments.
If I were low risk either watchful waiting or active surveillance would probably be at the top of my list.
As for myself, a Gleason 8, with high a volume disease, I figure my odds are approximately 7%-8% better surviving this disease with RP that I am having in May.
Is the anticipated edge worth the quality of life issues with RP? I say yes, but that is an individual decision.
Re: Johns Hopkins Article Supporting RP over AS GUILTY of its own Flaws (Omissions)
WOW! Boys, I am truly confused by all the "facts". I must not be smart enough to gain any conclusions from all this. To me, it is just a bunch of studies that really mean nothing to me as do much of the "facts and figures" gathered on this subject and presented as statistics. Statistics are notorious for being slanted, confusing, and inaccurate. In the case of PC, there are just too many variables to come up with anything more than a bunch of paperwork. Certainly nothing solid I would want to base my future on. It is probably why even the experts shrink away when you ask them their opinion is as to what course you should take. They know better than to commit to an unknown. They don't want that responsibility. Please don't misunderstand - I am not being sarcastic or critical. These studies are just doing their best to answer questions that we all wonder about in this grey and uncharted PC arena. These things are good to study and try to comprehend but must be considered with much precaution. I find the personal stories on this site to be as good a guide as anything in trying to find trends that might co-inside with one's own situation.
This site is a good source of information, including the article we are discussing here. It is (the site) a great help to many of us, giving us a way to communicate back and forth and share feelings and thoughts. I have really said very little here and wonder if I should even post this. I hope my words haven't "stepped on any toes" as I sure didn't mean to do that. Jon R.
Re: Johns Hopkins Article Supporting RP over AS GUILTY of its own Flaws (Omissions)
Alan,
Your analysis is spot on. I can only add that with the advent of the 3T-MP-MRI and fusion biopsy a man can safely choose AS and be 95% certain they sampled the highest risk tumor in his prostate.
Bobby,
I have no quarrel with your choice for RP with a gleason 8 tumor. As I am sure you are aware, your tumor would be considered high risk and therefore you would not qualify for AS.
