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New Study Out Dangerously Oversimplified By The Media

User
Posted 12 Mar 2023 at 18:24

Was watching the National News on ABC a day or two ago. One of the major stories was a "breakthrough study" regarding Prostate Cancer. They refer to a recently released New England Journal of Medicine article citing a study done between 1999 and 2009 in the United Kingdom, 82,429 men between 50 and 69 years of age. The way the study was summarized by the news anchor was that it was a major breakthrough study indicating you don't have a higher chance of dying from Prostate Cancer if you did no surgery or radiation than if you did.


WOW


I haven't dove deep into the study but only one third was medium to high risk. Also as we all know typically prostate cancer is diagnosed at an older age 60's and 70's. So a 15-year study like that, a significant portion of the cohort will die of other causes but do you want to be on ADT at the end of your life despite your cause of death? Do a study of patients diagnosed via biopsy with Prostate Cancer in their 50's with even Gleason 6 and follow them for 25 years instead of 15, or limit the study to Stage 2 but Gleason 8 and up and follow them for 15 years, and let me know how that turns out. (rolleyes)


https://www.nejm.org/doi/full/10.1056/NEJMoa2214122


 

User
Posted 12 Mar 2023 at 18:24

Was watching the National News on ABC a day or two ago. One of the major stories was a "breakthrough study" regarding Prostate Cancer. They refer to a recently released New England Journal of Medicine article citing a study done between 1999 and 2009 in the United Kingdom, 82,429 men between 50 and 69 years of age. The way the study was summarized by the news anchor was that it was a major breakthrough study indicating you don't have a higher chance of dying from Prostate Cancer if you did no surgery or radiation than if you did.


WOW


I haven't dove deep into the study but only one third was medium to high risk. Also as we all know typically prostate cancer is diagnosed at an older age 60's and 70's. So a 15-year study like that, a significant portion of the cohort will die of other causes but do you want to be on ADT at the end of your life despite your cause of death? Do a study of patients diagnosed via biopsy with Prostate Cancer in their 50's with even Gleason 6 and follow them for 25 years instead of 15, or limit the study to Stage 2 but Gleason 8 and up and follow them for 15 years, and let me know how that turns out. (rolleyes)


https://www.nejm.org/doi/full/10.1056/NEJMoa2214122


 

User
Posted 14 Mar 2023 at 10:24

I agree to report the death figure (or lack of them) out of context is misleading. The study actually does have some useful information if read in context.


Quite often we have new posts from people in a panic having just been diagnosed. They have massive anxiety waiting for results and are worried because treatment isn't happening right now.


It will be very reassuring for them, to be able to quote that 75% of people in their position would not even have disease progression after 15 years. So a six month wait for treatment doesn't amount to more than a hill of beans in the long term.


Of course plenty of newby posters have high risk disease, or are already locally advanced, so I am not for one second saying they can ignore the disease for 15 years, but they certainly can go to bed that night and not fear that tomorrow they will die.


It also shows the outcomes for RP and RT are almost identical with a slight advantage to RP, but this is based on technology as it was about 15 years ago, it has moved on.


As there is a slow rate of disease progression, I would argue it suggests Active Surveillance is a viable strategy for delaying side effects for around a decade (not if high risk though).

Dave

User
Posted 14 Mar 2023 at 22:01
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"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
Posted 14 Mar 2023 at 10:24

I agree to report the death figure (or lack of them) out of context is misleading. The study actually does have some useful information if read in context.


Quite often we have new posts from people in a panic having just been diagnosed. They have massive anxiety waiting for results and are worried because treatment isn't happening right now.


It will be very reassuring for them, to be able to quote that 75% of people in their position would not even have disease progression after 15 years. So a six month wait for treatment doesn't amount to more than a hill of beans in the long term.


Of course plenty of newby posters have high risk disease, or are already locally advanced, so I am not for one second saying they can ignore the disease for 15 years, but they certainly can go to bed that night and not fear that tomorrow they will die.


It also shows the outcomes for RP and RT are almost identical with a slight advantage to RP, but this is based on technology as it was about 15 years ago, it has moved on.


As there is a slow rate of disease progression, I would argue it suggests Active Surveillance is a viable strategy for delaying side effects for around a decade (not if high risk though).

Dave

User
Posted 14 Mar 2023 at 20:16
This isn't new and it is not dangerous reporting - it is factual. There is also recent European research (a much larger sample) which shows that for T1 / T2a prostate cancer, men do almost as well having no treatment and have a better quality of life because they don't have to live with the side effects of surgery, RT or HT. About 50% of men diagnosed with T1 / T2 may never need treatment.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 14 Mar 2023 at 20:52

All this study does is provide additional evidence for Active Surveilance which is not groundbreaking. When grossly oversimpilified, it risks misleading people to think AS is the appropriate treatment for them when it is not, as the patient has the final say, and we are all adverse to surgery and radiation. Nothing about this study is "groundbreaking" in my opinion. It's just noteworthy due to the combination of a very large cohort size and a relatively long follow-up period of 15 years. I would venture to say the majority of men, or at minimum one third, diagnosed with Prostate Cancer die of heart disease, lung cancer, or some other cause within 15 years of diagnosis.


Everyone knows Prostate Cancer has a relatively slow progression. This study to me basically says, if you and your doctor are "on the fence" about whether to due AS or proceed with surgery or radiation, you can feel more at ease choosing the AS route.


The flaw in this study is that it's a cohort of mixed ages and stages in the disease. I don't think it brings anything that new to the picture to make a night and day change to how treatment decisions are made. If you have advanced stage (like T3 or Gleason 8+) you get treatment. If you have Gleason 6 and a low percentage of positive biopsy cores, AS is a viable choice. If you're middle risk, like T2 Gleason 7, than the decision largely depends on your age. If the cancer isn't going to kill you in less than 20 years and most likely you won't live another 20 years, then just doing AS and then ADT if needed with no surgery or radiation could be a plausible option. If you are in the middle and diagnosed at age 53, that's a different story. It's not like no Urologist was ever recommending AS as an option before this study came out.


 

Edited by member 15 Mar 2023 at 14:56  | Reason: Not specified

User
Posted 14 Mar 2023 at 22:01
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"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
 
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