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Radical prostatectomy versus watchful waiting

Beau2
Posts: 245
Joined: Sep 2010

I was on another forum and a member posted a link to an interesting Scandinavian trial that I thought others may be interested in reading:

The link to the charts:

www.ncbi.nlm.nih.gov/images?term=18695132[PMID]

The article:

www.ncbi.nlm.nih.gov/pmc/articles/PMC2518167

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Beau,

Thanks for sharing this report which is quite detailed. I found many aspects quite interesting but I think it is worth noting the editorial comments that state that it is unclear whether these results could be duplicated today in the era of PSA testing. It's also worth noting that quality of life aspects were not addressed in the study and longevity appeard to be the overarching aim of the data.

Given that all of these men in the study were diagnosed before the advent of routine PSA testing, the cohort consisted of men where cancer was suspected from a DRE or some other symptom. My feeling is that despite the general T1 staging level these men were put in, it seems likely to me that many of these men had a more advanced cancer condition when they were enrolled in the study than most men who are first diagnosed today where a PSA score is is the most often used factor in triggering a biopsy.

I also find it incredible that so many men would knowingly submit to such a study where some were treated with surgery and others with watchful waiting. Reading between the lines on this aspect of the study it seems to me that some of the initial men were perhaps unknowing participants in the randomization of treatment but that after some years, the doctors seemed to realize the ethical issues surrounding this approach and went to a fully informed method for getting participants.

K

Beau2
Posts: 245
Joined: Sep 2010

Yes, when it comes to PCa studies and data it seems they all are lacking ... either they suffer from being old before they are published, or are not inclusive of all of the variables we would like examined. I my case they usually don't say what I want to hear.

Concerning the QOL issues, here's a newly published study covering the complications of Davinci. Seems the authors conclude there is an "overall complication rate" of 9.8%. Must read to see what this means.

https://docs.google.com/viewer?url=http%3A%2F%2Fts-si.org%2Ffiles%2Fdoi101016S1569905611604491.pdf

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Actually this study only addresses complications from the surgical process alone and involved complications within 30 days of the prostate removal. The authors conclude that this 9.8 percent rate was "safe.". I think QOL issues generally refer to incontinence, rectal, or ED issues and were not addressed in this study.

Beau2
Posts: 245
Joined: Sep 2010

Exactly.

Thats why I put quotes around "overall complication rate" (authors words not mine)and the statement that the reader needed to read the paper to define what they ment.

It is interesting to see what some guys consider QOL issues. I once had it rather forcefully explained to me that the only issue was staying alive. I guess it depends on your perspective.

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