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Prostate Cancer Surgery is “a waste of time”

VascodaGama's picture
VascodaGama
Posts: 1533
Joined: Nov 2010

The Daily Mail goes far in suggesting that Prostate Cancer Surgery is “a waste of time”.
http://www.dailymail.co.uk/health/article-2137135/Thousands-men-suffer-needlessly-prostate-cancer-surgery-waste-time.html

They report about comments by scientists from the PIVOT (Prostate Intervention Versus Observation Trial) study,involving 731 subjects (following them over 12 years since 1993), which has found that survival rates for low risk cancers do not significantly differ among patients who did surgery or has followed a Watchful Waiting approach.
(http://prostatecancerinfolink.net/2011/05/18/the-initial-results-of-the-pivot-study/)

One should consider that results from studies are based on percentages which may differ from one’s specific case. Nevertheless, the study provides “feed for thoughts”.

What is your opinion?

VGama

Samsungtech1
Posts: 350
Joined: Jan 2011

I did not have that choice, but if I were diagnosed with low grade cancer I think I would wait. Also I have read where they have some new treatments that seem to be doing pretty good.
A friend I served with in VN went with the surgery forlow grade. He seems to be doing ok, but it has only been 3 yeras. Another friend from VN is doing the watchful waiting. He is doing OK as well.
Unfortunately this isnot like a horse race where you place your bet and you win or lose, but no harm. This is where you make a decision that is for your life. Getting it wrong is bad news. Everyone has toplace their bet. Maybe one day we can move the odds to better favor us.

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

Vasco,

I appreciate the post but expect that you may open up a hornet's nest of opinion both for and against the results of the study. In the past two years since my own diagnosis I've come to believe that men elect treatment options for a variety of reasons and that most of the time it has little to do with a careful analysis of the results of studies like these although I wish it wasn't so. Most men who elect surgery, in my opinion, are doing so based on the recommendations of the urologist who makes the initial diagnosis. We are so conditioned to follow the recommendations of our physicians that most do not consider challenging them or seeking second opinions. If they do, they often go to another urologist who, based on their background and training, will also recommend surgery.

For low grade prostate cancer I suspect that if you did a similar comparison between men who elected radiation 10 or 15 years ago you would see closely similar results. It's too early to tell if newer forms of radiation make a difference.

One of the study conclusions seems to be that men with a life expectancy less than 12 years see no statistical benefit from surgery as a group. In the United States the average life expectancy is 75.6 years. That would suggest than men over 63 and who live in the USA should not elect surgery. Of course, we all come from different backgrounds and many of us in our 60s today may not be ready to start a countdown to 75. I know I certainly don't want to do that.

In any event, thanks for the post. It should be the catalyst for an interesting discussion.

ralph.townsend1's picture
ralph.townsend1
Posts: 352
Joined: Feb 2012

What were you thinking Vasco! Opening that can of worm's. I think a lot maybe as high as 40% of the surgery on low grade PC are not need it and can be treated with other form's (radiation). The urologist always want to go for the safe way to treat low grade PC. But saying that, I think they put a cloud over your head to make that decision of surgery. Having surgery with Gleason 4+5 was the right decision, but the PC had spread outside the Prostate. The doctor with have to take a lot of tissue and damage the muscle to get clean Margin's.

Radiation is a terrible alternative for the damage it does, almost barbaric. But for low grade PC it might be the better choice. It takes time, and everything start to recover. With surgery it's never the same!!! That's a Fact Jack!

spottydog10's picture
spottydog10
Posts: 73
Joined: Jul 2009

It's a vacuous article.
I was diagnosed as a gleason 6 and after surgery the pathology showed a gleason 7.
Not that there isnt times when I regret the surgery, there is, but with 2 years and 6 months undetectable I think my decision was the right one.

Mike

Swingshiftworker
Posts: 626
Joined: Mar 2010

Spotty: I'm happy that your surgery was successful BUT your personal experience hardly renders the article (cited by Vasco) "vacuous".

It was actually quite pertiment. Many men indeed do not require surgery and needlessly suffer its effects despite the availability of other equally successful and less detrimental treatment alternatives. The Pivot Study also makes the case that PCa is over-treated based on current early detection efforts and that active surveillance is a suitable alternative to premature treatment of PCa.

spottydog10's picture
spottydog10
Posts: 73
Joined: Jul 2009

swingy, I was calling the article vacuous not vasco's comments, I wouldt insult another member in that way.

I cant remember the figures offhand but a sizeable amount of biopsy gleasons end up upgraded after surgery.

Swingshiftworker
Posts: 626
Joined: Mar 2010

Spotty:

It was clear that you were criticizing the article as "vacuous" and my comments were meant to suggest that THAT criticism was IMHO unjustified.

hunter49
Posts: 200
Joined: Oct 2011

according to Hopkins it is over one third of all surgeries that either upgrade the Gleason score or find it more abundent in the prostate than siagnosed in a biopsy. Most common is it found in both lobes as opposed to only one as indicted in biopsy. That happened to me, my gleason was upgaded and it was found in both lobes.

spottydog10's picture
spottydog10
Posts: 73
Joined: Jul 2009

Swingy, your entitled to your opinion as I am to mine.
Mike

jbw901
Posts: 23
Joined: Feb 2012

I am also an individual who's cancer was only diagnosed in one lobe from biopsy (a saturation biopsy of 30 cores), but after RP surgery the Pathology report found cancer in both lobes.

I understand there are risks associated with all Prostate Cancer treatments. I believe one needs to research the risk / reward trade-offs and be comfortable with their individual treatment decision.

caseyh
Posts: 63
Joined: May 2002

This study is not an indictment of surgery. It is an indictment of treatment for low grade CaP. The study covered a subset of men from 1994 to 2010. “...most of the prostate cancers in the PIVOT study were flagged by PSA tests and were too small to feel in a physical exam.” The only large pool of patients available to this study in 1994 were surgery patients. IMRT was not available in 1994. I had it in 2002, and it was not available at most hospitals at that time. The study does not suggest that one form of treatment is superior overall, only that there is no advantage to treatment over AS for this subset of men. I have had both treatments so, I don't have a pony in the race.

The findings that this subset of men do as well on AS as they do with surgery is huge and will have a direct impact on how the disease is treated. It also raises my concern for the following reasons:

Validity of the Study - I believe that the data from this study has yet to be released. Many top CaP doctors are critical of the study's findings, and many academics are critical of its integrity. Essentially the expertise of this group seemed to be data crunching. I believe the study chair is a pediatrician.

The Danger of Casting a Large Net – Thirty to forty percent of all Gleason scores are either lowered or raised after surgery, or you might say that biopsies are only 60 to 70% accurate for disease staging purposes. Following the findings of this study could lead to a large number of men with Gleason sevens or eights winding up in the AS group. The argument can be made that AS will catch these patients, but I believe that many men will fall through the net and be lost.

Managing Healthcare Cost – Both government and private insurance plans will have the option of using studies like this (even if lacking in validity) to justify limiting healthcare coverage. It seems to me that patients stand the danger of losing their healthcare CHOICES because doctors over treated CaP in the past. The same doctors will now be charged with managing your AS. I am not a fan of Evidenced Based Medicine. Although it has its place, too often it is used to discredit innovative treatment at the clinical level. I fear that we are headed toward “vanilla” medicine. One size fits all.

guards
Posts: 72
Joined: Aug 2010

As recipient of Bracky and all the problems that followed, If I had been more aware
of the probabiliy of problems Vs Watchful waiting and longivity with normal life
functions ,I assure you I would have chosen the later. As science gets better so will
the ability to make decisions on our personal desires.

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