Prostate Cancer Surgery is “a waste of time”

Kongo said:

Hornet's Nest
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.

spottydog10 said:

It's a vacuous article.
I
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

spottydog10 said:

swingy, I was calling the
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.

hunter49 said:

according to Hopkins it is
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.

caseyh said:

Not an Indictment of Surgery
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.