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From: Leonard Evens on 8 May 2008 00:23
george conklin wrote:
> Earlier this month, a scientific review published in the Annals of Internal
> Medicine concluded that evidence was too thin to recommend treatment over
> watchful waiting, or one treatment over another.

Actually, if we read further, we discover that is not at all what the
study found.

> Studies do show that
> prostate cancer surgery mostly helps men under 65, said Dr. Timothy Wilt of
> the Minneapolis VA Center for Chronic Disease Outcomes Research, who led the
> review.

In other words, the best you can say is that "the evidence is too thin
to recommend treatment" for men over 65, and I think even that would be
putting it a bit too strongly.

>
> The new study shows that for men older than that, "observation is a very
> reasonable approach," he said. "Many men do quite well for a long period of
> time with no treatment."
>
> Look at http://www.msnbc.msn.com/id/23131943/
>
> for more details.

This study is consistent with other studies and pretty much in line with
the best current practice. It may suggest forgoing aggressive
treatment in some men in the age group 65-70, but even that is not clear
without further qualification with respect to the aggressiveness of the
disease.

I am sure some urologists jump in with the most aggressive treatment for
man of any age, but I hope there are fewer and fewer of such doctors.

Also, it is important to note that age is here simply a marker for
expected lifetime. It is really the latter that is important.

Let me use my case, since I was diagnosed in that age group, as an
example. I was diagnosed at age 67 in 2000 with a T!C, PSA 4.5, Gleason
7=3+4 case. Cancer was found in 4 of 6 samples on one side. My health,
except for some arthritis was quite good, better than that of a typical
man my age, and I had an expected lifetime of more than 15 years. With
such a diagnosis my chances of developing metastatic prostate cancer
within 5 to 10 years were sufficiently high that I didn't want to take
the chance, so I opted for aggressive treatment. On the other hand, had
I been much over 70, and had a Gleason of 6=3+3, with cancer found in
only 1 or 2 samples, I almost certainly would have opted for "expectant
management". I don't think the results of this study change that
calculus significantly.

Both Patrick Walsh and Peter Scardino, in their books, recommend
"expectant management" for typical men in their late 60s with such a
diagnosis. The American Urological Society's treatment guidelines
doesn't suggest aggressive treatment for men with an expected lifespan
of less than 10 years, and that has been true since at least 2000, and
probably somewhat longer.

It is important for people to recognize that prostate cancer is a
complex disease. There isn't a single prescription which applies to all
men. A man who is diagnosed with prostate cancer shouldn't
automatically assume that he needs immediate treatment nor that he will
live out his life without the cancer affecting him. He has to consider
the specifics of his diagnosis, as well as what risks he is willing to
take and what he considers most important.



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From: George Conklin on 8 May 2008 07:30

"Leonard Evens" <len(a)math.northwestern.edu> wrote in message
news:neydnerq-r3fHb_VnZ2dnUVZ_ozinZ2d(a)comcast.com...
> george conklin wrote:
> > Earlier this month, a scientific review published in the Annals of
Internal
> > Medicine concluded that evidence was too thin to recommend treatment
over
> > watchful waiting, or one treatment over another.
>
> Actually, if we read further, we discover that is not at all what the
> study found.
>
> > Studies do show that
> > prostate cancer surgery mostly helps men under 65, said Dr. Timothy Wilt
of
> > the Minneapolis VA Center for Chronic Disease Outcomes Research, who led
the
> > review.
>
> In other words, the best you can say is that "the evidence is too thin
> to recommend treatment" for men over 65, and I think even that would be
> putting it a bit too strongly.
>

The problem was researched by others who made the conclusions.


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