Replies to Thanks — that's interesting! Patients weren't randomly assigned into the RP, RT, or AS groups, so…

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Prostate Cancer | Last Active: 2 hours ago | Replies (32)

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@northoftheborder

Thanks — that's interesting!

Patients weren't randomly assigned into the RP, RT, or AS groups, so while it's suggestive that men who chose AS seem to have had a higher rate of metastasis, it could be due to some other cause (e.g. they were younger and would live longer for metastasis to happen, or they were elderly, and didn't want to deal with the side-effects of RT or RP in their remaining years, or they were just people who were more likely to avoid treatment later if the cancer progressed).

I honestly wouldn't know how to use this data to help me make a decision if I had a borderline diagnosis, except that both radiation and surgery have better outcomes and many fewer side effects than they did in 1998 when that study was launched, so the cost-benefit equation may have shifted in other ways.

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Replies to "Thanks — that's interesting! Patients weren't randomly assigned into the RP, RT, or AS groups, so..."

heavyphil | @heavyphil | 1 day ago

Hey North , the entire study is on nejm.org…(sorry, don’t know how to post that link or article to the forum). But there is a small disclaimer under “limitations” and they say that the high number of metastasis seen in the AS group was probably due to the fact that there were more intermediate cases than they realized in that cohort, which was supposed to be all Gleason 6’s.
They also say that they could have done a much better job at screening if they had all the methods, tests and scans we use today. Fifteen years ago is practically the Dark Ages for this disease - and you are living proof that better tests, techniques and remedies are ALWAYS just around the corner.
Best, Phil

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