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Decipher risk: prostatectomy RP vs radiation.
Prostate Cancer | Last Active: Mar 14 11:09am | Replies (75)Comment receiving replies
@wwsmith Instead of nomograms, men might even have to seek out one-by-one individual clinical trials like COMPPARE, PARTIQoL, ProtectT, FLAME and many others that look at each of the treatment types or treatment methods, compares them, and then publishes the data. That may entail looking through dozens (hundreds?) of clinical trials for the one(s) that might apply to one’s specific diagnostic situation.
As just one example, in 2023 the results of the ProtectT trial (https://www.nejm.org/doi/full/10.1056/NEJMoa2214122) came out comparing external radiation (IMRT w/ADT) against both surgery and active surveillance, and found that survival rates comparing surgery with radiation are statistically equivalent no matter what treatment chosen (and that active surveillance was actually only statistically a little worse), and that the treatment decision is mainly decided on side-effects and quality-of-life (or as that paper concludes, “… the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer.”).
And even the ProtectT trial results I would supplement with more research because ProtectT looked at men who were treated between 1999-2009, well before today’s next-generation imaging techniques, and modern diagnostic tools and treatments were available. (I first heard about that report on the evening news (https://www.nbcnews.com/news/amp/rcna74512), and then had to do some serious digging to find the trial report: ProtectT.)
Replies to "@wwsmith Instead of nomograms, men might even have to seek out one-by-one individual clinical trials like..."
@brianjarvis One thing I like about looking at clinical results from recent trials is that you get to have an early indication at how the standard of care (SOC) for various situations is likely to evolve going forward. The SOC changes slowly and is listed in the NCCN Guidelines here https://www.nccn.org/guidelines/guidelines-detail
If a doctor and patient always waited to use new treatment strategies only until after a strategy had made it into the NCCN guidelines, there would be many missed opportunities on obtaining the benefit of the new approach. As such, both doctors and patients should be aware of relevant recent studies to see whether the clinical results are promising enough to go ahead and apply to their own current cases.
@brianjarvis
There is one important thing to be aware of in clinical trials.
There are usually two groups one that gets the drug and one that gets a placebo. In some cases, those trials are not good for people because they need treatment not a placebo. Some trials have actually been found so effective that they’ve given the people that were on placebo‘s the drug, But that is not the normal case.
Just be aware of this possibility if you are signing up for a clinical trial.
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@brianjarvis Thanks for all of this great information....I'm a bit on overload being new to this all, but going to dig deepr. Much appreciated!