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Post by Tony Crispino on Dec 17, 2014 21:53:58 GMT -8
From the Agency for Healthcare Research and Quality: Therapies for Clinically Localized Prostate Cancer: Update of a 2008 Systematic Review
This is a very extensive and detailed document attached here that compares various trials for treating prostate cancer. It also lists many very needed research trials that are underway. This document was released yesterday. Attachments:ahrq 2014.pdf (2.95 MB)
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Post by Tony Crispino on Dec 18, 2014 0:36:13 GMT -8
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Post by redwing57 on Dec 18, 2014 10:26:19 GMT -8
Interestingly, their conclusion is that the whole comparison effort was of little value.
From the study:
"Conclusions. This systematic review update found that the evidence for most treatment comparisons is largely inadequate to determine comparative risks and benefits of therapies for clinically localized prostate cancer."
That's the key issue that frustrates so many newly diagnosed.
Also from the conclusions, My urologist made this same comment when we were trying to decide what to do:
"More RCTs and better designed observational studies that can control for many of the known and unknown confounding factors that can affect long-term outcomes are needed to evaluate comparative risks and benefits of therapies for clinically localized prostate cancer."
He said it's likely that the necessary RCTs will never be done, since men will not accept randomization into the radically different treatment arms that would be involved.
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Post by Tony Crispino on Dec 18, 2014 12:19:23 GMT -8
Yes and I agree with these assessments. Simply put there is a huge issue with funding these trials and they are very expensive. And any entity from the private will have bias. So it is that in order to get this data in an unbiased nature the NCI would likely have to fund it. They have limited resources that were cut this year by 25% and if we did not have the data yet we likely won't have it later.
I might contend against where we could get enough men into a trial to monitor radically differing treatments but it's moot for the other reasons.
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Post by Allen on Dec 19, 2014 13:18:37 GMT -8
There are big recruitment issues as well. The PIVOT trial was unique in that men agreed to be randomized to surgery or watchful waiting, but most men are not indifferent between treatments. Registries may help where randomized trials are unlikely. Then there's the whole issue of surrogate endpoints and whether long-term results continue to have relevance. I think we will always have to make decisions with lots of uncertainties about the information.
- Allen
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