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Posted 2/8/2016 8:05 PM (GMT -5)
Interesting article.....demonstrates the problem with articles though. No clue what studies the article sites. Probably most important though, at the bottom is the authors bio....surgeon. Ha ha

www.foxnews.com/health/2015/12/22/patients-with-prostate-cancer-have-better-outcomes-with-surgery.html
Posted 2/8/2016 8:21 PM (GMT -5)
The other interesting thing is that it's written by Dr Samadi, who happens to be a surgeon.
Posted 2/8/2016 8:44 PM (GMT -5)
My experience with the sales process of the author has been well documented in this forum. And that's all I'm going to say about it.
Posted 2/8/2016 8:47 PM (GMT -5)
It sounds like it was written by a marketing firm.

But... it's probably 100% true.
<G>

Mel
Posted 2/9/2016 7:26 AM (GMT -5)
It may very well be true. But that still doesn't mean a whole lot.

I've come to the conclusion that prostate cancer treatment is alot like politics. One can justify any statement one wants to justify and present it as fact to make a point. It's all about context, interpretation and motive (at least in an article like that one).

But, I have a hard time trusting studies (in general) because, what I dont understand is how the authors and researchers can know that they are comparing apples to apples.
Posted 2/9/2016 8:05 AM (GMT -5)
IT, great point. Dr. Samadi is notorious for (a) cherry picking patients and (b) publishing his outcomes as if every surgeon should do as well as he does.
Posted 2/9/2016 10:03 AM (GMT -5)
In my opinion, Samadi's conclusion from this article is probably NOT true. An opposing compilation by Dr. Grimm concluded just the opposite, i.e. that radiation was more effective than surgery. That was been quoted (and disputed) many times on this forum. The studies that Samadi quotes are flawed in that the primary radiation treatment considered was EBRT. The newer and highly effective radiation treatments like IMRT, LDR Brachy, HDR Brachy and SBRT were either ignored or under represented. As always, the devil is in the details...

My personal conclusion after reading hundreds of studies and articles is that the effectiveness of radiation and surgery for curing prostate cancer are similar. The differentiation for choice of treatment should not be which one works better, rather an individual patient's tolerance for side effects, need for information and confidence in their medical provider.

Jim
Posted 2/9/2016 10:52 AM (GMT -5)
Jim, My personal conclusion is similar. I also not (myself included), that everyone will overstate the risks and understate the benefits of the treatment they did not choose. We've all encountered that exact thing from medical professionals as well.

In the end, we all make a decision, we all roll the dice, and then we do what we do.
Posted 2/9/2016 11:00 AM (GMT -5)
To me, the disappointing thing is this can be published by a major media outlet under the guise of being a news article. (Clearly, mainstream media won't have the same vetting process as peer-reviewed medical journals, but at least they can run a disclaimer about the article's author and potential biases.) Most of us here know who Dr Samadi is, but I'd guess a very small number of people that read this article do.

I think it's healthy to debate different treatment options for PC, but I feel like this article cheapens that debate.
Posted 2/9/2016 6:01 PM (GMT -5)
Samadi is practically infamous especially in the Philly/NY/D.C./Boston metro area.

I think the Fox News article is a bad take on the recent metadata study that was announced:

medicalxpress.com/news/2015-12-survival-patients-prostate-cancer-surgery.html

Quoted from the article summation:

"This systematic review suggests that survival is better after surgery compared to various forms of radiotherapy. It deserves attention, as it is based on the best available data. However, definitive proof needs a large well-conducted randomized control trial, such as the upcoming PROTECT trial which is due to report next year. So we certainly need to take this analysis into account, but it doesn't yet give us a definitive answer as to the best treatment. Although this paper should not change clinical practice, I agree with the authors, this analysis gives us important, additional information."

RP has been the gold standard for a long time, and many doctors still say it is. I've known this all along during my travels regarding PCa. I'm willing to take the possible risk in going HDB-m along with lifestyle improvements (better diet, exercise, etc.) over the long term to avoid any possible recurrence, in return for lesser SEs when compared to RP. It's an educated decision that I'm willing to make for myself. Maybe RP will still show a real statistical advantage when PROTECT publishes, maybe not, only time will tell.

The PROTECT trial results will be of great interest to many of us when the time comes.
Posted 2/9/2016 6:40 PM (GMT -5)
Very well said,HitchHiker.,
Posted 2/9/2016 7:58 PM (GMT -5)
When I was weighing whether to have surgery or radiation I consulted with a medical oncologist who specializes in prostate cancer (something I highly recommend). He said that the marketing industry could learn a lot from the urology industry.

'Nuff said.
Posted 2/10/2016 9:28 AM (GMT -5)
As I hit the magic age of 70 in a very few months, it's all academic to me since even many surgeons recommend radiation if the patient has attained the age of 70.

Granted, I seem to be a pretty healthy 70. Even so, I think I would probably be a more ornery patient at 70 than at 50. smilewinkgrin
Posted 2/10/2016 10:12 AM (GMT -5)
Just in fairness...this article hits on a couple of the points made...

www.smh.com.au/national/health/prostate-cancer-patients-confused-in-urology-versus-radiation-oncology-wars-20160204-gmm5ol.html

FYI...i have no skin in this game, and was merely making a point about you can't believe everything you read on the internet and how "facts and stats" can be skewed to your viewpoint.
Posted 2/10/2016 11:26 AM (GMT -5)
Samadi is a talented surgeon..no doubt about it. He is also a salesman and very confident in his "product". Also very aggressive. All of which are part and parcel of who he is and why he is so good at his "craft". Is he full of crap? No Is he hard to take? For some people yes...so don't us him.
Posted 2/10/2016 12:31 PM (GMT -5)
Quote: The eternal problem in these comparisons is the systematic bias resulting from the pre selection of fitter patients for surgery. Only a randomized study demonstrates. A meta analysis orientates only.

A European Urology study from last year that came to the same conclusion:
Surgery Versus Radiotherapy for Clinically-localized Prostate Cancer: A Systematic Review and Meta-analysis

"Conclusions:
Radiotherapy for prostate cancer is associated with an increased risk of overall and prostate cancer-specific mortality compared with surgery based on observational data with low to moderate risk of bias. These data, combined with the forthcoming randomized data, may aid clinical decision making."

www.europeanurology.com/article/S0302-2838(15)01160-4/abstract/surgery-versus-radiotherapy-for-clinically-localized-prostate-cancer-a-systematic-review-and-meta-analysis
Posted 2/11/2016 9:00 PM (GMT -5)
I am always interested in Gemlin's posts, read everyone I see. He is well informed and comes from a European mindset, and I am always interested in an informed opinion from a different slant.

from the link said...

Evidence synthesis
Nineteen studies of low to moderate risk of bias were selected and up to 118 830 patients were pooled. Inclusion criteria and follow-up length varied between studies. Most studies assessed patients treated with external beam radiotherapy, although some included those treated with brachytherapy separately or with the external beam radiation therapy group.

So, if I am reading that right the European Urology study linked to was basically a "study of studies."

Not sure how to interpret that due to the difference in basic parameter's for each individual study and what studies were selected and not selected.

I've seen similar "studies of studies" in the US, and personally wonder about the value of such studies.

Basically, it seems to me that such studies are much like a person summing up statistically his interpretation of the various studies that he believes to be important.

While I may not be saying this well, the first one of these that I read had me thinking "say, what again?"

Maybe I'm too skeptical a cynic.
Posted 2/12/2016 9:27 AM (GMT -5)
My read of the european urology article is that it looks only at prostate-specific mortality, not QOL or side effects. It finds that there is a consistently higher mortality rate for primary radiotherapy vs RP for low-to-intermediate risk patients.

It also states at the top of the page that 'to date, there are no level 1 studies comparing the efficacy of radiotherapy vs RP'.

The study we'd all want to see doesn't exist (yet). Maybe it will someday, or maybe all we'll ever have is meta-studies of one kind or another.
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