From www.practiceupdate.com
-----------------------------------------------
Importance
The optimal treatment for Gleason score 9-10 prostate cancer is unknown.
Objective
To compare clinical outcomes of patients with Gleason score 9-10 prostate cancer after definitive treatment.
Design, Setting, and Participants
Retrospective cohort study in 12 tertiary centers (11 in the United States, 1 in Norway), with 1809 patients treated between 2000 and 2013.
Exposures
Radical prostatectomy (RP), external beam radiotherapy (EBRT) with androgen deprivation therapy, or EBRT plus brachytherapy boost (EBRT+BT) with androgen deprivation therapy.
Main Outcomes and Measures
The primary outcome was prostate cancer-specific mortality; distant metastasis-free survival and overall survival were secondary outcomes.
Results
Of 1809 men, 639 underwent RP, 734 EBRT, and 436 EBRT+BT. Median ages were 61, 67.7, and 67.5 years; median follow-up was 4.2, 5.1, and 6.3 years, respectively. By 10 years, 91 RP, 186 EBRT, and 90 EBRT+BT patients had died. Adjusted 5-year prostate cancer-specific mortality rates were RP, 12% (95% CI, 8%-17%); EBRT, 13% (95% CI, 8%-19%); and EBRT+BT, 3% (95% CI, 1%-5%). EBRT+BT was associated with significantly lower prostate cancer-specific mortality than either RP or EBRT (cause-specific HRs of 0.38 [95% CI, 0.21-0.68] and 0.41 [95% CI, 0.24-0.71]). Adjusted 5-year incidence rates of distant metastasis were RP, 24% (95% CI, 19%-30%); EBRT, 24% (95% CI, 20%-28%); and EBRT+BT, 8% (95% CI, 5%-11%). EBRT+BT was associated with a significantly lower rate of distant metastasis (propensity-score-adjusted cause-specific HRs of 0.27 [95% CI, 0.17-0.43] for RP and 0.30 [95% CI, 0.19-0.47] for EBRT). Adjusted 7.5-year all-cause mortality rates were RP, 17% (95% CI, 11%-23%); EBRT, 18% (95% CI, 14%-24%); and EBRT+BT, 10% (95% CI, 7%-13%). Within the first 7.5 years of follow-up, EBRT+BT was associated with significantly lower all-cause mortality (cause-specific HRs of 0.66 [95% CI, 0.46-0.96] for RP and 0.61 [95% CI, 0.45-0.84] for EBRT). After the first 7.5 years, the corresponding HRs were 1.16 (95% CI, 0.70-1.92) and 0.87 (95% CI, 0.57-1.32). No significant differences in prostate cancer-specific mortality, distant metastasis, or all-cause mortality (≤7.5 and >7.5 years) were found between men treated with EBRT or RP (cause-specific HRs of 0.92 [95% CI, 0.67-1.26], 0.90 [95% CI, 0.70-1.14], 1.07 [95% CI, 0.80-1.44], and 1.34 [95% CI, 0.85-2.11]).
Conclusions and Relevance
Among patients with Gleason score 9-10 prostate cancer, treatment with EBRT+BT with androgen deprivation therapy was associated with significantly better prostate cancer-specific mortality and longer time to distant metastasis compared with EBRT with androgen deprivation therapy or with RP.
Tuesday, March 20, 2018
Monday, March 19, 2018
Sunday, March 18, 2018
Saturday, March 17, 2018
Your local government at work
From Steve Landsburg's blog.
Another example of intelligent government.
Here is the link.
Government is not the answer.
Another example of intelligent government.
Here is the link.
Government is not the answer.
Good intentions; bad policy
From Steve Landsburg. A nice example of economic reasoning.
-------------------------------------
I learn from Scott Sumner’s blog that in many California cities, residents with past marijuana convictions will jump to the head of the line for licenses to sell the drug legally — this by way of compensating them for past persecution.
Scott approves. I don’t, for two reasons:
First, if you want to compensate people for past persecution, the right way to do it is with cash, not by misallocating productive resources. If there must be licenses, they should be allocated to those who can use them most efficiently, regardless of any past history.
Second, drug dealers have never been the primary victims of anti-drug laws. They can’t be, because there is free entry and exit from that industry. Anti-drug enforcement leads to exit, which in turn leads to higher profits for those who remain — and the exit continues until the profits are high enough to compensate for the risks. One way to think about this: All those “persecuted” drug dealers were, in effect, employing the government to stifle their competition, and paying a fair price for that privilege in the form of occasionally being convicted and punished themselves.
The primary victims of anti-drug legislation are potential consumers who were deterred by artificially high prices. How do you compensate those victims? You can’t. In a population of 1000 people who have never used drugs, it’s quite impossible to identify the 200 or 300 or 400 who would have happily indulged if only the price had been lower.
This is one more reason to be diligent against bad legislation generally. Even if you believe the legislation will eventually be repealed, attempts to compensate the victims are likely to be misdirected, misguided, and socially harmful.
-------------------------------------
I learn from Scott Sumner’s blog that in many California cities, residents with past marijuana convictions will jump to the head of the line for licenses to sell the drug legally — this by way of compensating them for past persecution.
Scott approves. I don’t, for two reasons:
First, if you want to compensate people for past persecution, the right way to do it is with cash, not by misallocating productive resources. If there must be licenses, they should be allocated to those who can use them most efficiently, regardless of any past history.
Second, drug dealers have never been the primary victims of anti-drug laws. They can’t be, because there is free entry and exit from that industry. Anti-drug enforcement leads to exit, which in turn leads to higher profits for those who remain — and the exit continues until the profits are high enough to compensate for the risks. One way to think about this: All those “persecuted” drug dealers were, in effect, employing the government to stifle their competition, and paying a fair price for that privilege in the form of occasionally being convicted and punished themselves.
The primary victims of anti-drug legislation are potential consumers who were deterred by artificially high prices. How do you compensate those victims? You can’t. In a population of 1000 people who have never used drugs, it’s quite impossible to identify the 200 or 300 or 400 who would have happily indulged if only the price had been lower.
This is one more reason to be diligent against bad legislation generally. Even if you believe the legislation will eventually be repealed, attempts to compensate the victims are likely to be misdirected, misguided, and socially harmful.
10 questions about school safety
From the Hill, by Kay Coles James, president of the Heritage Foundation.
Finally, some thought instead of emotion.
----------------------------------------------
The knee-jerk answer by many is “ban guns.” But the questions we face are too complex to be resolved by just two words. Here are 10 that keep me awake.
Public places of all kinds are protected. Why aren’t schools?
Unlike government buildings, stadiums, and shopping malls, schools are known as “soft targets” because they are so unprotected. Isn’t it time for states and localities to seriously consider security solutions such as armed guards, improved locks and cameras, magnetometers, concealed carry, or on-site police substations?
Does the threat facing students only come from the muzzle of a gun?
Since Columbine, the total number of primary and secondary school homicides, including beatings and stabbings, is estimated to be more than three times the number of lives that have been tragically lost to mass shootings on school grounds. All lives are precious, so shouldn’t we be focusing on all threats to school safety?
What if we banned all gun sales in America?
It’s tempting to believe banning gun sales will protect our students, but guns are merely one of many possible tools of destruction. The Columbine attackers brought powerful bombs to school, and a Maryland girl was recently arrested with plans to blow up her school. How would a gun ban have protected their classmates?
What if we severely restricted gun ownership everywhere?
Some say if gun ownership is restricted, peace will be restored. But take a look at Baltimore. It has some of the most restrictive policies in America. Yet, it was just named the nation’s most dangerous city. Criminals clearly aren’t abiding by Baltimore’s rules. Is there any basis for thinking it would be any different elsewhere?
Why is the background check system so full of holes?
America supposedly has a national database containing the information needed to keep criminals from buying a gun. But many state and federal agencies don’t regularly submit data to it, and what it does contain is often incorrect. In this high-technology era, how hard is it to have a background check system that works?
The FBI and police received tips about the Parkland shooter dozens of times. Why didn’t they do something?
I think Andrew Pollack, father of a slain Parkland student, spoke for us all when he expressed fury that his daughter and her school were so unprotected. It would be one thing if the shooter had been unknown. But he made frequent threats and was reported to authorities many times. Why didn’t they take the necessary action?
The Parkland shooter said, “Hi, I’m Nick. I’m a school shooter.” Why wasn’t he institutionalized?
I believe mental health should be treated with the same intensity as physical health. Yet, we see so many instances, like Columbine and Parkland, in which mentally ill individuals are able to commit heinous acts on innocent people. What breakdowns are preventing them from getting the care they obviously need?
He was bullied and ostracized at school. Why was nothing done to address that?
We now know the Parkland shooter was bullied and ostracized by his classmates. So, too, were the Columbine attackers. The U.S. Secret Service has documented that bullying played a major role in two-thirds of America’s premeditated school shootings. Yet, school officials do too little to prevent bullying. Why?
He played violent video games. How many virtual “kills” did he log before he committed real ones?
The Parkland shooter is said to have played violent games 12 or more hours a day. And the Columbine attackers were reportedly obsessed with “Doom”, a violent video game. Some commentators say the violence kids see in movies, on television, and in video games isn’t relevant. But doesn’t this striking coincidence warrant a closer look?
Is America finally ready to get serious about school safety and not just talk in bumper sticker soundbites?
The political debate raging today is so disappointing. If our nation really wants to make schools safer, we have to have a broader and more caring conversation. It must be one that includes mental health, family breakdown, culture, media and more. But instead, some insist on sticking with two-word slogans like “ban guns!” Can’t we do better?
Our children and grandchildren deserve to be safe at school. That means we need to set aside two-word bromides and address these questions in Washington, in state houses, in city halls, and most importantly, in our communities, churches and homes. We can’t allow another tragedy to occur. That’s why it’s time to get serious about school safety.
Finally, some thought instead of emotion.
----------------------------------------------
On April 20, 1999, two students attacked Columbine High School, killing 13 and wounding 21 more. Two weeks ago, a former student did the same thing at Marjory Stoneman Douglas High School in Parkland, killing 17 and wounding 16 more. Nearly two decades separate these tragedies. Yet, our grieving nation is still searching for a solution.
My children never experienced such horror, thank God. They are now beyond school age, but my grandchildren aren’t. So like mothers and grandmothers across America, I lie awake at night, worrying about the next tragedy and wondering what our society needs to do to prevent it.
My children never experienced such horror, thank God. They are now beyond school age, but my grandchildren aren’t. So like mothers and grandmothers across America, I lie awake at night, worrying about the next tragedy and wondering what our society needs to do to prevent it.
The knee-jerk answer by many is “ban guns.” But the questions we face are too complex to be resolved by just two words. Here are 10 that keep me awake.
Public places of all kinds are protected. Why aren’t schools?
Unlike government buildings, stadiums, and shopping malls, schools are known as “soft targets” because they are so unprotected. Isn’t it time for states and localities to seriously consider security solutions such as armed guards, improved locks and cameras, magnetometers, concealed carry, or on-site police substations?
Does the threat facing students only come from the muzzle of a gun?
Since Columbine, the total number of primary and secondary school homicides, including beatings and stabbings, is estimated to be more than three times the number of lives that have been tragically lost to mass shootings on school grounds. All lives are precious, so shouldn’t we be focusing on all threats to school safety?
What if we banned all gun sales in America?
It’s tempting to believe banning gun sales will protect our students, but guns are merely one of many possible tools of destruction. The Columbine attackers brought powerful bombs to school, and a Maryland girl was recently arrested with plans to blow up her school. How would a gun ban have protected their classmates?
What if we severely restricted gun ownership everywhere?
Some say if gun ownership is restricted, peace will be restored. But take a look at Baltimore. It has some of the most restrictive policies in America. Yet, it was just named the nation’s most dangerous city. Criminals clearly aren’t abiding by Baltimore’s rules. Is there any basis for thinking it would be any different elsewhere?
Why is the background check system so full of holes?
America supposedly has a national database containing the information needed to keep criminals from buying a gun. But many state and federal agencies don’t regularly submit data to it, and what it does contain is often incorrect. In this high-technology era, how hard is it to have a background check system that works?
The FBI and police received tips about the Parkland shooter dozens of times. Why didn’t they do something?
I think Andrew Pollack, father of a slain Parkland student, spoke for us all when he expressed fury that his daughter and her school were so unprotected. It would be one thing if the shooter had been unknown. But he made frequent threats and was reported to authorities many times. Why didn’t they take the necessary action?
The Parkland shooter said, “Hi, I’m Nick. I’m a school shooter.” Why wasn’t he institutionalized?
I believe mental health should be treated with the same intensity as physical health. Yet, we see so many instances, like Columbine and Parkland, in which mentally ill individuals are able to commit heinous acts on innocent people. What breakdowns are preventing them from getting the care they obviously need?
He was bullied and ostracized at school. Why was nothing done to address that?
We now know the Parkland shooter was bullied and ostracized by his classmates. So, too, were the Columbine attackers. The U.S. Secret Service has documented that bullying played a major role in two-thirds of America’s premeditated school shootings. Yet, school officials do too little to prevent bullying. Why?
He played violent video games. How many virtual “kills” did he log before he committed real ones?
The Parkland shooter is said to have played violent games 12 or more hours a day. And the Columbine attackers were reportedly obsessed with “Doom”, a violent video game. Some commentators say the violence kids see in movies, on television, and in video games isn’t relevant. But doesn’t this striking coincidence warrant a closer look?
Is America finally ready to get serious about school safety and not just talk in bumper sticker soundbites?
The political debate raging today is so disappointing. If our nation really wants to make schools safer, we have to have a broader and more caring conversation. It must be one that includes mental health, family breakdown, culture, media and more. But instead, some insist on sticking with two-word slogans like “ban guns!” Can’t we do better?
Our children and grandchildren deserve to be safe at school. That means we need to set aside two-word bromides and address these questions in Washington, in state houses, in city halls, and most importantly, in our communities, churches and homes. We can’t allow another tragedy to occur. That’s why it’s time to get serious about school safety.
So much for socialism and entitlements
From yahoo.com
By Anggy Polanco and Isaac Urrutia
------------------------------------------------
"We have spent 14 hours without electricity today. And yesterday electricity came and went: for six hours we had no power," said Ligthia Marrero, 50, in the western state of San Cristobal, noting that her fridge had been damaged by the frequent interruptions.
Crumbling infrastructure and lack of investments have hit Venezuela's power supply for years. Now, the situation has been exacerbated by dwindling rains.
In the worst-hit western cities, business has all but ground to a halt at a time when the OPEC nation of 30 million is already suffering hyperinflation and a profound recession. Many Venezuelans are unable to eat properly on salaries of just a couple of dollars per month at the black market rate, sparking malnutrition, emigration and frequent sights of Venezuelans digging through trash or begging in front of supermarkets.
Maybelin Mendoza, a cashier at a bakery in Tachira state, said business has been further hit because points of sale stop working during blackouts - just as Venezuelans are chronically short of cash due to hyperinflation.
In the most dramatic cases, the opposition governor of Tachira state said three people, including a four-month-old, died this week because they failed to receive assistance during a power outage.
"Because of electrical failures, the machines weren't able to revive the people and they died," said Laidy Gomez.
Reuters was unable to confirm the report.
Authorities have acknowledged that interruptions will continue for at least two weeks, but they have not said whether they will spread to other states.
"Of a possible 1,100 megawatts, we are only generating 150 right now," Energy Minister Luis Motta told reporters referring to the Fabricio Ojeda dam, in the western Andean state of Merida.
Capital city Caracas and other major cities have not been hit by rationing yet. Two years ago, rationing there lasted five months when a drought hit the Guri dam, the country's largest hydroelectric dam.
But because of the economic crisis, Venezuela has reduced electricity consumption to about 14,000 megawatts at peak hours, according to engineer and former electricity executive Miguel Lara. Two years ago, state-run Corpoelec put the figure at 16,000 megawatts.
By Anggy Polanco and Isaac Urrutia
------------------------------------------------
SAN CRISTOBAL, Venezuela (Reuters) - Venezuela imposed electricity rationing this week in six western states, as the crisis-hit country's creaky power grid suffered from a drought that has reduced water levels in key reservoirs needed to run hydroelectric power generators.
The four-hour formal outages began on Thursday. But many residents scoffed at the announcement, wryly noting that they have been suffering far more extended blackouts during the last week.
"We have spent 14 hours without electricity today. And yesterday electricity came and went: for six hours we had no power," said Ligthia Marrero, 50, in the western state of San Cristobal, noting that her fridge had been damaged by the frequent interruptions.
Crumbling infrastructure and lack of investments have hit Venezuela's power supply for years. Now, the situation has been exacerbated by dwindling rains.
In the worst-hit western cities, business has all but ground to a halt at a time when the OPEC nation of 30 million is already suffering hyperinflation and a profound recession. Many Venezuelans are unable to eat properly on salaries of just a couple of dollars per month at the black market rate, sparking malnutrition, emigration and frequent sights of Venezuelans digging through trash or begging in front of supermarkets.
Maybelin Mendoza, a cashier at a bakery in Tachira state, said business has been further hit because points of sale stop working during blackouts - just as Venezuelans are chronically short of cash due to hyperinflation.
In the most dramatic cases, the opposition governor of Tachira state said three people, including a four-month-old, died this week because they failed to receive assistance during a power outage.
"Because of electrical failures, the machines weren't able to revive the people and they died," said Laidy Gomez.
Reuters was unable to confirm the report.
Authorities have acknowledged that interruptions will continue for at least two weeks, but they have not said whether they will spread to other states.
"Of a possible 1,100 megawatts, we are only generating 150 right now," Energy Minister Luis Motta told reporters referring to the Fabricio Ojeda dam, in the western Andean state of Merida.
Capital city Caracas and other major cities have not been hit by rationing yet. Two years ago, rationing there lasted five months when a drought hit the Guri dam, the country's largest hydroelectric dam.
But because of the economic crisis, Venezuela has reduced electricity consumption to about 14,000 megawatts at peak hours, according to engineer and former electricity executive Miguel Lara. Two years ago, state-run Corpoelec put the figure at 16,000 megawatts.
The Conquest of Climate
Here is an interesting take on climate change.
What everyone seems to be ignoring is the possible ease of modifying climate to make it cooler, thereby offsetting the impact of greenhouse gases, and the fact that, at least in principle, population size can be matched to environmental resources.
Here is a link to the article.
Here are a few excerpts.
-------------------------------------------------
We have come to think of climate change as the canonical “extinction-level event,” a catastrophe so multifaceted and all-encompassing that it puts human survival in doubt. But when we think harder about the specific problems global warming poses—problems of water management, agricultural productivity, cooling and construction—the threat becomes less daunting. Our logistic and technical capacities are burgeoning, and they give us ample means of addressing these problems.
Moreover, the scope of warming issues, even under worst-case scenarios, is modest compared to the task of feeding and housing several billion extra people over the next few decades and accommodating the higher living standards that impoverished countries demand. That “development crisis” dwarfs the climate crisis, yet we don’t think of it as a crisis because we are steadily (though too slowly) resolving it and will continue to do so in the future. Along the way, we will resolve the climate crisis, which is fundamentally the same thing as the development crisis. Pre-modern Europe endured many climate crises—famines caused by inclement weather lasting a season or a century—that subsided with modern development; our contemporary warming issues are also symptoms of lingering underdevelopment. The faster we develop, the faster we resolve the climate crisis by decoupling our well-being from the weather.
Global warming will have serious consequences that need to be reckoned with. Cleaning up the energy supply is an important—and accelerating—aspect of development that should be nurtured, but it must be balanced against more pressing needs that sometimes conflict with it. To get the balance right greens need to give up their anxiety over development and over technologies like nuclear power that can make development both faster and cleaner. Like the man said, freedom from fear is the greatest liberation of all.
What everyone seems to be ignoring is the possible ease of modifying climate to make it cooler, thereby offsetting the impact of greenhouse gases, and the fact that, at least in principle, population size can be matched to environmental resources.
Here is a link to the article.
Here are a few excerpts.
-------------------------------------------------
How bad will climate change be? Not very.
No, this isn’t a denialist screed. Human greenhouse emissions will warm the planet, raise the seas and derange the weather, and the resulting heat, flood and drought will be cataclysmic.
Cataclysmic—but not apocalyptic. While the climate upheaval will be large, the consequences for human well-being will be small. Looked at in the broader context of economic development, climate change will barely slow our progress in the effort to raise living standards.
No, this isn’t a denialist screed. Human greenhouse emissions will warm the planet, raise the seas and derange the weather, and the resulting heat, flood and drought will be cataclysmic.
Cataclysmic—but not apocalyptic. While the climate upheaval will be large, the consequences for human well-being will be small. Looked at in the broader context of economic development, climate change will barely slow our progress in the effort to raise living standards.
We have come to think of climate change as the canonical “extinction-level event,” a catastrophe so multifaceted and all-encompassing that it puts human survival in doubt. But when we think harder about the specific problems global warming poses—problems of water management, agricultural productivity, cooling and construction—the threat becomes less daunting. Our logistic and technical capacities are burgeoning, and they give us ample means of addressing these problems.
Moreover, the scope of warming issues, even under worst-case scenarios, is modest compared to the task of feeding and housing several billion extra people over the next few decades and accommodating the higher living standards that impoverished countries demand. That “development crisis” dwarfs the climate crisis, yet we don’t think of it as a crisis because we are steadily (though too slowly) resolving it and will continue to do so in the future. Along the way, we will resolve the climate crisis, which is fundamentally the same thing as the development crisis. Pre-modern Europe endured many climate crises—famines caused by inclement weather lasting a season or a century—that subsided with modern development; our contemporary warming issues are also symptoms of lingering underdevelopment. The faster we develop, the faster we resolve the climate crisis by decoupling our well-being from the weather.
Global warming will have serious consequences that need to be reckoned with. Cleaning up the energy supply is an important—and accelerating—aspect of development that should be nurtured, but it must be balanced against more pressing needs that sometimes conflict with it. To get the balance right greens need to give up their anxiety over development and over technologies like nuclear power that can make development both faster and cleaner. Like the man said, freedom from fear is the greatest liberation of all.
Thursday, March 15, 2018
Prostate Cancer Survival Differences at 9 Years Between Aggressive vs Conservative Therapy
From practiceupdate.com.
The message: If you have prostate cancer, seek aggressive therapy for nonmetastatic disease.
Here is a summary of the study.
------------------------------------------------------
BACKGROUND
To the authors' knowledge, the survival benefit of local therapy in the setting of advanced prostate cancer remains unknown. The authors investigated whether prostate-directed treatment with either surgery or radiotherapy versus conservative treatment in the setting of locally advanced or metastatic disease was associated with improved survival within a cohort of men from the Centers for Disease Control and Prevention's (CDC) Breast and Prostate Cancer Data Quality and Patterns of Care Study (CDC POC-BP).
METHODS
Men diagnosed with locally advanced (cT3-T4 or N+ and M0) or metastatic prostate cancer were identified. The authors compared survival by treatment type, categorized as conservative (androgen deprivation therapy only) versus aggressive (radical prostatectomy or any type of radiotherapy). Nine-year overall survival and prostate cancer-specific survival were estimated using the Kaplan-Meier method. The Cox proportional hazards model was used to determine factors independently associated with 9-year prostate cancer-specific survival.
RESULTS
For men with advanced, nonmetastatic prostate cancer, conservative treatment alone was associated with a 4 times higher likelihood of prostate cancer mortality compared with men treated with surgery (hazard ratio, 4.18; 95% confidence interval, 1.44-12.14). In contrast, no difference was found between conservative versus aggressive treatment after adjusting for covariates for men with metastatic disease. The 9-year prostate cancer-specific survival rate was 27% for those receiving aggressive treatment versus 24% for men undergoing conservative treatment.
CONCLUSIONS
The authors did not observe a survival advantage with local therapy in addition to standard androgen deprivation therapy for men with metastatic prostate cancer. However, the results of the current study did affirm advantages in the setting of locally advanced disease. Aggressive local therapy in the setting of metastatic disease needs to be studied carefully before clinical adoption.
The message: If you have prostate cancer, seek aggressive therapy for nonmetastatic disease.
Here is a summary of the study.
------------------------------------------------------
BACKGROUND
To the authors' knowledge, the survival benefit of local therapy in the setting of advanced prostate cancer remains unknown. The authors investigated whether prostate-directed treatment with either surgery or radiotherapy versus conservative treatment in the setting of locally advanced or metastatic disease was associated with improved survival within a cohort of men from the Centers for Disease Control and Prevention's (CDC) Breast and Prostate Cancer Data Quality and Patterns of Care Study (CDC POC-BP).
METHODS
Men diagnosed with locally advanced (cT3-T4 or N+ and M0) or metastatic prostate cancer were identified. The authors compared survival by treatment type, categorized as conservative (androgen deprivation therapy only) versus aggressive (radical prostatectomy or any type of radiotherapy). Nine-year overall survival and prostate cancer-specific survival were estimated using the Kaplan-Meier method. The Cox proportional hazards model was used to determine factors independently associated with 9-year prostate cancer-specific survival.
RESULTS
For men with advanced, nonmetastatic prostate cancer, conservative treatment alone was associated with a 4 times higher likelihood of prostate cancer mortality compared with men treated with surgery (hazard ratio, 4.18; 95% confidence interval, 1.44-12.14). In contrast, no difference was found between conservative versus aggressive treatment after adjusting for covariates for men with metastatic disease. The 9-year prostate cancer-specific survival rate was 27% for those receiving aggressive treatment versus 24% for men undergoing conservative treatment.
CONCLUSIONS
The authors did not observe a survival advantage with local therapy in addition to standard androgen deprivation therapy for men with metastatic prostate cancer. However, the results of the current study did affirm advantages in the setting of locally advanced disease. Aggressive local therapy in the setting of metastatic disease needs to be studied carefully before clinical adoption.
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