We share
this very important news / study report about management of early prostate
cancer. We are not unaware that for most doctors in LMICs the processes
described in the PIVOT study is utopia at this time because in LMIC victims of
prostate cancer still report late because there no national screening programme
albeit the controversial PSA ( Prostate Specific Antigen) testing. Most
patients in LMICs will end up with orchidectomy because other non surgical
treatments are not available or are out of reach of most patients because there
is no health insurance and poverty is rife!. On all levels the advances are
lower than in resource rich countries: fewer radiological testing machines,
fewer pathologists to interpret the specimens and fewer surgeons to undertake
the taking of samples especially minimal invasive techniques. Most surgical
treatment are open with greater morbidity and mortality, post operative care is
still very rudimentary with low follow up and support.
We share the
article however because doctors in LMICs need to know what their colleagues are
advancing on health improvement elsewhere, and they need to become advocates
for their countries to invest in cutting-edge care for the population, not only
in prostate cancer but across the spectrum of cancers and other diseases ( Whole
System Change of Failing Health Systems) : READ ON
JULY 12,
2017 / 4:11 PM / 2 DAYS AGO
'Long-term,
surgery for localized prostate cancer offers little extra benefit
5 MIN READ
(Reuters
Health) - A large new study that has followed prostate cancer patients for up
to two decades concludes that surgery is probably not the best option for most
men with localized tumors.
Men who had
the surgery were only slightly more likely to live longer, but they were
definitely more likely to be forced to live with the side effects of surgery
such as urinary incontinence and erectile or sexual dysfunction.
For every
100 men diagnosed with early-stage prostate cancer who underwent surgery, only
four fewer died from the disease compared with those who were just kept under
observation and treated for symptoms.
For every
100 men with low-risk disease who had a radical prostatectomy, no more than one
was saved by surgery, a statistically insignificant difference, the researchers
report in the New England Journal of Medicine.
Yet 30 to 40
men out of 100 who had surgery experienced erectile dysfunction within five
years, 30 developed problems holding their urine within 10 years and 20 to 40
reported dissatisfaction with their ability to perform sexually.
The study,
known as PIVOT, was designed to shed light on the ongoing controversy over how
best to treat prostate cancer, a tumor that is diagnosed in 161,000 men in the
U.S. each year but often fails to kill them because the cancer grows so slowly
they are more likely to die from some other cause. Thus, many doctors simply
recommend some form of watchful waiting.
The cancer
kills about 27,000 annually, according to the American Cancer Society.
Because men
today are being diagnosed earlier, with smaller tumors than they were 20 years
ago, any benefits of surgery are probably even smaller than the study suggests,
lead author Dr. Timothy Wilt said in written comments to Reuters Health.
By the same
token, "Men currently diagnosed with prostate cancer will have even better
long-term overall and prostate cancer survival with observation than men
enrolled in PIVOT," Wilt said.
The findings
"reassure men with low-risk disease who have a life expectancy greater
than 10 years that active surveillance is safe and offers better overall
quality of life compared to radical treatment," said Dr. Behfar Ehdaie of
the Memorial Sloan-Kettering Cancer Center in New York, who was not part of the
study.
Some men
with an intermediate risk may also be able to avoid surgery as well, he told
Reuters Health in an email.
But Dr.
Alexander Kutikov, chief of urologic oncology at the Fox Chase Cancer Center in
Philadelphia, who also was not connected with the research, said the
"quite controversial" study of 731 men, most treated at Veterans
Affairs hospitals, was too small to be definitive and 20 percent of the men
didn't stick with their assigned treatment, muddying the results.
The study
also falls short because the men were selected because they were thought to
have a life expectancy of 10 years, Kutikov added. Yet at the 10-year mark
nearly half had died. "Prostate cancer treatment is an investment at least
10 years into the future," he said by email. "Men with limited
life-expectancy only risk side effects of treatment and don't live long enough
to reap its benefits."
"A
potential harm of observation is that prostate cancer may spread if left
untreated and could result in prostate cancer death," Wilt acknowledged.
"Fortunately for most men, this is very unlikely (about 10 percent of men
after 20 years) and was not different in men treated with observation or
surgery. Systemic progression and prostate cancer death are rare (about 5
percent) in men with low risk disease and are not decreased by surgery."
Only men at
intermediate risk showed a benefit from surgery; where survival was 14.5
percentage points higher. That translated to a 20 percent reduction in death
from all causes.
With 731 men
followed for a median of 12.7 years, PIVOT is one of the longest and largest
cancer studies ever conducted.
In the
surgery group, 61.4 percent of the men died from all causes and just 7.4
percent in the surgery group died from prostate cancer. In the observation
group, 66.8 percent died, 11.4 percent from prostate cancer.'
SOURCE: bit.ly/2u0BIwI New
England Journal of Medicine, online July 12, 2017.’’
Joseph Ana.
Africa Center for Clin Gov Research &
Patient Safety
@ HRI West Africa
Group - HRI WA
Consultants in
Clinical Governance Implementation
Publisher: Health and
Medical Journals
8 Amaku Street Housing
Estate, Calabar
Cross River State, Nigeria
Cross River State, Nigeria
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