Prostate Cancer Therapy Promoted Without Evidence?
Gerald Chodak, MDDec 03, 2012
"Hello. I am Dr. Gerald Chodak for Medscape. Today's topic is on the role of combining brachytherapy with external beam radiation for men with clinically localized prostate cancer. Critz and associates are reporting their series of more than 3500 men who were treated in this way and followed over a long period of time. Their results show some interesting findings.
First, they report that if a man has gone about
15 and a half years [after brachytherapy combined with external beam radiation without a recurrence], his chance of getting a recurrence beyond that time is extremely small. That finding should provide some confidence for men who have undergone this procedure that long ago. The more important question, however, is how does this treatment compare with other available therapies, and what message should we give to those men considering therapy?
We have absolutely no good evidence that there is an added benefit from combining external beam radiation with brachytherapy compared with either of those treatments alone for men with localized disease. The authors attempt to compare the results to radical prostatectomy and, of course, comparing series across different patient population groups is extremely difficult.
What they did not do was compare their results with those of men treated conservatively. One could point to several series and show that the men who have either low- or intermediate-risk disease seem to be doing just as well with conservative therapy as they do with this combination treatment. Also lacking in this report are information about
side effects and quality-of-life data. So we are totally unable to evaluate the overall results in terms of cost, benefit, and side effects.
The bottom line is that, at this time, it remains unclear whether men truly benefit from a combination of external beam radiation and brachytherapy compared with either of those therapies alone or compared with radical surgery. For men who have low-risk disease in particular, it is unclear whether there is any reason to treat them at all, whether or not this treatment offers a better outcome than that of men who receive a more conservative approach or who get active surveillance.
At the end of the day, we will continue to struggle in the absence of good randomized trials, and it seems mostly that this is all about
business. How do we get more patients, how do we promote our treatment, what do we say that makes patients think they are better off with one treatment vs another? This treatment has been promoted with advertising that has been misleading to the public. This is something that has bothered me personally for many years, and I think it is time that we begin to recognize where we have self-promotional reports rather than good scientific studies that truly tell us what the patient should do"www.medscape.com/viewarticle/775213?src=nl_topic
Post Edited (HOPENEVERDIE) : 12/3/2012 1:22:53 PM (GMT-7)