Yes, Peter. The NEJM abstract itself spells out that the primary benefit of surgery was amongst "those with intermediate-risk prostate cancer." The reason for this limitation is that PSA testing was not in use and the men in the study were primarily diagnosed with PC the old-fashioned way through a lump felt on a DRE. In other words, they all had clinical evidence of disease. This is very different than the majroity of men diagnosed during today's PSA-era with low-risk cases. In fact, Dr Philip Kantoff from Dana-Farber Cancer Institute commented on the study by speculating that "the benefits of performing immediate surgery in men with low-risk cancers would probably go away if they had been screened with PSA."
Two other interesting points from the report:
(1) little mention of the man who died from the surgical procedure; it was more common back then than today
(2) the majority of the men remaining on the "watchful waiting" arm (note: not AS) did not need any palliative treatment even after so many years (the study period was 1989-1999), indicating that even many intermediate-risk patients do not need treatment
Post Edited (JackH) : 3/6/2014 4:00:02 PM (GMT-7)