...if many men are at risk for overly aggressive treatments so that the few may be saved, then so be it.
BillyBob, the well-documented number needed to (over)treat (NNT) for PC to save one life is 27. (ref. ERSPC.org) You can start embedding that number right in your sentence next time. Start asking for volunteers...or do you just want to pick amongst the many names here at HW/PCJack, help me out here. When you (or they) say "the well-documented number needed to (over)treat (NNT) for PC to save one life is 27.", exactly what does that mean?
Does that mean for every early detected G8/9/10 that receives treatment, one out of 27 will have their life extended or saved?
Or perhaps that only 1 out of the 27 with aggressive PC would ever have died anyway(forget about
simply suffering with cancer symptoms for right now), therefore that 1 out of the 27 would actually be saved?
Or does it mean out of all of the PC cases diagnosed, including the least aggressive ones who probably need no treatment in the 1st place, If you treat the entire group you will manage to save one life out of 27 treated? If it is something more like the latter, then the way to greatly improve the numbers of lives actually saved by treatment is to simply stop with aggressive treatment for the very low risk, or at least not count them in the numbers for calculating lives saved.
In another thread about
the MSKCC normograms(sp?) for life expectancy, I plugged my G9 numbers in, and the results were that out of 100 men with my numbers, fifteen years later:
1: 31 will still be alive
2: 27 out of 100 will have died of untreated PC
3: 42 will have died of other causes.(But, as far as I can tell, with an unknown number of all three groups which could have been suffering with advanced mets for many years.)
So 27% would have died of untreated PC and of the 31 still alive in the 42 dead from other causes, some unknown number suffering from PC but not having yet been killed by it.
I went back and did the pre-RP normogram(sp?), to see how the numbers stack up for treatment. These results were significantly different. 99% probability of cancer specific survival at 15 years with RP as primary treatment. Even though I only had a 19% chance of NOT having a BCR >.05 at 10 years. This still did not tell me anything as far as I could see about
my chance of having metastasis and/or general suffering with the disease, even though only a 1% chance of having died of PC specific disease at 15 years, compared to the 27% for the untreated group. So that seems to me like a very significant improvement, definitely better than saving one life out of 27 that have been treated.(Plus, if PC specific death was significantly deceased- 1% vs 27%- would it be a logical guess to say that mets and suffering was also decreased a lot? Seems to me yes, but it is just a guess)
Plus there is this study: www.ncbi.nlm.nih.gov/pubmed/24510158
(And several more like) of almost 31,000 men with high risk PC treated primarily with a RP(13% had some sort of salvage RT) which showed 90% had not died of PC at 10 years vs only 80% using the MSKCC normogram and 82% vs 72% at 15 years.
Median cancer specific survival was 7.8 years for conservative therapy and more than 14 years for radiation therapy and radical prostatectomy. The risk of cancer specific death following radical prostatectomy was 68% lower than for conservative treatment and 49% lower than for radiation therapy
So that sounds to me like a significant number of lives being saved, definitely more than 1 in 27 treated, though of course we all wish it would be more. However, that is also with surgery patients going back(In the big study of 31,000 men) as much as 25 years(31% had died of PC at 25 years) and most of these men did not even have salvage RT and obviously not the newest drugs available. I would not be surprised if a similar study of men treated with various current techniques or combinations thereof would show even better numbers.
So to me all of this sounds like more than one life is being saved out of 27 being treated, at least among the high-risk men. But help me to understand more clearly exactly what that one saved out of 27 treated means?
Again, if the number is so low because the biggest percentage of those being treated are low risk men, then let's just do something about
over treatment of low risk men rather than preventing men with high-risk disease from getting an early diagnosis. Just because of a PSA test comes back at 5 or 10 does not mean that person has to end up with aggressive treatment. There is no reason that it has to.(There are at least a couple of reasons why it does often happen, but it certainly does not have to)
PSA 10.9 ~112013
Bx on 112013 at age 64 yrs 11 months, with 5 of 12 pos with one G9(5+4), 1 PNI, T2B.
RALP with lymph nodes at Vanderbilt 021914. (nodes clear, SV+, still G9 but down graded to 4+5, cut wide, but 1 tiny foci right at the edge of margin ) Pros. 106.7 gms!
At 15 months, not wearing a pad most days, mostly dry
PSA <.01 on 6/11, 8/20/14 and 3/4/15, up to .01 on 9/1/15, .01 3/10/16
Post Edited (BillyBob@388) : 3/19/2016 6:54:26 PM (GMT-6)