Tall Allen said...
Do you know of any follow ups of men on AS where 55% actually improve on their Bx and Gleason scores and even # of positive cores?
Yes. In fact, that's quite common. Remember these AS patients were only given TRUS biopsies on f/u. To be clear... The median # of positive cores at baseline was about
1.1 and the median after treatment was 0.8 -- not a big difference. The percent where they found no cancer on a 12 core f/u biopsy was 34%, which is exactly the same (32%)
as in this study among 657 men:www.europeanurology.com/article/S0302-2838(18)30025-3/fulltext
You will also notice that the percent who stayed at the same grade was 52%, not significantly different from the 43% in the above study (p=0.23).
As I said, nothing to get excited over, and it isn't surprising there was no f/u.
If you want to get excited, look at this study (n=76) where a 5-ARi was used among men on AS. 54% had no cancer found on follow-up. And that difference is statistically significant.
I often read posts on my iphones, and it makes it difficult if a post goes on for multiple pages. I have no problem clicking on a link and don't need the info in both places. It actually detracts from what ever point you are trying to make rather than adding to it. Imagine if in those studies you are fond of quoting, if the authors had printed the full text study for every study they footnoted! If you would just pull out the excerpt from the study that you think is important, it would make your point a LOT more strongly. You may have noticed that you are the only one on this site who does this.OK, point to you, at least for now as I don't have the time right now to go over that study in detail. So it seems you have a study where similar improvements were made with no intervention. Where as the study out of USC was comparing to their own " historical control subjects" in which case there was quite a difference.
Then apparently, it is normal per studies you have seen for most or many men on AS to actually improve on f/U bx? Or not? If so, all the more reason for low risk guys to go AS.
I'm going to have to look look closer at what you are saying about
the mean # of positive cores, as in the study I quoted those #s(total #s of positive cores) dropped about
57% in the intervention group but would be expected to increase about
38% based on their historical control subjects. Hence their conclusion "Patients with low-risk prostate cancer under active surveillance may benefit from vitamin D3 supplementation at 4000 IU/d.".
Also, looking quickly through the euro study linked above, I do see that 25% of men were reclassified "increase in Gleason grade and/or an increase in the ratio of biopsy cores to cancer to
> or = to 34%.". I don't know about
the ratio of Bx scores in the USC study(you probably do?), I only know about
the total positive cores improvement mentioned above. But only 14% had an increased Gleason, compared to their norm of 21%, closer to the 25% "reclassified" I don't know how much of that was Gleason increase.
Post Edited (BillyBob@388) : 4/20/2018 9:59:21 AM (GMT-6)