TA proved the point. Surgery is declining...
Uh, no. That's a laughable misinterpretation.
You seem to have not actually read/understand what TA wrote, didn't read the link he provided, and/or perhaps more importantly didn't read what I wrote.
I tried to clearly summarize the big picture in my very first reply to this thread. Let's try again, but this time with more details. First, here's what TA wrote, or actually, quoted from the report he linked to:
Tall Allen said...
"by 2013 approximately equal percentages of patients were treated with each of the three modalities. Expectant management use increased over time, while the proportion of patients opting for surgery decreased remarkably with increasing age at diagnosis in intermediate‐ and higher‐risk disease...Among those who pursue curative therapy, younger men remain more likely to elect surgery whereas older men tend to choose radiotherapy."
Lets just narrow it down to the specific part of that quote that you seem to be confused on...
- It seems that you took this TA statement: "the proportion of patients opting for surgery decreased remarkably with increasing age at diagnosis in intermediate‐ and higher‐risk disease"... (his words)
- to mean: "Surgery is declining..." (your words)
It seems like you focused only on the words in red
to make your assumption; if you did (and I'm just assuming here that you did), then you were wrong.
What the SEER data shows (and what TA quoted) is that (1) as age increases use of surgery decreases, and (2) as the NCCN risk-levels increase, use of surgery decreases. This makes total sense and is not new information
. (1) When seeking treatment, older men are often not well suited for the rigors of surgery, and older men have less to worry about
in terms of late-term radiation side effects, so use of surgery decreases with age. (2) And with higher-risk cases, the likelihood of the case no longer being "localized" decreases the likelihood of "cure" from surgery alone, so the more severe the case, the more men opt for radiation as first-line treatment over surgery. Kent M.'s and JNF's just-posted case-in-point.
So having resolved that element of your confusion, let's go back to your incorrect comment "Surgery is declining..."
In reality, use of surgery went slightly UP (although was generally flat) in the period of the SEER data (2004-2014); rough order of magnitude it was 35% of all choices in 2004, and its closer to but just under 40% recently in 2014. Flat.
What they term as "Expectant management" (the combination of AS & WW) went UP during the period. The sum of all radiation forms of treatment went DOWN during the period.
Today (as of 2014), these three modes are roughly
the same proportions (also see 1st sentence is TA's quote): using SEER data, surgery is now just under 40% (as I mentioned), all radiation is a hair over 30% (down from about
40% in 2004), and expectant management is hair over 25%. Again, roughly
the three are the same order of magnitude today, although when you get specific, surgery is and remains largest. There is also, BTW, an "other" category which has remained at about
5% of all cases throughout the period.
In hindsight, my comment in my first post of this thread sums up the big picture pretty well, referring back to the original poster's question (except that the "2X" should be more like "4X"):
Surgery is the most common aggressive treatment, close to 2X as frequent as both the types of brachytherapy combined (the RT leader) but still about equal to the total of all forms of radiation combined.
In the OP, InTheShop was quoted as saying: "Surgery is on the decline as RT methods improve and as patients become more informed of their choices." Now you know that surgery is NOT on the decline. Furthermore, if InTheShop meant to imply that RT was increasing, you also now know that's incorrect, too.
Post Edited (NKinney) : 6/6/2018 11:08:34 AM (GMT-6)